A 27-Year-Old Primigravida at 8 Weeks Gestation Is Found to Have

A 27-year-old primigravida at 8 weeks gestation is found to have a thyroid nodule during her initial prenatal visit.  She has fatigue and frequent nausea with vomiting.  The patient has no heat or cold intolerance and no skin changes.  She has no dysphagia to solids or liquids, although she has been eating more carbohydrates since becoming pregnant.  Medical history is otherwise not significant.  The patient does not use tobacco, alcohol, or illicit drugs.  Temperature is 36.7 C (98.1 F) , blood pressure is 110/70 mm Hg, pulse is 86/min, and respirations are 18/min.  Physical examination shows a small, 1.5-cm nodule in her right thyroid gland.  Pelvic examination reveals a slightly enlarged uterus consistent with 8 weeks gestation.  Serum TSH is normal.  Ultrasound of her thyroid reveals a 1.5-cm hypoechoic nodule in her right thyroid lobe with irregular margins, internal microcalcifications, and internal vascularity.  Which of the following is the next most appropriate step in management of this patient?

A) Fine-needle aspiration biopsy
B) MRI of the neck
C) Radionuclide scan
D) Reassurance and follow-up after delivery
E) Serum thyroglobulin
F) Total thyroidectomy in the second trimester

Correct Answer:

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