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A 16 year old female is seen because of a 6 month history of fatigue, nervousness, tremor, heat intolerance, polyphagia and weight loss. Her scholastic work has declined in quality. Recently she noticed some enlargement of her neck and prominence of her eyes. Physical examination reveals: B.P. 130/60 mm Hg., pulse 96/minute, smooth warm skin, eyelid retraction, symmetric thyroid enlargement, fine hand tremor and mild muscle weakness. Her TSH is low.
TR is a 40 year old female who presents for her annual physical. On exam, you palpate a 1.5x 2 cm nodule in the right lobe of her thyroid gland. The nodule is non-tender and mobile. Both her TSH and free T4 are normal.
Most important step in the diagnostic evaluation of thyroid nodules, exception would include hyperthyroidism where scintigraphy should be performed first or highly suspicious exams warranting immediate surgery.
Mean sensitivity higher than 80% and specificity higher than 90%.
Can categorize tissue into the following diagnostic categories: malignant, benign, thyroiditis, follicular neoplasm, suspicious, or nondiagnostic
Cost Effective – some studies estimate that it reduces cost by 25 % and reduce the need for diagnostic thyroidectomy by 20-50%.
F.H. is a 66 year old man who complains of a “a bump in his throat.” He states that he has also developed some discomfort while eating more recently. PMH is significant for childhood neck irradiation. There is no palpable mass on exam and oropharynx is clear.
Algorithm for the Cost-Effective Evaluation and Treatment of a Clinically Detectable Solitary Thyroid Nodule Hegedus: N Engl J Med, Volume 351(17). October 21, 2004. 1764-1771