A member asked:

97 yo pt with thyromegaly on ct. u/s showed thyroid nodular goiter.1 right calcific and 2 left hyperechoic solid nodules. should be worked up(age)?

32 doctors weighed in across 8 answers

Yes..: I would probably work them up further. If the pt has not had a thyroid scan and you still not sure if you want to order or perform a biopsy that should give you a better idea what you are dealing with. However if the solid nodules are > 1 cm they should be biopsied. It also depends on your TSH levels, if elevated then it all depends on the size, if low TSH and hyper functioning then needs tx.

Answered 10/6/2017

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Dr. Nayana Trivedi answered

Specializes in Internal Medicine

It depends: at this age Thyroid cancer is unlikely.Even if it turns out to be cancerous; correlate with patient's general condition and what is his desire( if he would like to undergo any treatment including Biopsy). What id the Thyroid function? is it hyperactive, Thyroid scan may be necessary as it is non invasive. I would be less aggressive in working up unless person is symptomatic

Answered 11/27/2017

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Dr. Richard Orr answered

Specializes in Surgical Oncology

Depends: Depends on 1) overall health and 2) symptoms. Unless a 97 year old is EXTREMELY healthy, I would not work up this goiter unless truly symptomatic. Even if the patient had a differentiated thyroid cancer, it is unlikely that overall survival would be changed much in a 97 year old - if it was undifferentiated (not likely) it is uncurable anyhow. So I would leave it alone unless truly symptomatic.

Answered 11/27/2017

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Thyromegaly: Her age makes it tough to proceed to any surgery. An imaging study might be in order but it depends on just how "well" or otherwise she is. I am making house calls to some older patients and most are appropriately reluctant for any testing or surgery.

Answered 3/24/2020

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Dr. Silviu Pasniciuc answered

Specializes in Internal Medicine

Goals of care: A perfect case for goals of care discussion. A half an hour discussion with the patient and family members about their expectations, what the diagnosis work up would entail, possible complications, usual outcomes, therapeutic modalities as a traditional approach. Alternatively, a comfort, symptom oriented approach should be discussed and offered with decision aligned with patient's goals.

Answered 1/5/2019

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Depends: It depends on the functional status and co-morbidities of the patient. Age shouldn't necessarily be a factor here, at least for a FNA.

Answered 11/27/2017

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Dr. Su Fairchild answered

Specializes in Integrative Medicine

Some workup: I would run a full thyroid panel and also check iodine. Age alone is not a contraindication to further workup, but rather function. How 'good' of a 97 yo is the patient? Bedridden vs still running marathons?

Answered 11/27/2017

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No: Medical care must do no harm to patient. Evaluation and treatment must be weighed against the benefit. Evaluating a 97 year old for an asymptomatic lesion will neither improve his quality of life nor prolong it even if he is in perfect health and functioning status. Treatment should be more for controlling of symptoms and management acute illness . Screening tests are not indicated.

Answered 1/2/2018

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