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Old 04-14-2011
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Thyroid Thyroid Nodule; T4 and TSH Normal; What is the next step?

When a patient has a thyroid nodule, perform thyroid function test if TSH and T4 normal... what should be next step ultrasound or biopsy ?
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Old 04-14-2011
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The next step would be ultrasound to get the size, location, number and complexity of the nodule, then biopsy based on the ultrasound results
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Old 04-14-2011
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Quote:
Originally Posted by usluipek View Post
The next step would be ultrasound to get the size, location, number and complexity of the nodule, then biopsy based on the ultrasound results
Yes..according to uworld, it is ultrasound to find out whether it is benign or malignant, if suspicious of malignancy, then u can go for FNAC...but in Kaplan lecture notes it is simply given go for FNAC without ultrasound, after doing TSH.
Ultrasound, they have mentioned for differentiating solid vs cyst.
so depending upon options, we can choose how to proceed
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Old 04-14-2011
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Arrow just alittle more I figured out after coming across same issue

I read couple of sources after I came across this issue, including step up to medicine, saunder's medicine, and here is the result. In general a nodule greater than 1cm in size is palpable on PE. so if any of these are present, it is suggestive of malignancy and go straight to FNA if not then use US.

1. if nodule is fixed in place and does not move on swallowing.
2. very firm consistency or irregularity of nodule.
3. nodule is solitary
4. hx. of radiation therapy to neck
5. hx. of rapid development
6. vocal cord paralysis
7. cervical adenopathy
8. elevated serum calcitonin

Now US can be used if the above not present and TSH is normal.
1. it can detect nodules 1-3mm
2. it can tell cystic from solid

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Old 04-14-2011
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Default Thyroid biopsy

First chk TSH and T4 levels
Family hx positive - biopsy
No family hx - ultrasound & uptake scan
This is what I have used for answers.... Seems to work
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Old 04-14-2011
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thanks everyone for the explaination
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Old 04-21-2011
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if im not mistaken, when a malignancy of the thyroid is suspected, a biopsy is a definite NO-NO without usg guidance or confirmation tht it isnt a solid mass. this was cause the tumor to spread!
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