World Journal of Endocrine Surgery

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VOLUME 7 , ISSUE 3 ( September-December, 2015 ) > List of Articles


A Case of Miliary Nodules, Hemoptysis and Hot Thyroid Cancer: Unusual Presentation of Papillary Thyroid Cancer

Jesse SL Hu, Rajeev Parameswaran

Citation Information : Hu JS, Parameswaran R. A Case of Miliary Nodules, Hemoptysis and Hot Thyroid Cancer: Unusual Presentation of Papillary Thyroid Cancer. World J Endoc Surg 2015; 7 (3):72-75.

DOI: 10.5005/jp-journals-10002-1174

Published Online: 01-12-2008

Copyright Statement:  Copyright © 2015; The Author(s).



Papillary thyroid carcinoma is the commonest thyroid cancer. Patients usually present with thyroid nodule and rarely with hyperthyroidism such that 2009 ATA guidelines recommended that cytological evaluation is not necessary in patients with hyperfunctioning nodules as they rarely harbor malignancy. We report a case of an unusual presentation of metastatic papillary thyroid carcinoma in a young patient.

Case presentation

A 17-year-old girl, presented to our hospital with 3 days of fever, cough and hemoptysis. Chest X-ray showed extensive miliary nodules and was treated for presumed miliary tuberculosis. Biochemical investigations revealed a hyperthyroid state (fT4 55.7 TSH < 0.02), with negative antibodies (TRAB and TSI). Radioisotope scan showed increased uptake on right lobe. She underwent bronchoscopy and biopsy which revealed metastatic papillary thyroid carcinoma.

Clinical examination revealed a small goiter with palpable cervical node at level III on the left. There were no clinical signs of Graves’ disease and she had no history of previous radiation or family history of endocrine disease. Ultrasound revealed multiple hypodense thyroid nodules with microcalcification and increased vascularity. Ultrasound of the neck showed the presence of abnormal lymphadenopathy.

She underwent total thyroidectomy, bilateral central neck dissection and left lateral modified neck dissection. Histology showed 1.3 cm papillary thyroid carcinoma involving the left lobe and multifocal papillary thyroid microcarcinomas involving both lobes. Ten out of 27 nodes were involved. She was BRAF mutation positive.

She recovered well postoperatively and was rendered hypothyroid. She underwent radioiodine ablation which showed no more disease in the neck but unfortunately there was no uptake in the lung metastases.


Metastatic papillary thyroid cancer developing in a young patient with hyperthyroidism is extremely rare and suggests a more aggressive behavior as confirmed by BRAF mutation.

How to cite this article

Hu JSL, Parameswaran R. A Case of Miliary Nodules, Hemoptysis and Hot Thyroid Cancer: Unusual Presentation of Papillary Thyroid Cancer. World J Endoc Surg 2015;7(3):72-75.

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  1. Incidental thyroid carcinoma in thyrotoxic patients treated by surgery. Hormone Research 2007;67(2):96-99.
  2. Cancer risk in patients with Graves’ disease: a nationwide cohort study. Thyroid: official j Am Thyroid Assoc 2013;23(7):879-884.
  3. Thyroid cancer in patients with hyperthyroidism. Hormone Res 2003;60(2):79-83.
  4. Present day trends in thyroid research. Western j surg obstet gynecol 1948;56(2):65-71.
  5. Incidence of malignancy in toxic and nontoxic nodular goiter. J Am Med Assoc 1954;154(16):1321-1325.
  6. Nodular goiter and malignant lesions of the thyroid gland. J clin endocrinol metabol 1951;11(10):1157-1165.
  7. Thyroid cancer in patients with hyperthyroidism. Hormone and Metabolic Research 2012;44(4):255-262.
  8. Hyperthyroidism and thyroid cancer risk: a population-based cohort study. Experimental and clinical endocrinology and diabetes: official journal, German Society of Endocrinology [and] German Diabetes Association 2013;121(7):402-406.
  9. Ultrasonographic screening for detection of thyroid cancer in patients with Graves’ disease. Clin Endocrinol 2004;60(6):719-725.
  10. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J clin endocrinol metabol 2002;87(5):1941-1946.
  11. Prevalence of incidental thyroid cancer and its ultrasonographic features in subcentimeter thyroid nodules of patients with hyperthyroidism. Endocrine 2011;39(1):13-20.
  12. Pulmonary metastases in differentiated thyroid carcinoma. Study of 58 cases with implications for the primary tumor treatment. Cancer 1984;53(4):982-992.
  13. Distant metastases in differentiated thyroid carcinoma: a multivariate analysis of prognostic variables. J clinical endocrinol metabol 1988;67(3):501-508.
  14. Long-term results of treatment of 283 patients with lung and bone metastases from differentiated thyroid carcinoma. J clin endocrinol metabol 1986;63(4):960-967.
  15. Treatment of micronodular lung metastases of papillary thyroid cancer: are the tumors too small for effective irradiation from radioiodine? Thyroid: official j Am Thyroid Assoc 1998;8(3):215-221.
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