Quick Endocrine question..Please!

[jay426k]

Well I wasn't able to get too much help from the USMLE II area so I'm coming directly to you guys. By chance do any of you have a good algorithm or know where I could find one for approaching thyroid nodules. I know they say FNA is the gold standard, but when it comes to a patient coming in and finding a nodule on their thyroid I assume you could start with a TSH then Ultrasound then RAIU? This is really the last thing I want to get down before my Step 2 exam and I would greatly appreciate it.

Thanks~

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[adam6]

Well I wasn't able to get too much help from the USMLE II area so I'm coming directly to you guys. By chance do any of you have a good algorithm or know where I could find one for approaching thyroid nodules. I know they say FNA is the gold standard, but when it comes to a patient coming in and finding a nodule on their thyroid I assume you could start with a TSH then Ultrasound then RAIU? This is really the last thing I want to get down before my Step 2 exam and I would greatly appreciate it.

Thanks~

I would go to the American Association of Clinical Endocrinologists' website: www.aace.com and look at the clinical guidelines on thyroid nodules (palpable vs. incidentaloma). It has a nice algorithm.
To summarize, a palpable nodule should be evaluated with TSH (and possibly US). If normal, go to ultrasound guided FNA. RAIU would be used if TSH is low and FT3/4 is high (thyrotoxic) to differentiate Grave's vs. subacute thyroiditis, etc.