Clinical Significance of a Solitary Cold Thyroid Nodule in the Setting of Graves Disease.

I-NaI thyroid uptake and scan in a 46-year-old woman with symptomatic hyperthyroidism demonstrated marked, diffusely increased uptake consistent with Graves disease, as well as a solitary hypofunctioning ("cold") nodule. Pathologic evaluation following total thyroidectomy and selective neck dissection revealed invasive multifocal papillary thyroid carcinoma in a background of Graves disease and 5 of 36 lymph nodes positive for metastatic disease. This case serves as a reminder that when present a cold nodule in the setting of Graves disease warrants further evaluation for underlying malignancy.