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Graves' disease with functioning nodules is referred to as Marine-Lenhart Syndrome. Only 2.7% of the patients with Graves’disease have concomitant functioning nodules.1 Thyroid scintigraphy often definitively confirms the diagnosis. However, in addition to a hyperfunctioning (i.e. "hot") nodule, the thyroid scan may reveal isofunctioning (i.e. "warm"), and or a nonfuntioning (i.e. "cold") nodule as compared to the normal surrounding thyroid. Since hyperfuntioning nodules rarely harbor malignancy, if one is found that corresponds to the nodule in question, no cytologic evaluation is usually necessary.2 Conversely, the majority of all nonfunctioning nodules may be benign or less frequently malignant, thus requiring cytopathologic evaluation.2 We report a patient with Marine-Lenhart syndrome with the dilemma of a “hot “nodule found on thyroid scintigraphy which had “suspicious” ultrasonographic features prompting thyroidectomy after cytological diagnosis of papillary thyroid cancer (PTC). In this case, the utilization of neck ultrasonography provided significant risk stratifying data to support appropriate management.