A 55 year old man was recently found to have a 2.0 cm thyroid nodule on palpation during his annual physical. An ultrasound revealed no suspicious features of malignancy. TSH and free T4 levels were normal. Patient denies any history of neck irradiation, pain, dysphagia or hemoptysis. There is no history of cancer in his family. The next best step in managing this nodule :
A. Suppressive therapy with levothyroxine
B. FNAC
C. Lobectomy with isthmectomy
D. Observation
E. Radio iodine therapy
Archer USMLE Step 3 Blog 
B
B
b,
bbbbbb
bbb??????
bbbbbbbbbbbb
D
these are my notes from Archer audio / PPTs;
first GET TSH → ↑ TSH or NL (NONFUNCTIONING) → US → if suspicious* → FNAC
* no suspicious features → free T4 → TPO Antibodies and Rx as Hashimatos
Based on the Archer notes, I was under the impression that you only do FNAC w/ ↑ or NL TSH if the US is suspicious for malignancy.
Dr. Red – could you please share the answer?
Threshold to do FNA of nodules that are NOT suspicious for malignancy (that is, partially cystic and lacking suspicious ultrasound features), is 2 cm or greater
B
B