Skill Checkup: A 55-Year-Old Woman With a Single, Painless, and Hard Neck Nodule

Lori J. Wirth, MD


March 07, 2023

The Skill Checkup series provides a quick, case-style interactive quiz, highlighting key guideline- and evidence-based information to inform clinical practice.

A 55-year-old woman in the United States presents with a single, painless nodule that is hard and fixed in front of the neck, just below the larynx at her annual physical exam. Otherwise, her physical exam is unremarkable. No evidence of lymphadenopathy or cervical masses is detected during her physical exam.

She has dyslipidemia controlled by a statin and is otherwise healthy. She is a nonsmoker and has no known exposure to radiation. However, her mother was diagnosed with thyroid cancer at the of age 60 years.

Laboratory testing showed an elevated thyroid-stimulating hormone (TSH) level of 6.5 mIU/L.

Her primary care physician found the findings from her physical exam: TSH as well as her family history of thyroid cancer concerning and warranted additional assessment.


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