Graves disease may occur in patients with a pre-existing nodular goitre. In this situation, clinical examination may be misleading as the patient may be diagnosed as having toxic multinodular goitre.
The scan appearance with overall diffusely increased uptake with a background of non-homogeneous uptake is diagnostic.
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Graves disease in a MNG - 99m Tc Thyroid scan
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Thyrotoxicosis in a nodular goitre may be due to Graves’ disease developing in a multinodular goitre.
Treatment with antithyroid drugs is first line management rather than radioiodine.
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A solitary palpable nodule in a thyrotoxic patient may not be due to Toxic uninodular disease. Cold nodules in Graves disease may present as a palpable nodule and requires evaluation with fine needle aspiration to exclude malignancy.
Images: In a small percentage of studies, an unexpected cold nodule will be identified which requires evaluation with FNA.
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Dominant Cold Nodule Graves in MNG
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A dominant palpable nodule in a patient with thyrotoxicosis may not be due to a toxic nodule.
A radionuclide scan will demonstrate whether a palpable nodule is functioning or non functioning.
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