Cold Spot Within a Hot Nodule: Thyroid Storm from Toxic Adenoma Revealing Rare Hurthle Cell Adenoma
https://doi.org/10.15605/jafes.041.S1
- Author:
Ying Guat Ooi
1
;
Jun Kit Khoo
1
;
Tharsini Sarvanandan
1
;
Quan Hziung Lim
1
;
Jeyakantha Ratnasingam
1
;
Lee Ling Lim
1
;
Shireene Ratna Vethakkan
1
;
Nicholas Ken Yoong Hee
1
Author Information
1. Endocrine Unit, Department of Medicine, Faculty of Medicine, University Malaya
- Publication Type:Journal Article
- MeSH:
Oxyphil Cells;
Thyroid Crisis;
Adenoma
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):103-104
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Hurthle cell adenoma is a rare benign thyroid neoplasm
that can only be diagnosed through histopathological
examination. Hurthle cell neoplasm typically presents as
nonfunctioning cold nodule on thyroid scintigraphy. We
report a rare case of Hurthle cell adenoma presenting with
thyroid storm, with unusual findings of “cold” within
“hot” thyroid nodule on scintigraphy.
Case:A 73-year-old male with hypertension, chronic kidney
disease, coronary artery disease, and Parkinson’s disease
presented to the emergency department with fever and
diarrhea. His temperature was 38.4°C, heart rate 106 bpm,
and blood pressure 138/75 mmHg, with atrial fibrillation
and signs of heart failure. The Burch-Wartofsky score was
50, consistent with thyroid storm.
Laboratory tests revealed free thyroxine 4 37.8 pmol/L
(NR 11.5–22.7), free thyroxine 3 5.6 pmol/L (NR 3.5–6.5),
and thyroid-stimulating hormone <0.01 mIU/L (NR 0.55–
4.78). Thyroid autoantibodies, including anti-thyroid
peroxidase, anti-thyroglobulin, and thyroid-stimulating
immunoglobulins, were negative (<0.10 IU/L). The thyroid
storm was precipitated by invasive Klebsiella syndrome
with endophthalmitis and lung and liver abscess. He was
treated with Lugol’s iodine, corticosteroid, antibiotics, and
carbimazole.
Ultrasound thyroid revealed a mixed cystic-solid nodule
in the left thyroid lobe, measuring 2.3 × 3.3 × 4.3 cm (TIRADS category 3). Technetium-99m thyroid scintigraphy
demonstrated a hyperfunctioning left thyroid nodule with
a focal intranodular cold spot measuring 5.0 × 3.7 cm.
Fine needle aspiration cytology of the nodule was benign
follicular cells. Following stabilization with anti-thyroid
treatment, he underwent left hemithyroidectomy. Histopathology examination revealed a Hurthle cell adenoma
without capsular or vascular invasion.
Postoperatively, he remained clinically euthyroid. Surveillance ultrasound performed 8 months later showed a
normal right thyroid lobe, and lifelong surveillance was
planned.
Conclusion:This case illustrates a rare and unusual presentation of
thyroid storm caused by a toxic Hurthle cell adenoma
containing an intranodular cold spot on scintigraphy. To
our knowledge, only one similar case has been reported
in the literature, and our case is the first to present with
thyroid storm.
- Full text:2026080416574373039EP_A151.pdf
