Management of the Thyroid Nodule

Dr. Leonard Newmark, Chief Resident in Medicine, the Jewish Hospital of St. Louis and Instructor in Medicine, Washington University School of Medicine: A 16-year-old white girl was admitted to the Jewish Hospital for the first time, complaining of a "lump in her neck" and a slight weight gain which had gradually increased over the previous three-month period. Abnormal physical findings were limited to the neck where a firm, but movable, slightly tender nodule in the right lobe of the thyroid gland was palpated; the right lobe was three to four times the size of the left lobe. Laboratory examination revealed a hemoglobin level of 15.5 gm/100 ml; hematocrit reading, 45%; white blood cell count, 6,260/cu mm, with 50% lymphocytes, 40% neutrophils, 2% basophils, 3% eosinophils, and 5% monocytes. Results of urinalysis were unremarkable. The T₄test (tetraiodothyronine) value by the column method was 8.4μg/100 ml and the protein-bound iodine