(3). A CAT scan (Figure 4), without contrast, was obtained in January 2007. Several nodules (some with calcifications) were observed in the cervical area. The largest nodule (8.5 X 5.9 X 6.3 cm) was detected at the right side with trachea deviation toward the left cervical area. The goiter involved the upper mediastinum. A micro-nodule (4 mm) was observed in the lower part of the lung (non-specific). Several lymph nodes were seen in the upper mediastinum. Signs of paraseptal emphysema in the lungs were detected.
Figure 4
Basal thyroid function tests indicated a suppressed serum TSH and an elevated Free T4. He was not treated with anti-thyroid drugs or beta-blockers. Free T4 returned to normal within 8 months. A possibility of iodine-induced hyperthyroidism was considered as an attractive hypothesis. Urinary iodine excretion was elevated at 296 µgI/L of urine (N 100-200 µg I/L of urine).
What would you like to do next?
1. Start Methimazole and a low iodine diet.