Q:

What are the high risk factors?

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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 are the high risk factors?

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The high-risk factors include a history of thyroid cancer in one or more first-degree relatives, a history of exposure to external beam radiation or ionizing radiation in childhood or adolescence, prior hemithyroidectomy with discovery of thyroid cancer, fluorodeoxyglucose (18F) avidity on positron-emission tomo-graphy scanning, multiple endocrine neoplasia (MEN) 2/familial medullary thyroid cancer-associated RET proto-oncogene mutation, or calcitonin levels >100 pg/mL. Focal [18F] fluorodeoxyglucose positron emission tomography (18FDG-PET) uptake within a sonographically confirmed thyroid nodule conveys an increased risk of thyroid cancer, and FNA is recommended for those nodules ≥1 cm. Diffuse 18FDG-PET uptake, in conjunction with sonographic and clinical evidence of chronic lymphocytic thyroiditis, does not require further imaging or FNA. FDG-PET/CT does not play a role in the workup of a nodule but any 18FDG-avid thyroid nodule found incidentally deserves a thorough workup for malignancy.

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