Q:

The TSH of the patient discussed above is normal. Should we do further biochemical evaluation?

waelhammad
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2022-11-18
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• A 42-year-old male with no active medical problem noticed a thyroid nodule 1 year back and was told by ENT specialist not to worry about it. Now he has come as he feels that the nodule is becoming more prominent. 

• Physical examination: 1 × 2 cm right lower pole nodule. There is also a lymph node which is hard and about 2 cm in size in the upper cervical chain in the right lateral neck region. An ultrasound is done which shows features of multinodular goiter. The FNA is done from the lymph node which showed metastatic papillary thyroid cancer. The patient was subjected to total thyroidectomy with radical neck dissection.

The TSH of the patient discussed above is normal. Should we do further biochemical evaluation?

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waelhammad
2022-11-18
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The recommendation is to do free thyroxine and anti-TPO antibodies, if the TSH level is increased. The TSH receptor antibody should be done, if the TSH is suppressed. The need to do thyroglobulin antibody is only in those patients where there is a suspicion of chronic lymphocytic thyroiditis and serum levels of anti-TPO are normal. The routine measurement of serum thyroglobulin as initial assessment is not recommended in all patients with thyroid nodule.

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