Friday, February 12, 2010

Sometimes you just can't leave work behind. I find it extremely ironic to be going over my patient charts here, while on vacation 9900 miles away. I had a bunch of pending labs when I left, but some of those I just couldn't punt to my colleagues.
Like that Mr. H I just saw last week. Sometimes you kinda knew what you were going to find.
He is a 34 year old man, who was found to have nodules in his thyroid during a CT scan following a motor-vehicle accident. He was promptly referred to me, and I was surprised that no one (himself especially) had noticed 2 prominent thyroid nodules, at least 2 cm by palpation. And it didn't feel good too; the nodules didn't have the firm-soft nodules you usually feel. Instead, they were rock hard.
Things didn't look better when I put the ultrasound probe on the neck- there were microcalfications within the hypoechoic nodules. Given the suspicious appearance, I biopsied both, each with 4 passes.
The results came back in my virtual desktop- papillary thyroid cancer for both contralateral nodules. I kinda suspected this when I saw him, and did somewhat prepare him. However given his young age and the slow-growing nature of these, the prognosis should be excellent.
I just didn't want to wait until March when I get back to work to set him up to see a thyroid surgeon.


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