#april2020mccqe1
A 19-year-old G1P0 woman at 32 weeks’ gestation presents for scheduled prenatal appointment. The pregnancy has been uncomplicated to date. However, she mentions that she recently noticed a hard lump on her neck. She denies pain or difficulty swallowing, speaking, or breathing. Physical examination reveals a firm, nontender, immobile, solitary nodule on the left hemithyroid. Ultrasound reveals a solid 2-cm mass. There is no cervical lymphadenopathy. Thyroid function tests reveal a thyroid- stimulating hormone level of 1.2 μU/mL and free thyroxine level of 0.9 ng/dL. Results of fine-needle aspiration biopsy are shown in the image. Which of the following is the best next step in management?
(A) Left hemithyroidectomy
(B) Monitor until after delivery
(C) Radioablation therapy
(D) Start methimazole
(E) Start propylthiouracil
A 19-year-old G1P0 woman at 32 weeks’ gestation presents for scheduled prenatal appointment. The pregnancy has been uncomplicated to date. However, she mentions that she recently noticed a hard lump on her neck. She denies pain or difficulty swallowing, speaking, or breathing. Physical examination reveals a firm, nontender, immobile, solitary nodule on the left hemithyroid. Ultrasound reveals a solid 2-cm mass. There is no cervical lymphadenopathy. Thyroid function tests reveal a thyroid- stimulating hormone level of 1.2 μU/mL and free thyroxine level of 0.9 ng/dL. Results of fine-needle aspiration biopsy are shown in the image. Which of the following is the best next step in management?
(A) Left hemithyroidectomy
(B) Monitor until after delivery
(C) Radioablation therapy
(D) Start methimazole
(E) Start propylthiouracil
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