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Plainfield, IL
A male 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)?

8 doctor answers32 doctors weighed in
Dr. Ivelisse Rivera-Godreau
Family Medicine 25 years experience
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.
Dr. David Lipkin
Internal Medicine 53 years experience
i disagree with the above approach to the issue. Thyroid micro-carcinomas(by definition < 1 cm) are found in 15 to 30 percent of thyroid glands at autopsy. The majority of patients with even metastatic disease have a very long life expectancy. The average life expectancy of a 97 y/o female is 2.9 years. Would you request surgery given the above, even if a macro-carcinoma? I doubt it.
Aug 13, 2015
Dr. Michael Kleerekoper
A Verified Doctor commented
A US doctor answered Learn more
It is really a good idea to pursue this in a person this age?
Nov 19, 2015
Dr. Bryan Treacy
Gynecology 36 years experience
I agree with David.
Nov 19, 2015
Dr. Nayana Trivedi
Internal Medicine 40 years experience
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
Dr. Richard Zimon
Internal Medicine 60 years experience
OBSERVE! Avoid invasive testing!
Jul 11, 2015
Dr. Richard Orr
Surgical Oncology 45 years experience
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.
Dr. Michael Kleerekoper
A Verified Doctoranswered
Endocrinology 52 years experience
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.
Dr. Silviu Pasniciuc
Internal Medicine 28 years experience
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.
Dr. Ankush Bansal
Internal Medicine 18 years experience
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.
Dr. Su Fairchild
Integrative Medicine 25 years experience
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?
Dr. Jovita Anyanwu
Internal Medicine 31 years experience
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.

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