Match the following thyroid nodule presentations and cytology findings with the most appropriate initial surgical or medical management.
- A 45-year-old woman with a 4.5-cm solid thyroid nodule. Cytology shows papillary thyroid carcinoma. Ultrasound demonstrates no suspicious cervical lymph nodes.Total thyroidectomy
- A 40-year-old man with a 1.5-cm thyroid nodule. Cytology shows medullary thyroid carcinoma. Serum basal calcitonin is markedly elevated.Total thyroidectomy with prophylactic central compartment neck dissection
- A 32-year-old woman with a 2.5-cm thyroid nodule. TSH is normal. Cytology shows a follicular neoplasm. Molecular testing is not available.Diagnostic thyroid lobectomy
- A 50-year-old woman with a 1.2-cm thyroid nodule. Cytology shows a benign colloid nodule. She is asymptomatic and euthyroid.Observation with routine ultrasound surveillance
Cevap
The correct matches pair papillary thyroid carcinoma > 4 cm with total thyroidectomy, medullary carcinoma with total thyroidectomy plus central neck dissection, follicular neoplasm with diagnostic lobectomy, and benign nodules with observation.
Each nodule requires a specific, distinct management strategy: PTC > 4 cm requires total thyroidectomy; medullary carcinoma requires total thyroidectomy plus central neck dissection due to aggressive lymphatic spread; follicular neoplasms require lobectomy to assess for capsular/vascular invasion; and asymptomatic benign nodules require observation.
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Anahtar Kavram
Surgical management of thyroid nodules depends heavily on the specific cytological diagnosis from fine-needle aspiration, tumor size, and histological subtype.
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