A 40-year-old woman with no significant past medical history presents for evaluation of a thyroid nodule found incidentally on ultrasound performed for neck pain. She denies constitutional symptoms, dysphagia, or voice changes. Vital signs are within normal limits. Physical examination reveals a firm, non-tender, mobile 3-cm nodule in the right thyroid lobe with no cervical lymphadenopathy or signs of airway compromise. Laboratory studies show TSH 2.3 mIU/L and free T4 1.1 ng/dL. Thyroid ultrasound demonstrates a hypoechoic nodule with smooth margins, no microcalcifications, no suspicious lymph nodes, and no extrathyroidal extension. Fine-needle aspiration (FNA) biopsy shows benign follicular cells without atypia, classified as Bethesda Category II (benign). Which of the following is the most appropriate next step in management?
- A)Perform total thyroidectomy followed by radioactive iodine ablation
- B)Initiate levothyroxine therapy to suppress TSH and prevent nodule growth
- C)Obtain CT scan of the neck and chest to evaluate for metastatic disease
- D)Repeat thyroid ultrasound in 6-12 months; clinical observation without interventionGABARITO
- E)Perform thyroid lobectomy with intraoperative frozen section analysis
Explicação
A benign FNA result (Bethesda Category II) in the setting of a euthyroid patient with no suspicious ultrasound features carries minimal risk for malignancy (<1%). American Thyroid Association guidelines recommend surveillance ultrasound at 6-12 months to estab... Ver explicação completa e trilha adaptativa →