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Clinical Case 1
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Objectives:

  • Recognize the major risk factors influencing the development and prognosis of thyroid carcinomas
  • Evaluate a thyroid nodule
  • Describe the management of papillary carcinoma, the most common of the thyroid cancers
  • Recognize and briefly describe the other types of thyroid cancer



1

A 45-year-old female presents to the office complaining of a “ball in my neck.” She noticed a lump in her anterior neck approximately 1 month ago. She is not sure if it has increased in size. She has not noticed any other lumps or masses. She denies dysphagia, odynophagia, neck pain, cough, weight loss, fever, chills, sweats, or a change in bowel habits. She also denies any hyperthyroid or hypothyroid symptoms. She is premenopausal, and her cycles are regular. She has been treated for diabetes for 6 years, which is well controlled with glyburide 5 mg daily. In 1993 she immigrated to the U.S. from Kiev, Ukraine, where she had lived for most of her life. She has no family history of thyroid or other endocrine disorders, but several relatives in Kiev have been diagnosed with various cancers.

Which of the following factors from her history INCREASES the likelihood that the nodule is malignant?

A)Nodule not increasing in size.
B)No regional adenopathy.
C)Age greater than 40 years.
D)Female.
E)History of possible radiation exposure.
2

Physical exam reveals an obese female in no acute distress. Her head, eye, nose, and oral exams are normal. She has a 2 cm firm nodule on the right pole of the thyroid. The nodule moves along with the other subcutaneous structures upon swallowing. She has no lymphadenopathy. The rest of the exam is normal.

Which of the following next steps would be most likely to yield a definitive diagnosis?

A)Thyroid ultrasound.
B)Fine needle aspiration.
C)Thyroid scan (Tc99).
D)Serum thyroglobulin level.
E)Serum calcitonin level.
3

A tissue diagnosis reveals probable papillary carcinoma. A serum thyroglobulin level, TSH, basic chemistries, a blood count, and a blood type are ordered.

What should be done next?

A)Observe the nodule for 1 month.
B)CT of the head and neck with contrast.
C)Radiation therapy with I131.
D)Radiation therapy with external beam radiation.
E)Suppression of TSH levels with thyroxine.







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