A 42-year-old woman has a 3 cm right thyroid nodule. Fine-needle aspiration (FNA) cytology reports 'follicular neoplasm' (Bethesda IV). The most appropriate next step is:
- A Repeat FNA in 6 months
- B Total thyroidectomy with central lymph node dissection
- C Diagnostic lobectomy (hemithyroidectomy) ✓
- D Radioactive iodine ablation
Correct answer: C. Diagnostic lobectomy (hemithyroidectomy)
Explanation
Bethesda IV (follicular neoplasm/suspicious for follicular neoplasm) carries a 25–40% risk of malignancy and FNA cannot distinguish follicular adenoma from follicular carcinoma because the diagnosis of carcinoma requires histologic evidence of capsular or vascular invasion. Diagnostic lobectomy provides definitive histopathology and is the recommended next step. Total thyroidectomy is considered if malignancy is confirmed or if there are additional risk factors.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.