Best of five
- A. Repeat FNAC until Thy2 is obtained
- B. Total thyroidectomy is mandatory for every Thy3f nodule
- C. Radioiodine ablation without surgery
- D. Discharge to primary care
- E. Diagnostic hemithyroidectomy
FRCS (ORL-HNS) · SECTION 1 SBA
Repeated Thy3f cytology
A euthyroid patient has a solitary thyroid nodule graded U4. Fine-needle aspiration is Thy3f, suggesting a follicular neoplasm. There are no distant metastases. What is the most appropriate diagnostic treatment?
E. Diagnostic hemithyroidectomy
Follicular carcinoma requires demonstration of capsular or vascular invasion, which cytology cannot provide. NICE recommends diagnostic hemithyroidectomy for Thy3f disease, with definitive management based on histology and risk.
Why every option is right or wrong
A. Repeat FNAC until Thy2 is obtained: Repeat cytology cannot reliably distinguish adenoma from carcinoma in a Thy3f lesion.
B. Total thyroidectomy is mandatory for every Thy3f nodule: Extent should not be escalated automatically without malignant histology or other indications.
C. Radioiodine ablation without surgery: Radioiodine is not a diagnostic substitute for histological assessment of invasion.
D. Discharge to primary care: U4 imaging and Thy3f cytology require diagnostic management.
E. Diagnostic hemithyroidectomy: Follicular carcinoma requires demonstration of capsular or vascular invasion, which cytology cannot provide. NICE recommends diagnostic hemithyroidectomy for Thy3f disease, with definitive management based on histology and risk.
What if the scenario changed?
If cytology were repeatedly Thy3a instead, repeat sampling, core biopsy, diagnostic hemithyroidectomy or selected surveillance could be discussed according to the whole risk profile.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for local policy and specialist judgement.
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