thyroid nodule workup

[Guest]

This should be a relatively straightforward topic but honestly I am tired of getting these questions wrong on practice exams. I want to make sure I don't screw this one up on PANCE as it should be an easy one.

 

On exam you find a thyroid nodule, what is the initial step in evaluation?

-Some of my books say TSH first, FNA second

-Some of my books and practice questions say FNA is first

 

 

Can anyone clear this up please for testing purposes? Thanks :)

[Guest JMPA]

what benefit would tsh be in evaluation? fna for evaluation?what other testing is of value?

[REMPAC]

Post the actual questions you missed on these practice exams in regard to the thyroid.

[FfIghter23]

With a solitary thyroid nodule-- when the patient is chemically or clinically euthyroid and the question gives you that clue, FNA is first.

 

If the question gives you ANY clinical signs of a possible chemical imbalance and no mention of a TSH/T4, the answer is probably drawing thyroid panel FIRST.

 

Make sense?

[waky02]

The focus of your inquire is what the test writer is asking you

1. The evaluation of a thyroid nodule. 

2. care of a pt which has issues, that might be related to a thyroid nodule.

 

(see how many words I needed to put into the stem, to make it be about the Pt)

 

 

With a solitary thyroid nodule-- when the patient is chemically or clinically euthyroid and the question gives you that clue, FNA is first.

If the question gives you ANY clinical signs of a possible chemical imbalance and no mention of a TSH/T4, the answer is probably drawing thyroid panel FIRST.

Make sense?

[rev ronin]

TSH is first: it's a standard lab/blood test.  When a question asks first, initial, next, or similar keywords, you need to heed those key modifiers.  First != definitive, but if there's a good reason to do something simple, cheap, and straightforward that helps risk stratify or prioritize or rule out a worse etiology, that's what's first.  First treatment for an acute MI, for example, is not PCI, it's assuring ABCs.

[gbrothers98]

This should be a relatively straightforward topic but honestly I am tired of getting these questions wrong on practice exams. I want to make sure I don't screw this one up on PANCE as it should be an easy one.

 

On exam you find a thyroid nodule, what is the initial step in evaluation?

-Some of my books say TSH first, FNA second

-Some of my books and practice questions say FNA is first

 

 

Can anyone clear this up please for testing purposes? Thanks :)

This is a basic knowledge question and likely wont find such on a summative test trying to determine your ability to synthesize and apply your knowledge.

Or at least phrased this way. The devil is in the details of the question. Plus what it seems you are doing is key term association which is a cramming technique.

So it all depends upon the question and your knowledge of where TSH and FNA fit in the evaluation.

Then one needs more of an understanding and synthesis of knowledge concerning thyroid nodules.

Why the concern about a nodule? Possibility of cancer. What is the likelihood of cancer? Low.

Does the pt have a risk for cancer? Question may or may not tell you.

What initially drives your process after the nodule is found? The function of the thyroid.

So the answer should be TSH. To get to FNA, have several steps to get through one of which is determining TSH.

I am told by PA faculty whom write these type of questions for test banks including PackRat and PANCE/PANRE that the terms initial, first and best are not good test question terms to use. Better to phrase the question as:

A 65 y/o female is found to have a thyroid nodule during an unrelated MRI of the neck. Which test should be done to evaluate for malignancy?

Answer should be FNA, cause TSH does not eval for malignancy but for function.

As for missing the question, one shouldnt count on an 'easy' question on the PANCE. Likely test question writers are anticipating the expectation of such a question and wont necessary deliver.

Better to look at an algorithm of thyroid nodule eval, a great one on up to date, and develop your own questions to make sure you understand the dynamics of this eval.

You should anticipate a question such as this:

 

A 65 y/o female is found to have a thryoid nodule during an unrelated MRI of the neck. Which test finding is an indication for FNA (fine needle aspiration)?

 

1. Hyperechoic nodule on thyroid ultrasound.

2. Serum TSH 10 mIU/L (range 0.5 - 4.70 mIU/L).

3. Hyperfunctioning nodule on thyroid scintigraphy.

4. Serum TSH 0.10 mIU/L (range 0.5-4.70 mIU/L).

 

Good luck

GB PA-C