Match each clinical presentation of a patient with a thyroid abnormality to the most appropriate guideline-indicated next step in their diagnostic workup.
- A 42-year-old woman with a 2.5-cm palpable thyroid nodule and a significantly suppressed serum thyroid-stimulating hormone (TSH) levelRadionuclide thyroid scintigraphy
- A 35-year-old man with a 1.5-cm solid, hypoechoic thyroid nodule featuring irregular margins and microcalcifications, with a normal serum TSH levelUltrasound-guided fine-needle aspiration biopsy
- A 55-year-old woman with an incidentally discovered 0.8-cm purely spongiform thyroid nodule and a normal serum TSH levelClinical observation and serial ultrasound surveillance
- A 65-year-old man with a massive multinodular goiter presenting with progressive stridor and dysphagia, pending surgical evaluationComputed tomography of the neck without intravenous contrast
Answer
The correct matches sequence the diagnostic workup based on initial TSH status, sonographic risk stratification, and the presence of compressive anatomical symptoms.
Proper test sequencing for thyroid nodules prevents diagnostic overutilization. Suppressed TSH requires scintigraphy. Normal TSH with suspicious large nodules requires FNA. Small low-risk nodules require observation. Compressive goiters require non-contrast anatomical imaging.
Step-by-Step Solution
Key Concept
Thyroid nodule evaluation begins with TSH measurement to separate functioning nodules (requiring scintigraphy) from nonfunctioning ones (requiring ultrasound risk stratification to guide FNA or observation).
Estimated Time:1m 15s