Discrepancy between UWorld and Step-Up to Medicine

[kaleerkalut]

I was doing some UWorld questions and I noticed discrepancy between UWorld and SUTM. QID# 3484 says best first initial test for a thyroid nodule is TSH while SUTM says FNA (pg. 164). Can anybody please explain this or anything I might be missing here? Thanks a ton 🙂

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[illegallysmooth]

I was doing some UWorld questions and I noticed discrepancy between UWorld and SUTM. QID# 3484 says best first initial test for a thyroid nodule is TSH while SUTM says FNA (pg. 164). Can anybody please explain this or anything I might be missing here? Thanks a ton 🙂

Well, a TSH is not going to lead to a definitive diagnosis, but it's important to determine if the pt is euthyroid or not. The FNA will give you a definitive diagnosis in the vast majority of cases so it's the most important DIAGNOSTIC step. Perhaps those points are stated differently - does SUTM say the best initial DIAGNOSTIC test is FNA?

 

[kaleerkalut]

Well, a TSH is not going to lead to a definitive diagnosis, but it's important to determine if the pt is euthyroid or not. The FNA will give you a definitive diagnosis in the vast majority of cases so it's the most important DIAGNOSTIC step. Perhaps those points are stated differently - does SUTM say the best initial DIAGNOSTIC test is FNA?

It's a flow chart for the work-up of solitary thyroid nodule.

 

[werd]

here's my two cents... if you've established that you have a thyroid nodule, the next diagnostic step is an FNA. if you note a lump near the thyroid on exam, ie suspected thyroid nodule, you should probably get the TSH and ultrasound before considering sticking a needle in there.