Step II thyroid nodule

[chngsr]

Ugh

Usmle world: Initial test is TSH,
1.) if elevated - do uptake scan
2.) If decreased- do FNA if nodule is greater than 1 cm bc likely hashimoto's
3.) If neutral- FNA

Then

Step- up
FNA !!!!!! as the initial test....

anyone have any idea what is right

 

[lord_jeebus]

Would you ever have a patient with a thyroid nodule that you would not want to biopsy?

 

[RussianJoo]

yeah if it's a hot nodule. i wouldn't bx it. what's the point?

 

[medInUSA]

yeah if it's a hot nodule. i wouldn't bx it. what's the point?

Completely agree with RussianJoo,

Step Up is wrong on this one.

Kaplan Notes page 21.

the best initial step is TSH. If its low, means hot nodule. Then do an uptake scan to identify any cold nodules and FNA those

 

[chngsr]

What if TSH is high? what would be your next step?

 

[lord_jeebus]

yeah if it's a hot nodule. i wouldn't bx it. what's the point?

I also agree, particularly if the patient is to seek surgical treatment.

From the AAFP:

 

[RussianJoo]

[YOUTUBE]http://www.youtube.com/watch?v=8buf8v-uWCY[/YOUTUBE]


this guy pretty much has the same algorithm as Lord Jeebus posted. his other algorithms are pretty good too, the only thing is he doesn't post a source, which would be nice to see.