From the FDA Drug Label
The mapping (imaging) of Sodium Iodide I 123 distribution in the thyroid gland may provide useful information concerning thyroid anatomy and definition of normal and/or abnormal functioning of tissue within the gland.
The best next step for evaluating this patient is Thyroid ultrasound and fine-needle aspiration of the nodule.
- The patient has a swelling in the anterior triangle of her neck, which moves superiorly when she swallows, suggesting a thyroid nodule.
- The patient's thyroid-stimulating hormone (TSH) level is elevated at 8.03 uU/mL, indicating potential thyroid dysfunction.
- However, the FDA drug label for iodine-123 does not directly support the use of radionuclide scanning with iodine-123 as the best next step in this scenario 1.
- A thyroid ultrasound and fine-needle aspiration of the nodule would provide more direct and relevant information for evaluating the patient's condition.
From the Research
The best next step for evaluating this 72-year-old woman with a neck swelling is thyroid ultrasound and fine-needle aspiration of the nodule. This approach is recommended because the patient presents with a 2-3 cm thyroid nodule that moves with swallowing, which is characteristic of thyroid origin. The elevated TSH level (8.03 μU/mL) indicates subclinical hypothyroidism, but this doesn't explain the nodule itself. Thyroid ultrasound provides detailed imaging of the nodule's characteristics including size, composition (solid vs. cystic), and vascularity, while fine-needle aspiration allows for cytological examination to rule out malignancy. This is particularly important given the nodule's size (>1 cm) and the patient's age, which are risk factors for thyroid cancer, as noted in studies such as 2 and 3. Although the patient lacks classic risk factors like radiation exposure or family history of thyroid cancer, the combination of ultrasound and FNA provides the most definitive evaluation for thyroid nodules and is considered the gold standard initial diagnostic approach, as supported by 4 and 5. Other options like CT scanning or radionuclide imaging would be secondary considerations depending on the ultrasound and FNA results. It's also worth noting that while fine-needle aspiration is a safe procedure, it can have rare complications such as Horner's syndrome, as reported in 6, but this does not change the recommendation for its use in evaluating thyroid nodules. Key points to consider in the evaluation of thyroid nodules include: