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Old 02-27-2012
tyagee's Avatar
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Thyroid Thyroid nodule; next step FNAC or TSH?

During her visit to a primary care physician, a 39-year-old woman relates that she has recently had bouts of hoarseness often associated with difficulty in swallowing and breathing. Upon taking a history, the physician also determines that she immigrated with her parents from the Ukraine in 1988 at the age of 17 years, married a 40-year-old American citizen a year ago, and gave birth to her first child 8 months ago. Upon examination, the physician discovers a firm nodule near her Adam’s apple.
The next step in obtaining a diagnosis is which of the following?
(A) Analyzing the results of an ultrasound scan
(B) Doing a fine needle aspiration biopsy
(C) A thyroid nuclear scan using 123I
(D) Determining the serum thyroid level
(E) A formal surgical biopsy

please give reason too.
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Old 02-27-2012
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determining serum thyroid levels..is always the first test for any pt with thyroid enlargement
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Old 02-27-2012
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D. Determining the serum thyroid level
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Old 02-29-2012
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ans was FNAC.
book is reliable.

here is the explanation...

Although several procedures provide clues concerning whether a thyroid nodule is benign or cancerous, a
definitive answer requires a biopsy and histological analysis by a pathologist; thyroid fine needle aspiration
(FNA) biopsy (choice B) is a nonsurgical method that usually can definitely differentiate between benign and
malignant nodules. Consequently, it commonly is the first and only test used to evaluate the potential malignancy
of a nodule. Performing a successful fine needle aspiration biopsy early in the workup of a nodule typically
provides a rapid and unambiguous diagnosis, thus reducing cost and saving the patient anxiety. That
she immigrated from the Ukraine is relevant because of the accident at Chernobyl.
Analyzing the results of an ultrasound scan (choice A) and/or a thyroid nuclear scan using 123I (choice C)
are generally reserved for the approximately 5% of fine needle aspiration biopsies that are reported to be nondiagnostic
or the approximately 10% of results categorized as suspicious. A report of nondiagnostic biopsy
generally results from an inability to obtain a sufficient number of thyroid cells using FNA, whereas about
75% of the nodules identified as suspicious are benign follicular adenomas that cannot be distinguished from
follicular or Hürthle cell cancers. A solid or complex ultrasound scan result implies that the nodule is malignant,
and a cold area after a thyroid scan (i.e., where 123I is not taken up) indicates possible malignancy since
about 95% of hot nodules are benign. Consequently, a cold nodule found suspicious by FNA is generally
removed surgically. In addition to being an aid in diagnosis, an ultrasound scan is also carried out to help in
the placement of the needle while performing FNA.
Determining the serum thyroid level (choice D) is generally an early test done to obtain an overview of the
patient’s thyroid function, but it is not able to diagnose the potential malignancy of a nodule. A formal surgical
biopsy (choice E) is reserved for the diagnosis of nodules labeled nondiagnosable or suspicious after FNA.

so what say?
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