Thyroid Carcinoma in Hot Nodules: Review of the Literature

Abstract

Thyroid hot nodules are virtually always considered benign. Rare cases of hot thyroid carcinoma exist. We briefly described a clinical case and performed a review of the literature. We performed an extensive research on medical databases, such as PubMed and compiled all published cases matching preset criteria defining true hot thyroid carcinomas as well as guidelines regarding their management. We analyzed 103 articles published over the past 50 years. We selected 16 articles, including 45 cases matching our criteria. The majority were follicular carcinomas. Papillary carcinomas were infrequently found in this setting. Recommended management and survival rates were similar to classical cold thyroid cancer. Although hot nodules should continue to be considered benign most of the time, rare cases of hot thyroid cancers exist and clinicians should not hesitate to ask for additional tests if they encounter any abnormal finding. This form of thyroid cancer can reasonably be managed the same way as the cold thyroid cancers.

An Unexpected Finding of Poorly Differentiated Thyroid Carcinoma in a Toxic Thyroid Nodule

“…Some clinicians think of PDTC as thyroid cancer that does not trap iodine on radioiodine scans and mention that the ATA recommends CT/PET scans for initial staging and monitoring of patients with PDTC [ 7 ]. Although rare, there have been documented hot nodules that harbor thyroid cancers [ 8 ].…”

Das „heiße“ Schilddrüsenkarzinom mit einem kritischen Blick auf die Thermoablation

“…Der hier vorliegende Fall unterstreicht, dass auch bei szintigraphisch heißen Knoten an eine mögliche Malignität gedacht werden muss. Wiederkehrende Publikationen, meist als Fallberichte, zeigen, dass Schilddrüsenkarzinome sowohl bei Kindern als auch bei Erwachsenen in autonomen Adenomen auftreten können [ 2 , 9 ]. Im Rahmen einer umfangreichen Literaturrecherche konnte bei mehr als 1100 Fällen mit einem hyperfunktionellen Knoten eine durchschnittliche Prävalenz von 3,1 % für das Auftreten von Schilddrüsenkarzinomen gesichert werden [ 11 ].…”

Characteristics of the scintigraphy with 99mTcpertechnetate in patients with differentiated thyroid carcinoma

“…Podaci saopšteni u drugim studijama ukazuju na veoma retku pojavu tireoidnog karcinoma kod bolesnika koji imaju hipertireoidizam (3,14,15). U retrospektivnim studijama je nađeno da incidencija tireoidnog karcinoma iznosi 1-5,8% kod hipertireoidnih bolesnika (16)(17)(18)(19). Vodeća udruženja u vodičima za lečenje preporučuju da scintigrafski "vrući" tireoidni nodusi nisu indikovani za dalje ispitivanje, uključujući ehosonografiju i FNAC, s obzirom na veoma nisku verovatnoću za prisustvo maligniteta unutar ovih lezija (10).…”

“…Vodeća udruženja u vodičima za lečenje preporučuju da scintigrafski "vrući" tireoidni nodusi nisu indikovani za dalje ispitivanje, uključujući ehosonografiju i FNAC, s obzirom na veoma nisku verovatnoću za prisustvo maligniteta unutar ovih lezija (10). Štaviše, podaci pokazuju da kod većine pacijenata, kod kojih je urađen FNAC "vrućeg" nodusa, dobijeni citološki nalaz po pravilu ima karakteristike koje bude sumnju na folikularnu neoplazmu, što bi značajno moglo da poveća broj nepotrebnih hirurških resekcija štitaste žlezde zbog benigne bolesti koju je lako lečiti nehirurškim vidovima lečenja (19).…”