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Clinical Crossroads
Clinician's Corner
December 1, 2004

A 64-Year-Old Woman With a Thyroid Nodule

Author Affiliations

Clinical Crossroads Section Editor: Margaret A. Winker, MD, Deputy Editor.


Author Affiliations: Dr Mandel is Associate Chief for Clinical Affairs, Division of Endocrinology, Diabetes, and Metabolism, Hospital of the University of Pennsylvania, and Associate Professor of Medicine and Radiology, University of Pennsylvania School of Medicine, Philadelphia.

JAMA. 2004;292(21):2632-2642. doi:10.1001/jama.292.21.2632

DR REYNOLDS: Mrs G is a 64-year-old woman from Brazil with an incidentally discovered thyroid nodule. On a routine visit for follow-up of her multiple medical problems, Mrs G’s primary care physician palpated a left-sided thyroid abnormality.

Mrs G had a right-sided cold thyroid nodule resected in Brazil several decades ago; she became hypothyroid and has been receiving thyroid replacement therapy. During the past 10 years here in the United States, her thyroid-stimulating hormone (TSH) level has always been within normal limits, and her thyroid exam has been either unremarkable or not documented by her physicians. Then, during a recent annual examination, Mrs G’s doctor felt a left-sided thyroid nodule on the background of an enlarged gland. Mrs G’s thyroid function was normal. A thyroid ultrasound suggested a previous right partial thyroidectomy, a small amount of residual right-sided gland, and a completely calcified node. The left lobe measured 2.3 cm × 2.6 cm in transverse diameter at the level of the isthmus; a large solid heterogeneous nodule arose from the left lobe.

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