Complexity of diagnosis and management of a giant thyroid nodule: A case report and a concise literature

Authors

  • Sarah Firdausa Division of Endocrinology, Metabolism, and Diabetes, Thyroid Center, Department of Internal Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia; Division of Endocrinology, Metabolism, and Diabetes, Thyroid Center, Department of Internal Medicine, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
  • Hendra Zufry Division of Endocrinology, Metabolism, and Diabetes, Thyroid Center, Department of Internal Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia; Division of Endocrinology, Metabolism, and Diabetes, Thyroid Center, Department of Internal Medicine, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia https://orcid.org/0000-0002-0569-4617
  • Agustia S. Ekadamayanti Division of Endocrinology, Metabolism, and Diabetes, Thyroid Center, Department of Internal Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia; Division of Endocrinology, Metabolism, and Diabetes, Thyroid Center, Department of Internal Medicine, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
  • Krishna W. Sucipto Division of Endocrinology, Metabolism, and Diabetes, Thyroid Center, Department of Internal Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia; Division of Endocrinology, Metabolism, and Diabetes, Thyroid Center, Department of Internal Medicine, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
  • Henry W. Burhan Department of Internal Medicine, School of Medicine, Sam Ratulangi University, Manado, Indonesia https://orcid.org/0009-0005-4368-2077
  • Sergio Pratama Department of Internal Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
  • Andrés MMB. Benalcazar School of Medicine, Pontificia Universidad Catolica Del Ecuador, Quito, Ecuador

DOI:

https://doi.org/10.52225/narra.v3i3.224

Keywords:

Follicular neoplasm, follicular thyroid cancer, follicular thyroid adenoma, thyroidectomy, thyroid carcinoma

Abstract

It is crucial for doctors to decide whether a thyroid nodule is benign or malignant when a patient presents with one, as it will significantly impact how the patient is managed in the future. However, it is not as straightforward to determine between the two; even a physical examination, thyroid function test, ultrasonography, and biopsy have been well performed. It can be more stressful if a patient has an increased risk of malignancy, such as age (below 20- and above 60-year-old), solid nodule, rapid growth, hoarseness, lymphadenopathy, and microcalcifications on the ultrasonography. The aim of this case was to present the management of a giant thyroid nodule with malignancy presentation and a benign biopsy finding. A 41-year-old male complained of a palpable neck mass, hoarseness, and dysphagia. The thyroid function test was normal. Ultrasonography revealed suspicion of malignancy with category 4 of American College of Radiology-Thyroid Imaging Reporting and Data System (ACR-TIRADS). The biopsy revealed follicular neoplasm, and was classified as Bethesda IV. The patient underwent a total thyroidectomy due to the large tumor size and symptoms. Histopathological findings post-surgery revealed a follicular thyroid adenoma. This case highlights a complex diagnosis and management of follicular thyroid neoplasm due to their potential for both benign and malignant. Comprehensive pre- and post-operative care is essential to determine the nature of nodules. Post-operative follow-up care might improve the patient’s outcome and prevent complications.

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