A 39 year old woman presents with a slowly enlarging lump in the front of her neck, which she first noticed around an year ago. No other symptoms are present, and she has not sought medical advice in this respect earlier, due to the fear that she would be asked to undergo surgery. Her medical, surgical, and family histories are unremarkable, and she is not on any medications. She only drinks socially and does not smoke. She also consumes a well-rounded diet, which includes seafood, and red meat. A complete blood count is found to be within normal parameters.
The thyroid gland is diffusely enlarged, measuring 4.8 x 4.2 x 2.3cm in size, with hypoechoic heterogeneous changes involving the entire gland. There is no evidence of nodules or increased vascularity. The cervical lymph nodes are not enlarged.
TSH: 12.9 mIU/L (0.4-4.5) Free T4: 0.9 ng/dL (0.7-1.9) Free T3: 2.5 pg/mL (2.3-4.2)
Anti-Thyroid Peroxidase Antibodies: 65 IU/mL (<35) Anti-Thyroglobulin Antibodies: 30 IU/mL (<20) Anti-TSH Receptor Antibodies: 1.5 IU/L (<1.75)
The uptake scan demonstrates a 24-hour iodine uptake of 34%, with a mixed pattern of areas showing hypo- and hyper-uptake.