Nodules and hyperthyroidism

doi:10.1136/bmj.b3346

Published 18 August 2009, doi:10.1136/bmj.b3346
Cite this as: BMJ 2009;339:b3346

Letters

Thyroid swellings

Nodules and hyperthyroidism

The first 150 words of the full text of this article appear below.

Hatton and colleagues say that nodules in hyperthyroid patientsare unlikely to be malignant, suggesting that no further investigationis required if thyroid function tests indicate hyperthyroidism.¹However, the presence of a solitary or dominant thyroid nodulein a patient with biochemical evidence of hyperthyroidism isone of the few remaining indications for isotope scanning ofthe thyroid.

An autonomous "hot" nodule is indeed unlikely to be malignant,and fine needle aspiration is not indicated. However, if thepatient has one nodule, others may (and often will) be present.If thyroid stimulating hormone is suppressed, you need to besure that the palpable nodule is suppressing it: an impalpablehot nodule may exist elsewhere in the gland, and the presentinglesion may be cold and require fine needle aspiration.

To summarise, in euthyroid patients, isotope scanning to characterisenodules is not indicated because they will either be cold orwarm, . . . [Full text of this article]

Bob Bury, consultant radiologist¹

¹ Leeds Teaching Hospitals Trust, Leeds LS1 3EX

bobbury@gmail.com