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Graves' disease - Case 4.

Nodular goiter

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Clinical data: a 58-year-old woman was treated with methimazole for 4 months because of Graves' disease. She had multiple nodules, none of them proved to be hyperfunctioning. Her complaints had resolved. She came to a follow-up examination.

Palpation: the right lobe was enlarged and nodular.

Results of blood tests: hyperthyroidism with undetectable TSH-level. FT4 was 33.9 pM/L. TSAb-assay 3.1 U/L (normal value under 1.5).

Ultrasonography: a diffusely hypoechogenic thyroid was found with multiple nodules.

Cytology: was performed from the nodule located in the upper part of the right lobe. Extremely atypical and pleomorphic cells were found on the smears. FNAC resulted in benign lesion with atypia caused by either the dysfunction or the thyrostatic agent.

Surgery was advised.

Histopathology: diffuse and benign hyperplastic nodular goiter.

Comment: it is worth analyzing the atypia demonstrated on cytological images. The extent of pleomorphism reaches that observed in anaplastic cancer. Nevertheless, this possibility can be excluded by the patient history. The only question was whether this patient would have a follicular tumor or not. The lack of a halo sign significantly decreased this possibility.

 

 
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