Papillary thyroid carcinoma with skeletal metastasis: Late presentation of thyroid cold nodule

A 60-year-old female presented with complaints of swelling in front of the neck; on evaluation with thyroid uptake, study showed the presence of cold nodule in the right lobe of thyroid. Fine-needle aspiration of the nodule showed benign disease and started on antithyroid medications. The patient was lost to follow-up for 10 years, after which she presented with swelling in the same region of the cold nodule. Due to the continued increase in the size of the swelling, she underwent a fine-needle aspiration biopsy and ultrasound with findings consistent with carcinoma, for which she underwent total thyroidectomy, followed by radiation therapy. On further evaluation for residual thyroid using iodine, whole-body scan showed residual disease with disseminated osseous and lymph node metastases, which was treated twice with 100 mCi of I131, resulting in. A cold nodule on thyroid scan can be benign or malignant and should be kept on regular follow-up and if left untreated may present with disseminated aggressive disease.