A 45-year-old female high school teacher comes to the clinic for a routine wellness examination. She reports feeling generally well and has no complaints of dysphagia, hoarseness, neck pain, palpitations, or weight changes. Her vital signs are within normal limits. During the physical examination, a firm, mobile, non-tender nodule measuring approximately 2 cm is palpated in the right lobe of the thyroid gland. The cervical lymph nodes are not enlarged, and the remainder of the examination is unremarkable. Which of the following tests should be ordered as the concurrent initial steps in the diagnostic workup for this physical finding? (Select two)
- Neck ultrasonographyAnswer
- Serum thyroid-stimulating hormone levelAnswer
- CFine-needle aspiration biopsy of the nodule
- DRadionuclide thyroid scintigraphy
- EComputed tomography of the neck with intravenous contrast
Answer
The correct initial steps are a neck ultrasonography and a serum thyroid-stimulating hormone (TSH) level.
The correct initial evaluation of any newly discovered thyroid nodule requires concurrent anatomical and functional assessment. Neck ultrasonography is the most sensitive, non-invasive anatomical test to confirm the presence of a nodule, measure its exact dimensions, evaluate for suspicious sonographic features (e.g., microcalcifications, irregular margins, hypoechogenicity), and assess the cervical lymph nodes. Simultaneously, a serum thyroid-stimulating hormone (TSH) level provides the functional status of the thyroid gland. The combination of these two initial tests establishes the foundation of the diagnostic algorithm and determines whether the patient will subsequently require a fine-needle aspiration, a radionuclide scan, or simple clinical observation.
Step-by-Step Solution
Key Concept
The initial diagnostic workup for a newly discovered thyroid nodule requires concurrent structural assessment with a dedicated neck ultrasonography and functional assessment with a serum TSH level.