A 25-year-old man presented with a left-sided neck mass. He denied difficulty breathing, swallowing, aspiration or change in his voice. There was no family history of thyroid cancer and no history or radiation. He had no symptoms of hyperthyroidism. T3 was slightly elevated and antithyroid antibodies were positive. calcitonin was normal. Chest X-ray showed tracheal deviation to the right. Ultrasound showed an 8x6x4-cm solid hypervascular mass of the left lobe. Vocal cord function was normal on direct laryngoscopy.
The patient was taken to the operating room for total thyroidectomy (see thyroidectomy.) Total was chosen because of the possibility that the mass harbored a carcinoma, facilitating subsequent radioablation and monitoring.
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