BMJ Case Reports 2017; doi:10.1136/bcr-2017-221913
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Toxic multinodular goitre: a surprising finding

  1. Olinda Marques3,4
  1. 1Department of Pediatrics, Hospital de Braga, Braga, Portugal
  2. 2Department of Pediatrics, Hospital da Senhora da Oliveira Guimaraes EPE, Guimaraes, Portugal
  3. 3Pediatric Endocrinology Unit, Hospital de Braga, Braga, Portugal
  4. 4Department of Endocrinology, Hospital de Braga, Braga, Portugal
  1. Correspondence to Dr Marlene Rodrigues, rodrigues.f.marlene{at}
  • Accepted 3 September 2017
  • Published 12 September 2017


A 16-year-old healthy adolescent boy was referred to the paediatric endocrinology clinic because of multiple thyroid nodules detected by cervical ultrasound, in the context of cervical lymphadenopathies. There was no family history of thyroid disease. He denied recent infections, asthenia, weight loss, sweating, palpitations, mood or sleep disturbances, dysphagia or dysphonia. At physical examination, an enlarged, irregular and fibroelastic thyroid, with a predominant right lobe, was identified. The remaining examination was normal.

The analytical profile was thyroid stimulating hormone (TSH) <0.01 uUI/mL (normal 0.5–4.8 uUI/mL), free triiodothyronine (FT3) 7.27 pg/mL (normal 2.3–4.2 pg/mL) and free thyroxine (FT4) 2.02 ng/dL (normal 0.8–2.3 ng/dL). Thyroid antibodies were negative. Cervical ultrasound revealed an enlarged right thyroid lobe due to the presence of multiple mixed nodules with similar characteristics: the biggest one, …

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