A 40 year-old man, Ron McNab, has a 3 cm soft, non-fixed thyroid nodule found on routine physical examination. No lymph nodes are palpable. He has no local symptoms, including no hoarseness.
What two questions should be asked on history to see if he has an increased risk of malignancy?
Family history of thyroid cancer.
Personal history of radiation exposure.
What is his risk of malignancy in the nodule if the answer to the above questions is “no”?
What is the likeliest diagnosis?
How would you investigate him?
Check his sTSH. If it is normal or elevated, he needs a thyroid ultrasound and a fine needle biopsy of the nodule.
If the TSH is suppressed, he needs a thyroid scan.
If the nodule is cold, it should be biopsied; if hot, he should be treated for a hot nodule (no biopsy needed).