humbty
Forum Elite
Topics: 24
Posts: 135
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OK next question:
56 yo Female solitary nodule in her thyroid, no PMH, no symptoms.
TSH: 1.1 mIU/l
fT4: 1.5 ng/dl
FNA read as indeterminate.
Whats the next best step in mgmt?
a) no treatment
b)RAI uptake
c)surgery
d)repeat FNA
e)Thyroid replacement therapy
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| frank100
Forum Guru
Topics: 48
Posts: 586
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not always true but: since TSH is normal the patient is euthyroid so (e) is not the answer. we still have not a definitive diagnosis so (c) would be inappropriate.
FNA is inconclusive so US would be the best next step (FOR POSIBLE FOLLOW UP), but beacuse it is not in the options, to repeat FNA is a god option and had demonstrated that a second one turns out as positive or negative.
choice (a) Would be very irresponsible, since we are talking about a thyroid mass.
i would choose (d) repeat FNA, because the previous one in inconclusive and TFT´S seem to be normal.
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| drk1980
Forum Guru
Topics: 147
Posts: 1,038
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i'll go for RAIU.......r/o cold nodule
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| humbty
Forum Elite
Topics: 24
Posts: 135
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I wasnt sure what indeterminate FNA meant, I thought it maybe means the indeterminate follicular pathology.
So I thought surgery because indeterminate follicular FNA has to be removed.
Their answer is RAI uptake, i think thats absolutely not the right answer. I also looked at the Harrisons algorithm for thyroid nodule and RAI uptake is never considered if someone is euthyroid.
After Harrisons repeat US guided FNA would be recommended, I think thats probably a good answer.
I dont understand Kaplans reasoning pretty often, thats really annoying. UW is much better in my opinion.
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| drk1980
Forum Guru
Topics: 147
Posts: 1,038
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US guided FNA wud hv been the right choice if it were in the choices. Surgery, this early in evaluation in this woman who doesnt hv risk factors or a suspicious sounding personal/family history, might be jumping the gun.
One use of RAIU scan in thyroid nodules is for indeterminate cytology. However nowadays, the FNAs esp US guided are quite superior....so its possible scans hv bcome obsolete in the real sense.
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| humbty
Forum Elite
Topics: 24
Posts: 135
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Ok thank you! Your answer help me very much.
I only took surgery because I confused indeterminate FNA with the follicular indeterminate if malignant or benign pathology.
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