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Suspicious Thyroid Nodule — RACP Adult Medicine MCQ

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HardEndocrinologySuspicious Thyroid NoduleRACP Adult Medicine

A 35-year-old has a 2.5-cm solid hypoechoic thyroid nodule with irregular margins and punctate echogenic foci plus a suspicious lateral cervical node. TSH is normal. What is the next diagnostic step?

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Correct answer: B — Perform ultrasound-guided FNA of the thyroid nodule and suspicious node, adding thyroglobulin washout when nodal features indicate

The best answer is “Perform ultrasound-guided FNA of the thyroid nodule and suspicious node, adding thyroglobulin washout when nodal features indicate”. This nodule has multiple high-suspicion features and exceeds any reasonable biopsy threshold; the abnormal node also requires sampling because nodal confirmation changes staging and operative planning. Scintigraphy is principally used when TSH is suppressed. Observation, suppressive therapy and unplanned surgery bypass essential diagnostic information.

Reference: Australian Prescriber: Investigating thyroid nodules: https://australianprescriber.tg.org.au/articles/investigating-thyroid-nodules.html