Diagnostic and Therapeutic Management of a Painful Thyroid Mass with Discordant Thyrotropin and Thyroid Hormone Measurements: A Case Report
Authors
Peter Mattew George1,2,3,4,6*, Arda Işık5
1 European Union of Medical Specialists, Brussels, Belgium
2 School of Health and Medical Sciences, Kesmonds International University, Yaoundé, Cameroon
3 Department of Surgery, School of Medicine, Texila American University, Georgetown, Guyana
4 Department of Surgery, Hospital Protestant de Ngaoubela, Adamawa Region, Cameroon
5 School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
6 The Operating Room Global (TORG)
Corresponding Author: Dr. Peter Mattew George · [email protected]
Case Summary
Background
Thyroid nodules presenting with elevated circulating thyroid hormones but a non-suppressed thyrotropin (TSH) pose a diagnostic and therapeutic challenge, particularly where free-hormone assays, ultrasonography, scintigraphy, cytology, and histopathology are unavailable.
Case Presentation
A 30-year-old woman presented with a painful, progressive left neck mass of one year’s duration. She was clinically euthyroid. Total triiodothyronine was 4.46 nmol/L and total thyroxine 189.55 nmol/L, with a non-suppressed TSH of 0.39 mIU/L. Mild leukopenia was also noted. Ultrasonography, fine-needle aspiration, scintigraphy, free-hormone assays, and histopathology were unavailable at the treating facility. Following multidisciplinary discussion, left hemithyroidectomy was performed without preoperative antithyroid drugs. The recurrent laryngeal nerve and parathyroid glands were preserved, estimated blood loss was approximately 35 mL, and there was no perioperative thyroid crisis, vocal change, or clinical hypocalcemia. Short-term follow-up showed wound healing and resolution of neck pain.
Conclusion
In this patient, clinical euthyroidism and a non-suppressed TSH, together with baseline leukopenia, supported withholding thionamides and proceeding to hemithyroidectomy for a symptomatic mass. The observations are specific to the circumstances described and do not constitute a validated general management algorithm. Lack of imaging, cytology, histopathology, postoperative thyroid function tests, and longer-term biochemical follow-up are important limitations.
Keywords: Thyroid Nodule · Hemithyroidectomy · Discordant Thyroid Function Tests · Euthyroid Hyperthyroxinemia · Resource-Limited Setting · Case Report
Case at a Glance
Thyroid Function & Available Investigations
Clinical Decision-Making Pathway
The management pathway reflected the circumstances of this individual patient in a resource-limited hospital and was not presented as a validated or general clinical algorithm.
Presentation
Painful, progressively enlarging left thyroid mass with no overt clinical features of thyrotoxicosis.
Preoperative Judgment
Thionamides were withheld because the patient was clinically euthyroid, TSH was non-suppressed, and baseline leukopenia was present.
Intervention
Left hemithyroidectomy under general anaesthesia with preservation of the recurrent laryngeal nerve and parathyroid glands.
Short-Term Outcome
No thyroid crisis, normal voice, no clinical hypocalcemia, wound healing, and resolution of neck pain.
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Article Details
Case Report
Clinical case report describing the diagnostic and therapeutic management of a painful thyroid mass with discordant thyroid function tests.
Editorial Timeline
Received 29 August 2026
Accepted 19 September 2026
Available Online 29 September 2026
CC BY 4.0
Creative Commons Attribution 4.0 International licence.
Conflict & Funding
The authors declared no competing interests. No specific grant was received from public, commercial, or not-for-profit funding agencies.
Volume 2 · Issue 3
September 2026 · ISSN 3105-3262
DOI: 10.64573/torgj2609002
Written Informed Consent
Written informed consent was obtained for publication of the case report and anonymized laboratory data. Identifying details were omitted.
Review Exemption
The Institutional Ethics and Review Board of Hospital Protestant de Ngaoubela, Cameroon, exempted formal review because the report described anonymized standard care without experimental intervention.
Language & Formatting Only
AI-assisted tools were used only for language editing and formatting. Clinical data, interpretation, and final content were reviewed and approved by the authors; no AI tool was used for medical decision-making.
Case Report Standards
The manuscript was checked against the CARE case-report framework and includes patient information, clinical findings, a timeline, diagnostic assessment, intervention, follow-up and outcomes, patient perspective, informed consent, discussion, and explicit limitations.
Authors’ Contributions
Peter Mattew George: Conceptualization, clinical care, data collection, and drafting of the manuscript.
Arda Işık: Supervision and critical revision of the manuscript.
Both authors approved the final version and agreed to be accountable for all aspects of the work.