DR REYNOLDS: Mrs
G is a 64-year-old woman from Brazil with an incidentally discovered thyroid
nodule. On a routine visit for follow-up of her multiple medical problems,
Mrs G’s primary care physician palpated a left-sided thyroid abnormality.
Mrs G had a right-sided cold thyroid nodule resected in Brazil several
decades ago; she became hypothyroid and has been receiving thyroid replacement
therapy. During the past 10 years here in the United States, her thyroid-stimulating
hormone (TSH) level has always been within normal limits, and her thyroid
exam has been either unremarkable or not documented by her physicians. Then,
during a recent annual examination, Mrs G’s doctor felt a left-sided
thyroid nodule on the background of an enlarged gland. Mrs G’s thyroid
function was normal. A thyroid ultrasound suggested a previous right partial
thyroidectomy, a small amount of residual right-sided gland, and a completely
calcified node. The left lobe measured 2.3 cm × 2.6 cm in
transverse diameter at the level of the isthmus; a large solid heterogeneous
nodule arose from the left lobe.