Benign thyroid nodule mimicking malignancy with compressive symptoms: importance of timely surgical management

Abstract

Introduction: Thyroid nodules are a common clinical finding in endocrine practice and warrant careful monitoring due to their potential for malignant transformation and progressive enlargement, which can lead to compressive symptoms. These processes often justify surgery for both diagnostic and therapeutic purposes. Materials and Methods: This report presents a 35-year-old patient who presented with an anterior cervical painful mass, globus sensation, periodic dysphagia, and fatigue, with a 10-year history of a gradually enlarging thyroid nodule, previously monitored by an endocrinologist. During follow-up, Tyrozol was administered in order to achieve and maintain clinical euthyroidism. Laboratory investigations included thyroid function tests and tumor markers—thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), calcitonin, and thyroglobulin—accompanied by a neck ultrasound. Results: Laboratory results demonstrated TSH 0.27 µIU/mL, FT4 0.87 ng/dL, and FT3 2.99 pg/mL, findings consistent with clinical euthyroidism under Tyrozol therapy. Calcitonin levels were within the normal range (<0.5 pg/mL), while thyroglobulin was elevated (108.87 ng/mL), reflecting increased thyroid tissue activity associated with the nodular lesion. Neck ultrasonography revealed a heterogeneous thyroid nodule measuring approximately 3 cm, containing calcifications and irregular structural areas suspicious for malignancy. Considering the progressive enlargement of the nodule, the persistence of compressive symptoms, and the imaging findings, surgical treatment was indicated. The patient underwent hemithyroidectomy, and histopathological examination revealed a follicular adenoma with fibrosclerotic changes and secondary osseous metaplasia. Postoperative recovery was uneventful, without complications, and the patient was discharged on the fifth postoperative day with hormone replacement therapy. Conclusion: Benign thyroid nodules may present with structural and tissue alterations that simulate malignancy on imaging studies, leading to diagnostic uncertainty. At the same time, progressive growth of such lesions may result in compressive syndrome affecting adjacent cervical structures. Therefore, surgical management should not be unnecessarily delayed when suspicious imaging findings coexist with compressive symptoms. Timely hemithyroidectomy allows definitive diagnosis, prevents further progression of compressive manifestations, and ensures optimal patient outcomes.