Question

A 57 year old female with hypertension presents for scheduled follow-up. On physical examination, the patient's blood pressure is 128/80, but a new mass is palpated on the patient's left thyroid lobe. The mass is firm, smooth, and nontender, and measures 2cm by 1cm. There is no cervical lymphadenopathy or lid lag, and the patient has no history of head or neck radiation or thyroid disease. Laboratory evaluation shows TSH of 1.9 mU/L and calcium of 9.9 mg/dL. Which of the following is the most appropriate next step in the management of this patient?

A. Reassurance
B. Radionuclide thyroid scan
C. FNA
D. Begin PTU
E. Total thyroidectomy

Answer 1

A radionuclide thyroid scan would be the most appropriate next step in the management of this patient.

Step-by-step explanation:

The most appropriate next step in the management of this patient would be a Radionuclide thyroid scan (option B). A radionuclide thyroid scan uses a radioactive isotope to evaluate the structure and function of the thyroid gland. This scan can help determine if the mass on the patient's left thyroid lobe is functioning normally or if it is suspicious for thyroid cancer.

Option A (Reassurance) would not be appropriate because a new thyroid mass requires further evaluation. Option C (FNA) may be considered if the scan shows features concerning for malignancy, but it is not the initial step. Option D (Begin PTU) would be more appropriate if the patient had hyperthyroidism, not a thyroid mass. Option E (Total thyroidectomy) is a more invasive option and should be considered after a conclusive diagnosis has been made.