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Teachable Moment
December 2017

Unnecessary Thyroid Ultrasonography in the Evaluation of Laboratory Thyroid Abnormalities

Author Affiliations
  • 1Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
  • 2Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas
JAMA Intern Med. 2017;177(12):1851-1852. doi:10.1001/jamainternmed.2017.5521

A previously healthy woman in her 30s presented to her primary care physician after 6 weeks of fatigue, cold sensitivity, and constipation. Her only medication was a multivitamin. She reported no personal or family history of cancer, autoimmune, or thyroid disease. On examination, she appeared healthy, and her vital signs were within normal range. Her skin was dry. Examination of the neck revealed a nontender thyroid gland that rose with swallowing. No regional lymphadenopathy, goiter, thyroid nodules, or asymmetry was noted. No bruit was heard over the thyroid gland. Laboratory studies revealed a serum thyroid-stimulating hormone (TSH) level of 6.7 mIU/L (reference range, 0.5-4 mIU/L) and a serum free thyroxine (T4) level of 0.4 ng/dL (reference range, 0.7-1.9 ng/dL).

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