What is the diagnosis in this woman with an enlarging neck mass?

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 78-year-old woman is evaluated for a rapidly enlarging neck mass that has been present for 4 weeks and is associated with neck discomfort, dysphagia, and hoarseness. The patient has had Hashimoto thyroiditis and hypothyroidism since age 24 years and has been taking levothyroxine since that time. Physical examination reveals an older woman in severe distress. Temperature is 39.4 °C (102.9 °F), blood pressure is 145/75 mm Hg, pulse rate is 110/min, and respiration rate is 16/min; BMI is 23. Pulmonary examination reveals dyspnea with bilateral basilar rhonchi, and cardiac examination shows tachycardia without a murmur. The thyroid gland is enlarged and firm without nodules. Facial plethora and distended bilateral cervical neck veins are noted. The patient is hoarse. Bilateral cervical lymphadenopathy is palpated. Although neurologically intact, she finds it difficult to concentrate when asked questions. A thyroid ultrasound shows an enlarged thyroid gland with heterogeneous echotexture but no specific nodularity and multiple bilateral cervical lymph nodes measuring 1 to 3 cm in diameter. Which of the following is the most likely diagnosis? A: Bleeding into the thyroid gland B: Medullary thyroid cancer C: Papillary thyroid cancer D: Primary thyroid lymphoma Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A s...
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions Endocrinology Source Type: blogs