• Cystic thyroid nodules most commonly occur with a euthyroid state and appear as cold lesions on radioactive iodine scan. I describe a 32-year-old woman who presented during the third trimester of her second pregnancy with a toxic cystic lesion of the thyroid. In studies performed post partum, the serum free thyroxine (T4) index was normal, while the triiodothyronine (T3) level was elevated and thyrotropin level was low and unresponsive to thyrotropin-releasing hormone stimulation. Iodine 123 thyroid scan demonstrated localized nonsuppressible uptake over the nodule. Multiple echo-free (fluid-filled) cavities were observed by ultrasound study. Thyroid lobectomy demonstrated a thyroid colloid nodule with areas of cystic degeneration containing hyperplastic papillary projections. Postoperatively, the patient developed transient hypothyroidism followed by spontaneous recovery to euthyroidism with normal function of the suppressed gland. Blood obtained from the venous effluent of the thyroid nodule had extremely high T3 and T4 concentrations: 359.1 nmol/L and 2420 nmol/L, respectively, while peripheral venous blood showed isolated elevation of T3, to 4.6 nmol/L (normal, 1.2 to 3.1 nmol/L), and a normal T4 level of 116 nmol/L (normal, 64 to 154 nmol/L). Serum T3 and T4 thyroidal/peripheral ratios were close to one in two euthyroid patients undergoing neck surgery. Thus, thyroid nodules may present with isolated elevation of serum T3 levels despite increased thyroidal release of T4.
(Arch Intern Med 1988;148:1866-1868)
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and
Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early
dhildhood mortality and growth failure data and their association with maternal
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 1
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.