Endocrine System


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S21_F1.jpg"}},{"insert":"\n\n"},{"insert":"It has been a rather leisurely day so far, and the end of your shift is rapidly approaching.\n\nThe next patient steps into the room. You are surprised to see that it is Catherine, your longstanding neighbor. After a few pleasantries, you ask her what brought her in today.\n\nShe hands over a referral letter. In this, her primary care physician asks you to look into a mass he discovered in her neck, during a routine office visit.\n\nYou note that she is 46 years old and completely asymptomatic. Her medical history is unremarkable, and she is not on any medications.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S21_F3.jpg"}},{"insert":"\n\n"},{"insert":"On examination, you find Catherine\u0027s BMI to be 24 kg\/m2. All vitals are stable.\n\nYou proceed to palpate a firm non-tender lump in front of her trachea, which is around 3 cm in diameter. The lump moves with swallowing and is not fixed to the adjacent tissues.\n\nThere is no cervical, supraclavicular, or axillary lymphadenopathy, and the remainder of the examination reveals no abnormal findings.\n\nYou order a thyroid profile and ultrasound scan of the neck and ask Catherine to drop in later, once the results are available.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S21_F5.jpg"}},{"insert":"\n\n"},{"insert":"Early next week, Catherine is in front of you once more. You proceed to review her test results.\n\nThyroid profile:\r\n- TSH: 2.1 mIU\/dL (0.2-4.7) \r\n- T4: 7.4 mcg\/dL (4.5-12.5) \r\n- T3: 140 ng\/dL (100-200)\n\nUltrasound scan:\nThere is a solid, hypoechogenic mass in the right thyroid lobe, measuring 3.6 \u00d7 3.2 \u00d7 2.8 cm in size, with a blurred medial edge, and increased intranodular blood flow. No enlarged lymph nodes are observed.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S21_F1.jpg"}},{"insert":"\n\n"},{"insert":"You put down the results of the thyroid profile and ultrasound scan and ponder the next step.\n\nWhat will you order now?\n"}]}
1. A radioiodine scintiscan
2. Fine needle aspiration biopsy (FNAB)