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Thyroid Nodule — RACP Adult Medicine MCQ

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ModerateEndocrinology & DiabetesThyroid NoduleRACP Adult Medicine

A 35-year-old woman presents with a thyroid nodule. Ultrasound shows a 2.5 cm hypoechoic solid nodule with microcalcifications and irregular margins. Fine needle aspiration cytology returns as Bethesda category V (suspicious for malignancy). What is the recommended management?

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Correct answer: D — Diagnostic hemithyroidectomy or total thyroidectomy

Bethesda V (suspicious for malignancy) carries a malignancy risk of 60–75%. Diagnostic surgical excision (hemithyroidectomy or total thyroidectomy depending on nodule size, patient factors, and molecular testing results) is recommended. The ultrasound features (hypoechoic, microcalcifications, irregular margins) are highly suspicious for papillary thyroid carcinoma. Radioactive iodine is post-operative therapy, not diagnostic.

Reference: Cancer Council Australia – 2023 – Thyroid Cancer Guidelines; ATA – 2015 – Thyroid Nodule Guidelines