Endocrinology: solitary thyroid nodule: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

General Medicine · Endocrinology: solitary thyroid nodule

Sample item

A 38-year-old woman has a 2-cm solitary thyroid nodule with no compressive symptoms or lymphadenopathy. Her serum TSH is suppressed at 0.01 mIU/L. What is the best next investigation?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Radionuclide (technetium) thyroid scan

Initial evaluation of a thyroid nodule is TSH and ultrasound. A low TSH suggests an autonomously functioning nodule, so a radionuclide scan is done: a hot nodule is almost never malignant and FNA can be avoided. A normal or high TSH proceeds to ultrasound-guided FNA by size and sonographic risk.

Option by option

  • A. Radionuclide (technetium) thyroid scan (correct)

    A suppressed TSH points to a toxic nodule, and a scan shows if the nodule concentrates tracer and avoids unnecessary biopsy.

  • B. Immediate hemithyroidectomy

    Surgery before characterising the nodule is not justified.

  • C. Serum thyroglobulin estimation

    Thyroglobulin is not a diagnostic test for nodules and is a follow-up marker after thyroidectomy.

  • D. Fine needle aspiration cytology

    FNA is the next step when TSH is normal or raised, but a hyperfunctioning nodule is rarely malignant.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Radionuclide (technetium) thyroid scan. Initial evaluation of a thyroid nodule is TSH and ultrasound.

Why is "Immediate hemithyroidectomy" not the answer?

Surgery before characterising the nodule is not justified.

Why is "Serum thyroglobulin estimation" not the answer?

Thyroglobulin is not a diagnostic test for nodules and is a follow-up marker after thyroidectomy.

Why is "Fine needle aspiration cytology" not the answer?

FNA is the next step when TSH is normal or raised, but a hyperfunctioning nodule is rarely malignant.

What concept does this question test?

It tests Endocrinology: solitary thyroid nodule in General Medicine. A low TSH suggests an autonomously functioning nodule, so a radionuclide scan is done: a hot nodule is almost never malignant and FNA can be avoided. A normal or high TSH proceeds to ultrasound-guided FNA by size and sonographic risk.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Endocrinology: solitary thyroid nodule?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.