IM Radiology Case - Thyroid Nodule

Question 1

Important information to know about a patient prior to a I-123 thyroid scintigraphy scan?

Answer 1

Pregnant or breastfeeding?

On any medications interfering with thyroid uptake or radio-iodine?

Question 2

The greatest concern in a patient with a thyroid nodule is the ___.

Answer 2

Risk of malignancy

Question 3

Important history to assess risk of thyroid cancer?

Answer 3

Symptoms of hyper or hypothyroidism
Compressive symptoms (dyspnea, coughing, choking, dysphagia, hoarseness)
Prior history of head or neck radiation
Family history of thyroid cancer or endocrine abnormalities

Regional lymphadenopathy on exam

Question 4

Fewer than ___% of patients with a hot nodule have a carcinoma, whereas ___% of patients with cold nodule do.

Answer 4

1; 10-20

Question 5

A family history of ___, ___, or ___ warrants a full work-up for MEN syndrome.

Answer 5

Thyroid cancer
Hyperparathyroidism
Pheochromocytoma

Question 6

True or false - routine FNAB is required for hot nodules.

Answer 6

False

Question 7

What are the effects of a hot nodule on the rest of the thyroid gland?

Answer 7

Suppression (low uptake with scinitgraphy)

Question 8

DDx - hot nodule?

Answer 8

Thyroid adenoma
Graves disease
Thyroiditis
Thyroid cancer (though they are usually cold)