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Endocrine surgery rewards precise knowledge of a small number of pathways. The domain covers neck swellings and lymphadenopathy, thyroid nodules and their cytology, thyroid cancer, goitre and thyrotoxicosis, thyroidectomy and its complications; primary, secondary and tertiary hyperparathyroidism and parathyroid surgery; adrenal incidentaloma, Cushing’s syndrome and Conn’s syndrome, phaeochromocytoma and paraganglioma; and neuroendocrine tumours and the multiple endocrine neoplasia syndromes.
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A 31-year-old woman has had a rubbery 3 cm left supraclavicular lymph node for eight weeks, with drenching night sweats. Two smaller nodes lie beside it on ultrasound. Fine-needle aspiration shows a mixed lymphoid population with occasional large atypical cells and is reported as non-diagnostic.
What is the most appropriate next step?
A 52-year-old woman has albumin-adjusted calcium results of 2.68 and 2.71 mmol/L found incidentally. Parathyroid hormone is 5.9 pmol/L (1.6–6.9), 25-hydroxyvitamin D 68 nmol/L and eGFR above 90 mL/min/1.73 m². She has no symptoms, and her mother and brother have been told they have 'high calcium'.
What is the most appropriate next investigation?
Unusual diagnoses can appear when the history points to them; one of the JCIE’s own sample questions is set on an unexpected thyroid histology.
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