A patient with a thyroid nodule undergoes FNAC, which yields a result suggestive of follicular carcinoma. What is the most appropriate next step in management?

1. A

   A. Hemithyroidectomy

2. B

   B. Total thyroidectomy

3. C

   C. Radioactive iodine therapy

4. D

   D. Repeat FNAC

Appeared in: INI-CET EXAM -2026

Explanation

• Fine Needle Aspiration Cytology (FNAC) cannot differentiate between a benign follicular adenoma and a malignant follicular carcinoma.
• The definitive diagnosis of follicular carcinoma requires histopathological examination of the entire nodule to check for capsular or vascular invasion.
• Hemithyroidectomy (surgical removal of one thyroid lobe) is the standard initial procedure to obtain the necessary tissue for a definitive diagnosis.
• This procedure is both diagnostic (to confirm or rule out cancer) and potentially therapeutic (if the nodule is benign or a low-risk cancer).

Why Other Options Were Wrong

• Option B: A total thyroidectomy is considered overtreatment as an initial step for an indeterminate follicular lesion, as many turn out to be benign. It exposes the patient to higher risks (e.g., bilateral recurrent laryngeal nerve injury, permanent hypoparathyroidism) unnecessarily.
• Option C: Radioactive iodine (RAI) therapy is an adjuvant treatment used after surgical removal of the thyroid for confirmed cancer. It is not a primary treatment for a thyroid nodule.
• Option D: Repeating the FNAC is futile because it will yield the same indeterminate result. The limitation is inherent to the cytology method, which cannot assess tissue architecture (capsular/vascular invasion).

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Management of indeterminate thyroid nodules (follicular neoplasm) in acute care settings.
• Nurses play a vital role in educating patients about why a definitive diagnosis cannot be made with FNAC alone for follicular lesions, managing their anxiety about the uncertainty of cancer, and preparing them for a two-step surgical plan (diagnostic lobectomy, followed by potential completion thyroidectomy).
• Post-hemithyroidectomy, the nurse must monitor for complications such as bleeding, hematoma, respiratory distress, and signs of recurrent laryngeal nerve injury (hoarseness).
• What if? If the patient had a family history of thyroid cancer or prior head/neck radiation, the index of suspicion for malignancy would be higher, and the surgeon might discuss an upfront total thyroidectomy even with an indeterminate FNAC result.

How to Approach the Question

• First, identify the core clinical problem: a patient has a thyroid nodule with an FNAC result 'suggestive of follicular carcinoma'.
• Recognize the key limitation of the diagnostic test mentioned. Understand that FNAC for follicular lesions is indeterminate because it cannot assess for invasion, the hallmark of carcinoma.
• Evaluate the options based on this limitation. The next logical step must be one that can overcome this diagnostic uncertainty.
• Option A (Hemithyroidectomy) allows for histopathological analysis of the entire nodule and capsule, directly addressing the diagnostic problem.
• Eliminate other options: Total thyroidectomy is too aggressive initially, RAI is a post-surgical adjuvant therapy, and repeating the same limited test (FNAC) is illogical.
• Conclude that hemithyroidectomy is the standard 'diagnostic lobectomy' for this specific clinical scenario.

Concept Tested & Keywords

• Concept Tested: Management of indeterminate thyroid nodules (follicular neoplasm)
• Stem keywords: thyroid nodule, FNAC, follicular carcinoma, management
• Lead-in keywords: most appropriate next step
• Clinical cues: FNAC result suggestive of follicular carcinoma

Question ID

QzcKzWXBxgvp8_KX0CbVDy

Copy ID

Reference Book

E6 Medicine Davidson Principles Practice 24e pp. 663-665, 669-671

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 4 p. 26-28