Thyroid Disorders USMLE Step 1 Practice Question
A 40-year-old woman with no significant past medical history presents for evaluation of a thyroid nodule found incidentally on ultrasound performed for neck pain. She denies constitutional symptoms, dysphagia, or voice changes. Vital signs are within normal limits. Physical examination reveals a firm, non-tender, mobile 3-cm nodule in the right thyroid lobe with no cervical lymphadenopathy or signs of airway compromise. Laboratory studies show TSH 2.3 mIU/L and free T4 1.1 ng/dL. Thyroid ultrasound demonstrates a hypoechoic nodule with smooth margins, no microcalcifications, no suspicious lymph nodes, and no extrathyroidal extension. Fine-needle aspiration (FNA) biopsy shows benign follicular cells without atypia, classified as Bethesda Category II (benign). Which of the following is the most appropriate next step in management?
Answer choices
- APerform total thyroidectomy followed by radioactive iodine ablation
- BInitiate levothyroxine therapy to suppress TSH and prevent nodule growth
- CObtain CT scan of the neck and chest to evaluate for metastatic disease
- DRepeat thyroid ultrasound in 6-12 months; clinical observation without interventionCorrect answer
- EPerform thyroid lobectomy with intraoperative frozen section analysis
- FRepeat FNA biopsy immediately to confirm benign classification
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