A 36-Year-Old Woman Comes to the Office Due to Fatigue

question 718

Multiple Choice

A 36-year-old woman comes to the office due to fatigue and neck discomfort.  Her symptoms began several weeks ago following an upper respiratory infection.  The patient's medical history is unremarkable and she takes no medications.  She works as a nuclear medicine technician, has a current 20-pack-year smoking history, and does not use alcohol or illicit drugs.  There is no family history of thyroid cancer, but the patient's mother has hypothyroidism treated with thyroid replacement therapy.
Vital signs are normal.  On examination, the thyroid gland is low lying and difficult to palpate.  There is no cervical lymphadenopathy and the remainder of the examination is unremarkable.
Laboratory results show a TSH of 12 µU/mL and free T4 of 1.1 ng/dL (normal: 0.9-2.4) .  Ultrasound reveals 2 nodules in the right thyroid lobe, each measuring 1.7 cm in maximal diameter, and a 1.4 cm nodule in the left lobe.  All of the nodules are hypoechoic without internal vascularity or microcalcification.
Which of the following increases the risk for thyroid cancer in this patient?

• A)Elevated TSH
• B)Occupation as a nuclear medicine technician
• C)Presence of multiple nodules
• D)Recent upper respiratory infection
• E)Smoking history

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Definitions:

Massage

A therapeutic technique involving the manipulation of the body's muscles and tissues to relieve stress, pain, and tension.

Alternative Medical Systems

Health care practices and products not traditionally recognized by mainstream medicine, such as acupuncture and homeopathy.

Psychological Factors

Refer to mental and emotional aspects that influence an individual's behavior and wellbeing.

Physical Factors

Environmental, biological, or chemical elements that can influence the physical condition and health of individuals.