Step3Qbook - thyroid nodule

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Step3Qbook - thyroid nodule

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drk1980
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04/26/07 - 08:36 AM

Step3 Qbook
During the course of a physical exam for a 10 yr old girl you discover a firm, nontender nodule of the left lobe of thyroid. There is no significant lymphadenopathy, and the rest of her examination is unremarkable. You know that a solitary thyroid nodule in a child warrants prompt evaluation. Current management recommendations suggest that the next best step for this girl is:

A. a FNA biopsy
B. a redionucleotide I123 scan
C. serum T4 and TSH
D. surgery
E. an ultrasound only

Justice
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04/26/07 - 08:51 AM

Based on the Pt presentation, I would assume that she is euthyroid... That limits my enthusiasm about (C)...
I would offer (A), and if results are not conclusive, move to (B)...

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silver
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04/26/07 - 09:04 AM

B

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Adam
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04/26/07 - 03:24 PM

As Kaplan, we should do TSH first, it it's normal we move to FNA, so I'll go with (C)

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radonc
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05/01/07 - 10:56 PM

My answer is C. I thought you always do TFTs first in assessing any thyroid nodule.

Luckyall
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05/01/07 - 11:45 PM

C
TSH FIRST, if TSH is Normal---> proceed to FNA.... FNA needed to evaluate the pt and is the initial test of choise for the Evaluation

drk1980
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05/02/07 - 08:30 AM

Thanks for the answers
I too had thought the correct opion would be TSH studies. But according to the Answer Key, it is A - FNA biopsy, to r/o cancerous lesion.
Any further comments?

Justice
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05/03/07 - 01:25 PM

drk1980 wrote:
Thanks for the answers
I too had thought the correct opion would be TSH studies. But according to the Answer Key, it is A - FNA biopsy, to r/o cancerous lesion.
Any further comments?

Where is this Q from?

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coolmavs
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05/05/07 - 07:24 AM

It is mentioned in the question heading that it is from step 3 Qbook. drk can you please post the entire rationale if possible, sine I would also like to think that you would first like to Thyroid Function studies.

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