Toxic multinodular goitre: a surprising finding

Description

A 16-year-old healthy adolescent boy was referred to the paediatric endocrinology clinic because of multiple thyroid nodules detected by cervical ultrasound, in the context of cervical lymphadenopathies. There was no family history of thyroid disease. He denied recent infections, asthenia, weight loss, sweating, palpitations, mood or sleep disturbances, dysphagia or dysphonia. At physical examination, an enlarged, irregular and fibroelastic thyroid, with a predominant right lobe, was identified. The remaining examination was normal.

The analytical profile was thyroid stimulating hormone (TSH) <0.01 uUI/mL (normal 0.5–4.8 uUI/mL), free triiodothyronine (FT3) 7.27 pg/mL (normal 2.3–4.2 pg/mL) and free thyroxine (FT4) 2.02 ng/dL (normal 0.8–2.3 ng/dL). Thyroid antibodies were negative. Cervical ultrasound revealed an enlarged right thyroid lobe due to the presence of multiple mixed nodules with similar characteristics: the biggest one, 5 cm diameter, predominantly cystic with a peripheral ring of solid isoechoic parenchyma (figure 1A); the second characteristically mixed nodule, 2.2 cm diameter (

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