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Chapter 12. Endocrine

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?

A. Left thyroid lobectomy with left modified radical neck dissection

B. Total thyroidectomy with bilateral modified radical neck dissection

C. Left thyroid lobectomy with postoperative I-131 therapy

D. Total thyroidectomy with postoperative I-131 therapy

E. Total thyroidectomy alone

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.

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?

A. Left thyroid lobectomy alone

B. Left thyroid lobectomy with left modified radical neck dissection

C. Total thyroidectomy with left modified radical neck dissection

D. Total thyroidectomy with postoperative I-131 therapy

E. Preoperative FNA of the palpable cervical lymph node

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.

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?

A. Familial MTC

B. Follicular thyroid cancer

C. MEN 1

D. MEN 2a

E. MEN 2b

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.

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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