Question

Upon examining a 67-year-old woman, the NP detects a palpable thyroid nodule that is 1.5 cm in diameter. The most appropriate next step for this patient is:

a) Schedule follow-up in 3 months to determine if the size changes.
b) Obtain TSH measurement and thyroid ultrasound.
c) Schedule MRI imaging of the head and neck.
d) Referral to an oncologist.

Answer 1

The most appropriate step after finding a thyroid nodule is to obtain TSH measurement and a thyroid ultrasound. This evaluates the nodule and thyroid function, with potential for radioactive iodine imaging if necessary.

Step-by-step explanation:

Upon detecting a palpable thyroid nodule that is 1.5 cm in diameter in a 67-year-old woman, the most appropriate next step is to obtain TSH measurement and thyroid ultrasound. This approach is to assess the thyroid function and to visually evaluate the nodule for characteristics that may indicate malignancy or benign processes.

The use of thyroid imaging with radioactive iodine, such as I-131 or I-123, or employing gallium-67 for cancer imaging may come later in the diagnostic process based on initial test results. Such radioactive isotopes are specially concentrated in the thyroid due to the gland's use of iodine to produce thyroxine, a hormone essential for regulating metabolism. The imaging process, which involves a small dose of radioactive iodine, provides a picture that assists in evaluating the structure and function of the thyroid gland.