MON-387 Hot Nodule, Chronic Anxiety, and Normal Thyroid Function

Abstract Disclosure: C.M. Barrera: None. Background: The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) has anxiety and panic attacks among the most common psychiatric disorders. Previously published cases have shown multiple thyroid nodules associated with chronic anxiety and panic attacks despite normal thyroid function and uptake scan. A low-dose methimazole trial resolved their anxiety (1). Case 1: A 58-year-old Latin female is referred for thyroid nodule evaluation. The thyroid ultrasound demonstrated three left-side nodules of 33x28, 43x35, and 10x7 mm. An I123-Thyroid Scan showed an uptake of 17.7% (High is >35%) with a left inferior hot nodule. No cold nodules were reported. The echotexture was homogeneous, with no reported suppression. The patient had a history of chronic anxiety and panic attacks, with an elevated heart rate of 93 bpm on the initial visit. She was referred for a right hemithyroidectomy. Pre-surgery TSH was 0.51 mIU/L (0.40-4.5 mIU/L), and T4 was 7.7 mcg/dL (5.1-11.9 mcg/L). Post-surgery TSH was 4.49 mIU/L (0.40-4.5 mIU/L) and T4 6.7 mcg/dl (5.1-11.9 mcg/dl). A PROMIS short form anxiety scale total was 27 pre-surgery and 13, 2 months post-surgery. Case 2: A 59-year-old Latin female is referred for thyroid nodule evaluation. The thyroid ultrasound demonstrated two right mid-pole nodules measuring 26x13 and 24x18 mm and two on the left measuring 30x21 and 20x10 mm. The I123-Thyroid Scan had an uptake of 36.4% (within the normal margin of error, High is >35%). The patient had a history of chronic anxiety and panic attacks. The patient was sent for a thyroid biopsy, but the surgeon decided to do a total thyroidectomy. Her pre-surgery TSH was 0.43 mIU/L (0.40-4.5 mIU/L) and free T4 1.2 ng/dl (0.8-1.8 ng /dl). Post-surgery, on 2 months of levothyroxine 100 mcg daily, TSH was 4.5 mIU/L and T4 8.7 mcg/dl. The PROMIS short form anxiety scale was 31 pre-surgery and 10, 2 months post-surgery. Conclusion: Two more cases are presented, demonstrating that anxiety/panic attacks can be resolved not just with low-dose methimazole (1) but with surgical removal of the thyroid nodules. Learning Points: These cases demonstrate that some chronic anxiety disorders have autonomous thyroid nodules as their underlying cause despite normal thyroid function tests and uptake scans. This strengthens the case for a new diagnostic category: Subclinical toxic multinodular goiter. 1. Thyroid Nodules, Normal Thyroid Levels, and Chronic Anxiety: A Case for Sub-Clinical Toxic Multinodular Goiter. CM Barrera. J Endocr Soc, Vol 8, Supplement 1, Oct-Nov 2024, bvae163.2103, https://doi.org/10.1210/jendso/bvae163.2103 2. Teresi JA, Ocepek-Welikson K, Kleinman M, Ramirez M, Kim G. Measurement equivalence of the patient-reported outcomes measurement information system®(PROMIS®) anxiety short forms in ethnically diverse groups. Psychol Test Assess Model. 2016;58(1):183-219. Presentation: Monday, July 14, 2025