Anterior distant image obtained with Tc-99m-pertechtenate shows that the gland is enlarged. Activity throughout gland is increased relative to the background due to hyperfunctionality of the gland.
The pyramidal lobe (remnant of the thyroglossal duct) is visualized projecting cephalad from isthmus (red arrow). The pyramidal lobe is usually not seen (because it is small) unless the gland is overly stimulated.