DISTANT METASTATIC LESIONS

Question 1

Lab/imaging findings of a patient with distant metastatic lesions

Answer 1

a) Thyroid-stimulating hormone (TSH) and free thyroxine (FT4) can
exclude hypothyroidism or hyperthyroidism
(b) Neck ultrasound indicated for all palpable nodules
1) Ultrasound imaging is used to determine nodule size, consistency,
whether it is part of a multinodular goiter.
2) Solid nodules often malignant; cystic nodules usually benign

Question 2

Treatment of a patient with distant metastatic lesions

Answer 2

(a) Refer to endocrinology (thyroid biopsies typically performed by an
endocrinologist or interventional radiologist)
(b) Ultrasound guided fine-needle aspiration (FNA) biopsy of suspicious
nodules (thyroiditis may coexist with malignancy)

Question 3

Disposition of a patient with distant metastatic lesions

Answer 3

MEDEVAC or referral to Endocrinology.