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.
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.
Mandel SJ. A 64-Year-Old Woman With a Thyroid Nodule. JAMA. 2004;292(21):2632-2642. doi:10.1001/jama.292.21.2632