For a thyroid nodule with suppressed TSH, which next steps are appropriate?

For a thyroid nodule with suppressed TSH, which next steps are appropriate?

• A. Do nothing
• B. Order CT neck
• C. Obtain ultrasound features and consider FNA
• D. Start methimazole

Answer: (C)

When a thyroid nodule comes with a suppressed TSH, the patient likely has a hyperfunctioning (toxic) nodule. The next step is to image the thyroid with a high-resolution ultrasound to characterize the nodule’s features and to guide whether a biopsy is needed. Ultrasound helps identify suspicious characteristics (such as irregular margins, microcalcifications, taller-than-wide shape, hypoechogenicity) and to determine which nodules warrant fine-needle aspiration cytology. If the ultrasound shows benign features or a clearly hot, toxic nodule, FNA may not be necessary, but if there are suspicious features or a nonfunctioning component, FNA is indicated. Ordering a CT neck isn’t needed for initial evaluation, and starting methimazole addresses symptoms of thyrotoxicosis but isn’t the correct diagnostic next step. So, obtain ultrasound features and consider FNA based on what those features show.

When a thyroid nodule comes with a suppressed TSH, the patient likely has a hyperfunctioning (toxic) nodule. The next step is to image the thyroid with a high-resolution ultrasound to characterize the nodule’s features and to guide whether a biopsy is needed. Ultrasound helps identify suspicious characteristics (such as irregular margins, microcalcifications, taller-than-wide shape, hypoechogenicity) and to determine which nodules warrant fine-needle aspiration cytology. If the ultrasound shows benign features or a clearly hot, toxic nodule, FNA may not be necessary, but if there are suspicious features or a nonfunctioning component, FNA is indicated. Ordering a CT neck isn’t needed for initial evaluation, and starting methimazole addresses symptoms of thyrotoxicosis but isn’t the correct diagnostic next step. So, obtain ultrasound features and consider FNA based on what those features show.