AAFP Board Review – Endo Exam with Guaranteed Accurate Answers

While performing a routine physical examination on a 42-year-old female you discover an apparent nodule in the left lobe of the thyroid measuring approximately 1 cm in diameter, which is confirmed on ultrasonography. The most appropriate next step in the evaluation of this finding is a A. serum calcitonin level B. serum free T3 level C. serum TSH level D. serum thyroglobulin leve E. radionuclide thyroid scan - correct answer C. serum TSH level - Nodules 1 cm should also be fully evaluated when found in patients with a family history of thyroid cancer, a personal history of head and neck irradiation, or a finding of cervical node enlargement. - 1st steps: measurement of TSH or ultrasound - The American Thyroid Association's guidelines recommend that TSH be the initial evaluation (SOR A) and that this be followed by a radionuclide thyroid scan if results are abnormal. - Diagnostic ultrasonography is recommended for all patients with a suspected thyroid nodule, a nodular goiter, or a nodule found incidentally on another imaging study (SOR A). A 45-year-old white male undergoes a health screening at his church. He has a carotid Doppler study, abdominal ultrasonography, heel densitometry, and a multiphasic blood panel. He receives a report indicating that all of the studies are normal, but a 0.7-cm thyroid nodule was noted. The TSH level is normal. He schedules a visit with you and brings you the report. A neck examination and ENT examination are normal, and you do not detect a nodule. You recommend (check one) A. a radionuclide thyroid scan B. T3, T4, and calcitonin levels C. repeat ultrasonography in 6-12 months D. a fine-needle biopsy E. hemithyroidectomy - correct answer C. repeat ultrasound in 6-12 mos - classic incidentaloma. - Nodules are detected in up to 50% of thyroid sonograms and carry a low risk of malignancy (5%). - If the TSH level is normal, nuclear scanning and further thyroid studies are not necessary. - it is reasonable to follow small nodules with clinical examinations and periodic sonograms A 57-year-old previously healthy menopausal female presents to your office with a 1-year history of palpitations and an unintentional 10-lb weight loss. A review of systems is negative for tremors or visual changes. Vital signs include a blood pressure of 129/85 mm Hg and a heart rate of 110 beats/min. A physical examination is otherwise unremarkable except for a nontender, diffusely enlarged thyroid with no distinct nodules, and mild proptosis. Laboratory studies are significant for a TSH level0.01 :U/mL (N 0.60-3.30), a free T3 level of 14.51 pg/mL (N 2.0-3.5), and a free T4 level of 4.52 ng/dL (N 0.71-1.40). A thyroid-stimulating immunoglobulin test is positive. In addition to a β-blocker, which one of the following is the most appropriate initial management? (check one) A. Radioactive iodine ablation