Surprise Surprise

Allan (not his real name, duh) had his surgery Friday. The surgeon made a courtesy call to let me know post op that he was doing well. He also called to give me a hard time:

"You saw this guy for a problem with his nuts, and you diagnosed him with thyroid cancer??? WTF???" (this surgeon is a friend of mine)

Yea, I was surprised, too. Tip to the medical students out there: Don't neglect your physical exam.

I saw Allan initially for hypogonadism (probably related to an old testicular injury) over a month ago. As always, you do a good exam, which includes checking the family jewels in these cases. Now, as an endocrinologist I always also check the thyroid, but was unprepared to find a pretty decent-sized but previously undiagnosed thyroid nodule. It was pretty hard too, clinically suspicious, so I had him return a couple of days later and performed an ultrasound and fine-needle aspiration. The sonographic features were fairly classical- hypoechoic with increased vascularity and microcalcifications, so I wasn't overly surprised when the pathologist called me up a few days later and gave me the report: papillary thyroid cancer.

I saw Allan in the hospital while he was recovering. He looked great and I assured him that I expected him to do really while though we would need to monitor things closely in the next several years. Gave him a gentle reminder that in all probability his smoking probably puts him at greater risk than that 1.1 cm focus of thyroid cancer that now hopefully has ceased to exist in his body, but we will know at follow up.

But yes, neither one of us did expect to start off seeing a patient for a problem with the nuts and to end up with a problem at the other end of the body.