An unusual initial manifestation of metastatic papillary thyroid carcinoma: radioiodine uptake in lymph node metastatic lesions in a patient with Graves' disease.

OBJECTIVE

To report an unusual manifestation of metastatic papillary thyroid carcinoma with functional metastatic lesions demonstrated by radioiodine scanning and to discuss the relationship of Graves' disease and thyroid carcinoma.

METHODS

A case report is presented, and the current literature is reviewed.

RESULTS

An 82-year-old man had symptoms and laboratory results suggestive of thyrotoxicosis. 123I thyroid uptake scanning demonstrated lateral uptake, which directed attention to the lateral aspect of the neck and resulted in subsequent identification of previously overlooked lymphadenopathy. Total thyroidectomy, including excision of the central compartment and right jugular chain lymph nodes, was performed.

CONCLUSION

In two previous reports of similar cases of metastatic thyroid carcinoma, imaging was done with use of a different scanning agent. To our knowledge, this is the first published case report of functional metastatic lesions imaged with 123I before thyroidectomy. This preoperative finding facilitated clinical management of the patient's thyroid cancer and thyrotoxicosis.