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Chapter 12. Endocrine
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A 27-year-old woman presents to the office with a left-sided neck mass approximately 2.5 cm in size. FNA reveals papillary thyroid cancer. 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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Answer: E. 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 the office with a left-sided neck mass approximately 2.5 cm in size. FNA reveals papillary thyroid cancer. 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. Preoperative FNA of the palpable cervical lymph node
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Answer: E. The size of the tumor necessitates a total thyroidectomy. This patient has a palpable cervical lymph node, and thus preoperative FNA of the lymph node should be done. A lateral neck dissection is indicated if the lymph node is positive for malignancy.
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A 17-year-old male has a 2-cm right thyroid 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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B. Follicular thyroid cancer
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Answer: D. 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 diagnostic workup should include all of the following except:
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