During a routine employee wellness check, a 35-year-old female teacher is noted to have an asymmetric neck. She reports feeling entirely well, with no recent weight changes, palpitations, heat intolerance, or changes in bowel habits. Her medical history includes only mild seasonal allergies, for which she takes an over-the-counter antihistamine as needed. Her blood pressure is 118/76 mmHg and heart rate is 72/min. On palpation, a 2.0-cm, firm, non-tender mass is identified in the right thyroid lobe. The mass moves upward when the patient swallows. No adjacent cervical lymphadenopathy is appreciated. Which of the following represents the most appropriate initial step in the diagnostic workup for this patient?
- Measurement of serum thyroid-stimulating hormone and thyroid ultrasonographyCevap
- BFine-needle aspiration biopsy of the mass
- CComputed tomography of the neck with intravenous contrast
- DMeasurement of serum thyroglobulin concentration
- EReassurance with a scheduled repeat physical examination in 6 months
Cevap
Measurement of serum thyroid-stimulating hormone and thyroid ultrasonography
The correct sequence for evaluating a newly discovered thyroid nodule begins with a serum thyroid-stimulating hormone (TSH) level and a high-resolution thyroid ultrasound. The TSH level dictates the subsequent pathway: if the TSH is subnormal (indicating hyperthyroidism), a radionuclide scan is indicated to determine if the nodule is hyperfunctioning (a 'hot' nodule, which is almost never malignant). If the TSH is normal or elevated, the ultrasound characteristics (e.g., size, microcalcifications, irregular margins, hypoechogenicity) will directly determine whether a fine-needle aspiration (FNA) biopsy is required.
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The initial diagnostic sequence for a newly discovered thyroid nodule consists of simultaneous measurement of serum TSH and a dedicated thyroid ultrasound.
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