A 26-year-old lady presents with an incidentally noticed swelling in the right side of the neck region which she noticed about 2 weeks back. She had not noticed the swelling earlier. She is concerned about whether this could be malignant. The size of the swelling is 20 mm × 20 mm. There are no compressive symptoms such as change in voice, swallowing difficulty or difficulty in breathing. She has no history suggestive of hyperthyroidism or hypothyroidism. There is no family history of any thyroid disorder or any thyroid cancer. She has no history of any radiation exposure to the neck in the past. She does not belong to an iodine deficient area. She is getting married in next 2 months but wants to clear any doubts about the swelling. What is the next course of action for her? She is advised to go for thyroid function tests to check for any evidence of hyperthyroidism or hypothyroidism. Her TSH is 2 mIU/L And her T4 is 9 ug/dL T3 is 87 ng/mL Anti-TPO is 42 U/L Should she be subjected to surgery? Should she be asked to go for any further tests?
What type of physical features need to be noted on examination?
A careful physical examination to note the size of the nodule location, consistency, adenopathy and any evidence of neck tenderness to be noted. A single dominant or solitary nodule is more likely to represent carcinoma than a single nodule within a multinodular gland, with an incidence of malignancy from 2.7% to 30% and 1.4% to 10%, respectively. However, the overall risk of malignancy within a gland with a solitary nodule is approximately equal to that of a multinodular gland due to the additive risk of each nodule.
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