The (quite rare) association of TSH dependent functioning nodules and Graves' disease or other thyrotoxic forms of autoimmune thyroiditis is referred to as Marine-Lenhart syndrome.
Marine-Lenhart syndrome is diagnostically challenging as nodules will initially appear as cold areas on thyroid scans because of TSH suppression associated with hyperthyroidism. Following therapy, e. g. with antithyroid drugs or I-131 radioablation, however, the nodules will accumulate radiotracer and appear like hot nodules as TSH level starts to rise.
