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Thyroid nodule — ABIM Board MCQ

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HardEndocrinology/MetabolismThyroid noduleABIM Board

A 61-year-old woman has a 2.2-cm solid thyroid nodule with punctate echogenic foci. TSH is 0.04 mIU/L and free T4 is normal. She has no compressive symptoms. Which next diagnostic study should precede a decision about biopsy?

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Correct answer: D — Obtain radionuclide thyroid scintigraphy to determine whether the nodule is autonomous

The best answer is “Obtain radionuclide thyroid scintigraphy to determine whether the nodule is autonomous”. A suppressed TSH changes the sequence: radionuclide scanning determines whether the nodule is hyperfunctioning. An autonomous hot nodule has a very low malignancy risk and generally does not require FNA, whereas a nonfunctioning suspicious nodule does. Thyroglobulin, delayed reassessment and levothyroxine suppression do not resolve this initial classification.

Reference: 2015 ATA Guideline for Thyroid Nodules: https://pmc.ncbi.nlm.nih.gov/articles/PMC4739132/