approach to a thyroid nodule UW ID 3484 - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 04-03-2014
discimed's Avatar
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 48
Threads: 17
Thanked 3 Times in 3 Posts
Reputation: 13
Help approach to a thyroid nodule UW ID 3484

pls correct me if I am wrong and/or clarify these doubts if u are aware.


1) clinical evaluation suspicious of cancer (FH, Radiation exposure, hoarseness, difficulty swallowing, cervical lad ) -

next best step -do FNA ??

question is will you do TSH or U/S before FNA in this case ?


2) clinical evaluation normal - do tsh ?? or u/s or both ??

what is to be done with TSH result is well given in UW..

but I dont get this point.. If TSH is normal or low, one would do FNA anyway.. so why do U/S.. ???

3) if they give a thyroid nodule with normal clinical evaluation and what is d next best step
a) usg
b) FNA
c) TSH

WHAT will u choose ??
Reply With Quote Quick reply to this message



  #2  
Old 04-03-2014
usbound's Avatar
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 121
Threads: 5
Thanked 20 Times in 19 Posts
Reputation: 30
Default

Actually uworld very clearly explained this. You gotta interpret it properly. It mentions clinical evaluation, usg and tsh together for simplicity, but the following flow chart makes it clear. lets consider different scenarios:
1)1st step: clinical evaluation. if suspicious, do fna. other things dont matter.
2)clinical evaluation is normal. do usg. suspicious features-proceed to fna. dont care about tsh in this case. cuz the only reason you do tsh is to evaulate the need for fna. but presence of suspicious usg overrides that anyway.
3) if both clinical evaluation and usg normal, tsh is done. and then you know the steps cuz you said you understood that.

so to answer your last question, its basically usg before tsh if normal clinical evaluations with no risk factors.
Hope this clears it up.
Reply With Quote Quick reply to this message
The above post was thanked by:
discimed (04-03-2014)
  #3  
Old 04-03-2014
discimed's Avatar
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 48
Threads: 17
Thanked 3 Times in 3 Posts
Reputation: 13
Default

Quote:
Originally Posted by usbound View Post
Actually uworld very clearly explained this. You gotta interpret it properly. It mentions clinical evaluation, usg and tsh together for simplicity, but the following flow chart makes it clear. lets consider different scenarios:
1)1st step: clinical evaluation. if suspicious, do fna. other things dont matter.
2)clinical evaluation is normal. do usg. suspicious features-proceed to fna. dont care about tsh in this case. cuz the only reason you do tsh is to evaulate the need for fna. but presence of suspicious usg overrides that anyway.
3) if both clinical evaluation and usg normal, tsh is done. and then you know the steps cuz you said you understood that.

so to answer your last question, its basically usg before tsh if normal clinical evaluations with no risk factors.
Hope this clears it up.

thanks.

but MTB2 pg 115 says in an asymptomatic nodule.. most appropriate next step is to do TSH..

usg of thyroid is done to evaluate the size of the lesion but does not change the need for either thyroid function testing or needle aspiration !

this contradicts UW and this confused me..

reading various threads here on usmle forums confused me even more..
Reply With Quote Quick reply to this message
  #4  
Old 04-03-2014
usbound's Avatar
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 121
Threads: 5
Thanked 20 Times in 19 Posts
Reputation: 30
Default

Quote:
Originally Posted by discimed View Post
thanks.

but MTB2 pg 115 says in an asymptomatic nodule.. most appropriate next step is to do TSH..

usg of thyroid is done to evaluate the size of the lesion but does not change the need for either thyroid function testing or needle aspiration !

this contradicts UW and this confused me..

reading various threads here on usmle forums confused me even more..
alright, i think i see the prob. its tsh before usg. because if tsh is high, we have to do fna anyway. only if it is low we do raiu.
so ideally its high tsh, and suspicious usg-fna.
high tsh normal usg-also fna
normal tsh suspicious usg-also fna
normal usg and normal tsh-also fna. cuz thats the only way we could evaluate. that is why uworld didnt differentiate between tsh or usg first, cuz the management for both is fna.
Reply With Quote Quick reply to this message
  #5  
Old 04-03-2014
discimed's Avatar
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 48
Threads: 17
Thanked 3 Times in 3 Posts
Reputation: 13
Default

so based on what you wrote.. if you had to choose single best answer btwn TSH and USG as best next step in mx of an asymptomatic nodule.. WHAT would you choose.. ?

mtb says TSH

UW SAYS usg ? ?!!!
Reply With Quote Quick reply to this message
  #6  
Old 04-03-2014
usbound's Avatar
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 121
Threads: 5
Thanked 20 Times in 19 Posts
Reputation: 30
Default

Quote:
Originally Posted by discimed View Post
so based on what you wrote.. if you had to choose single best answer btwn TSH and USG as best next step in mx of an asymptomatic nodule.. WHAT would you choose.. ?

mtb says TSH

UW SAYS usg ? ?!!!
Go with tsh and then usg but i doubt a question will ask to choose btw those 2 only.
Reply With Quote Quick reply to this message
  #7  
Old 04-03-2014
DrAGA's Avatar
USMLE Forums Guru
 
Steps History: Step 1 Only
Posts: 340
Threads: 46
Thanked 148 Times in 85 Posts
Reputation: 158
Default

for endocrine disorders always start with lab ANalysis then imaging study...so first TSH and thyroid panels(free t4/t3 TSH) then US then biopsy...for all cases
Reply With Quote Quick reply to this message



Reply

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Thyroid Nodule question gear2d USMLE Step 2 CK Forum 0 03-23-2013 12:45 PM
Thyroid Nodule Workup aknz USMLE Step 2 CK Forum 20 02-13-2013 12:13 PM
Solitary thyroid nodule mis.med88 USMLE Step 2 CK Forum 4 08-30-2012 05:46 AM
solitary thyroid nodule usmleman2020 USMLE Step 1 Forum 3 08-09-2011 11:12 AM
Thyroid nodule ? next step kemoo USMLE Step 2 CK Forum 8 06-08-2011 11:46 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)