Case presentation
HPI: M is a 30 yo M  referred to endocrine surgery for a palpable thyroid nodule on physical exam by PMD. No dysphonia, dysphagia, odynophagia, change in voice. No smoking history. Recent cough for a few weeks. No fevers, chills, weight loss. No hx of radiation to neck
PMH: major depressive disorder, sleep apnea
Meds: desipramine, buproprion
PSH: left shoulder surgery 1996, pilonidal cyst excision 2000
All: NKDA
FHx: M: Hashimoto’s, F: benign goiter MAunt: hypothyroidism
SHx: no tobacco, social etoh, no drugs
PE
VS: unable to obtain (afebrile, normotensive)
Gen: NAD, healthy appearing
HEENT: palpable ~3 cm nodule in thyroid R lower lobe
CV: RRR, no murmurs
Pulm: CTA b/l, no wheezes
Abd: SNTND
Extr: 2+ DP pulses b/l

Case Presentation cont’d: US and FNA
US: Hypoechoic nodule in R lower lobe with punctate calcifications and some cystic degeneration measuring 2.9 x 3.0 x 3.4 cm sagittal. At the extreme R right lower pole, an adjacent hypoechoic nodule measured 1.2 x 1.6 x 1.4 cm sagittal with irregular margins. In the mid-R lobe, a cystic nodule measured 0.9 x 1.0 x 0.9 sagittal. A mid-L complex nodule with isoechoic solid elements measured 0.9 x 1.4 cm sagittal. A lower L hypoechoic nodule measured 0.7 cm

FNA: Positive for malignant cells. Papillary thyroid carcinoma. Foamy cells c/w cyst contents and/or cystic degeneration. Scant colloid. Rare nuclear grooves present. Rare intranuclear inclusions present.

1% of all new malignant disease
94% differentiated thyroid carcinoma
Derive from follicular epithelial cells
Papillary or follicular thyroid carcinoma
5% medullary thyroid carcinoma
Neuroendocrine tumors
1% anaplastic
Dedifferentiated thyroid carcinoma..

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