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Thyroid nodule — MCCQE Part 1 MCQ

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ModerateNeck MassThyroid noduleMCCQE Part 1

47-year-old woman presents with a new anterior neck lump. Ultrasound shows a 2.1 cm solid hypoechoic nodule with microcalcifications. Which of the following is the most appropriate next step?

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Correct answer: E — Arrange fine-needle aspiration according to ultrasound risk criteria

Arrange fine-needle aspiration according to ultrasound risk criteria is best because suspicious ultrasound features and size meet FNA criteria. Discharge with oral analgesia only is suboptimal because analgesia alone may mask a surgical emergency; Delay surgical assessment until routine clinic is suboptimal because time-sensitive surgical presentations require urgent assessment; Treat with laxatives or antacids as sole therapy is suboptimal because a benign gastrointestinal explanation does not account for the red flags; Perform an invasive bedside procedure without imaging or senior input is suboptimal because invasive treatment can worsen outcomes when anatomy or diagnosis is uncertain. TSH and ultrasound risk pattern guide next steps.

Reference: Canadian thyroid nodule guidance