Background: Pyramidal lobe is remnant of thyro-glossal duct and is seen in 15 - 75% of patients arising upwards from right lobe, left lobe or isthmus of thyroid gland. Hot nodule is a common thyroid pathology but hasn't been reported in the pyramidal lobe of thyroid gland. Case presentation: A female patient, 20 years of age presented in outdoor department with complaint of lump in front of the neck. After clinical examination, thyroid scan was advised with other investigations. An ultrasound evaluation showed a single 26mm nodule with increased flow on color doppler in the pyramidal lobe arising from right half of isthmus. A radionuclide (99mTcO4) thyroid scan showed focal intense uptake adjacent to the medial border of right lobe of thyroid in clinically palpable nodule. Patient was euthyroid clinically and biochemically. Conclusion: Hot nodule in the pyramidal lobe of thyroid gland is a unique case. It has not been reported previously in literature. This will add to the list of differential diagnosis for lump in front of the neck and should always be kept in mind to avoid burden of undue investigation on patient.

Keywords: Case report, 99mTcO4 Thyroid scintigraphy, Hot nodule, Pyramidal lobe