THE PATIENT is a 14-year-old girl referred 6 months earlier by her pediatrician for examination of a right thyroid nodule detected during a routine physical examination. She was asymptomatic, and results of the thyroid function studies obtained are shown in the Table. A technetium-99m pertechnetate thyroid scan revealed two "hot" nodules replacing the right lobe of the gland and a normal-sized left lobe with diminished uptake (Figure). Levothyroxine sodium therapy, 100 μg/d, was begun to suppress the nodules. Five months after initiating therapy, further enlargement of the gland was noted, and the dose of levothyroxine sodium was increased to 125 μg/d. Results of thyroid function studies at that time are shown in the Table.
When seen 6 months later by a pediatric endocrinologist, she was asymptomatic except for abdominal cramping and diarrhea related to the increased dose of levothyroxine. Assessment of her medical history was negative, with normal onset
Clark PA, Rogers BM, Rogol AD. Radiological Case of the Month. Arch Pediatr Adolesc Med. 1995;149(6):697–698. doi:10.1001/archpedi.1995.02170190107019
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