A 27-year-old woman with no significant past medical or surgical history presents for evaluation after her gynecologist discovered a palpable mass in the right anterior neck and was told to follow up with her PCP.
The patient was previously unaware of the mass and has not experienced neck pain, dysphagia, hoarseness, or compressive symptoms. She is not on any medications and has NKDA. Family history is negative for thyroid carcinoma but several family members have goiters. The patient has no history of irradiation to the head or neck.
Physical examination reveals an enlarged thyroid with a 2.0-cm thyroid nodule on the right that moves with swallowing. There is no palpable cervical lymphadenopathy. The rest of her exam is unremarkable.
Thyroid is an important endocrine organ involved in production of T3, T4 which plays an important role in maintaining hemostasis in us. Diffuse enlargement of Thyroid is called Goitre. However this 27 year old lady has a solitary thyroid nodule as revealed on local examination.
What lab tests, if any, would you order at this time and why?
Thyroid profile constituting TSH (thyroid stimulating hormone), T3 (triiodothyronine) and T4 (tetraiodothyronine): Helps to diagnose Hypothyroidism or Hyperthyroidism
Free T3 and Free T4 estimation will be better than Bound T3 and T4
Estimation of Antibodies against Thyroid peroxidase (TPO) and Thyroglobulin (Tg) to rule out Autoimmune thyroiditis
Basic Hematological Investigations such as Complete Blood Counts with Erythrocyte Sedimentation Rate.
Serum Calcium to rule out hypocalcemia
What diagnostic or imaging tests would you order and why?
Radioiodine uptake using Iodine isotope to diagnose cold nodules, hot nodules
Thyroid USG - To diagnose cysts, nodules and any lesions
Fine needle aspiration cytology of nodule
Thyroid biopsy if malignancy is suspected
What subjective symptoms would you ask about to evaluate for possible hyperthyroidism?
Hyperactivity and Irritability
Palpitations
Weight loss and Increased appetite
Oligomenorrhea
What subjective symptoms would you ask about to evaluate for possible hypothyroidism?
The important symptoms are
Tiredness, weakness,
Weight gain in spite of poor appetite
Menorrhagia (later oligomenorrhea or amenorrhea)
A 27-year-old woman with no significant past medical or surgical history presents for evaluation after her...
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