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Chapter 12. Endocrine

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A 27-year-old woman presents to your office with a left-sided neck mass approximately 2.5 cm in size. FNA reveals papillary thyroid neoplasm. She has no palpable lymph nodes. What is the best management for this patient?

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A. Left thyroid lobectomy with left modified radical neck dissection

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B. Total thyroidectomy with bilateral modified radical neck dissection

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C. Left thyroid lobectomy with postoperative I-131 therapy

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D. Total thyroidectomy with postoperative I-131 therapy

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E. Total thyroidectomy alone

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For papillary thyroid cancers larger than 2 cm, total thyroidectomy is indicated. Postoperative I-131 therapy is given for tumors >4 cm or extrathyroidal disease. Neck dissection is unnecessary without evidence of nodal disease.

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A 27-year-old woman presents to your office with a left-sided neck mass approximately 2.5 cm in size. FNA reveals papillary thyroid neoplasm. She has a 1-cm palpable left cervical lymph node. What is the best management for this patient?

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A. Left thyroid lobectomy alone

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B. Left thyroid lobectomy with left modified radical neck dissection

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C. Total thyroidectomy with left modified radical neck dissection

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D. Total thyroidectomy with postoperative I-131 therapy

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E. Total thyroidectomy alone

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The size of the tumor necessitates a total thyroidectomy. This patient has a palpable cervical lymph node, and thus a unilateral modified radical neck dissection or excision of the enlarged lymph node should be done.

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A 17-year-old male has a 2-cm right cervical nodule. An FNA is done and cells stain positive for calcitonin. Labs also reveal elevated calcium. What is the most likely diagnosis?

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A. Familial MTC

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B. Follicular thyroid cancer

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C. MEN 1

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D. MEN 2a

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E. MEN 2b

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Calcitonin-positive cells indicate a diagnosis of MTC. Elevated calcium suggests hyperparathyroidism. Along with pheochromocytoma, these diagnoses make up MEN 2a. MEN 2b would include MTC, pheochromocytoma, and mucosal neuromas.

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A 46-year-old woman presents to the emergency department with fever, tachycardia, diaphoresis, and tremors. She has a history of a goiter. Initial management should include all of the following except:

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A. PTU

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B. Steroids

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C. β-blocker

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D. Oxygen

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E. I-131

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