Question of the week #46 and #47

1. A 55-year-old man presented for a regular follow-up to your office 2 weeks ago at which time a palpable nodule of 1.7 cm was noted in the left thyroid lobe. He denies a history of head and neck irradiation, hoarseness, pain, dysphagia, or hemoptysis. His physical exam is otherwise normal, with no lab abnormalities. Most appropriate next step in management?

A. Ultrasound of thyroid

B. TSH level

C. Fine Needle Aspiration ( FNAC)

D. Observation

E. Suppressive therapy with levothyroxine

2. The patient in Q1. subsequently, underwent an FNAC which revealed Papillary Carcinoma of thyroid. Staging work-up revealed no evidence of distant metastases and a neck CT scan does not reveal any lymphadenopathy. The most appropriate management of his thyroid cancer involves:

A. Radio iodine therapy ( RAI)

B. Partial thyroidectomy

C. Total thyroidectomy

D. Life long levothyroxine + Total Thyroidectomy + RAI therapy

E. Total Thyroidectomy + Life long levothyroxine

F. Partial thyroidectomy + life long levothyroxine

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