Question

A 30-year-old female presented with swelling in the neck. What is the next step in evaluation?

• A. I131
• B. FNAC
• C. TSI & T4
• D. FSH

Hint:

Measuring thyroid hormones (TSH, T3, T4) is crucial for diagnosing thyroid disorders in patients with neck swelling.

Answer 1

The Correct Option is C

Step 1: Define the clinical problem.
A 30-year-old woman with neck swelling most often has a thyroid lesion. Before deciding whether the swelling is structural (a nodule needing tissue diagnosis) or functional/autoimmune, the logical first move is to learn how the gland is working.

Step 2: Establish the evaluation principle.
Thyroid work-up begins with biochemistry. Assessing function with thyroid hormone (T4) and, where autoimmune disease is suspected, Thyroid-Stimulating Immunoglobulin (TSI) tells you whether the patient is hyper-, hypo- or euthyroid and whether an autoimmune process (e.g. Graves' disease) is driving the swelling. This biochemical status then guides every subsequent test.

Step 3: Test each option against that principle.
• I¹³¹ (radioiodine uptake/scan): useful for characterising function/nodules, but it is not the first-line step and is generally deferred until biochemistry suggests it.
• FNAC: the cytology test of choice for a discrete suspicious nodule, but it answers a structural/malignancy question, not the initial functional screen.
• FSH: a reproductive hormone with no role in evaluating a thyroid swelling.
• TSI & T4: directly assesses gland activity and autoimmunity - the appropriate next step.

Step 4: Conclusion.
The next step in evaluating thyroid-origin neck swelling is to check function and autoimmune status with TSI and T4.

Final answer: Option 3 - TSI & T4.