Thyroid disease The University of Texas Health 甲状腺疾病德克萨斯大学的健康.pptVIP

* * * * * * * * * * * * * * * Computed tomography (CT) scan of the neck and the thoracic outlet. This shows a large thyroid mass predominantly affecting the right lobe of the thyroid gland. The trachea has been pushed over to the left. Shahi et al. Journal of Medical Case Reports 2010 4:15 doi:10.1186/1752-1947-4-15 * * * * * * THYROID DISEASE NODULES AND NEOPLASMS By: Christine B. Taylor, MD LEARNING OBJECTIVES After reviewing this module, the student will have the ability to: Approach History physical exam of patients with thyroid pathology Understand which patients require surgery and appropriate surgical timing Describe the process of evaluating and working up various thyroid pathologies CASE PRESENTATION 29 year old Female referred to Head Neck clinic for evaluation of a thyroid nodule. Patient reports this nodule was found incidentally while she was getting ready for work one morning. She went to her PCP, who ordered a thyroid ultrasound, which demonstrated a 2cm nodule in the right lobe of the thyroid. QUESTION After thorough history and physical, what would you order first for this patient? A. Thyroid function tests (TSH, T4) B. CT neck C. MRI neck D. Radioactive Iodine uptake scan E. All of the above QUESTION After thorough history and physical, what would you order first for this patient? A. Thyroid function tests (TSH, T4) B. CT neck C. MRI neck D. Radioactive Iodine uptake scan E. All of the above EXPLANATION What would you order first for this patient? A. Thyroid function tests (TSH, T4) It is important to first establish the patient’s thyroid function. This will help determine if the known thyroid nodule is hyperfunctioning, hypofunctioning, or nonfunctioning. At this point, you should also obtain Fine Needle Aspiration (FNA) with ultrasound guidance, if necessary, to obtain cells for cytopathology. This will help determine if nodule is benign or malignant IMPORTANT POINTS - PATIENT HISTORY Family history of thyroid disease or thyro