Breast and Endocrine Surgery (Demo)

A 48-year-old woman with a history of thyrotoxicosis presents to the endocrine clinic for further management. She was initially treated with carbimazole but had poor disease control. Due to severe proptosis, she underwent orbital radiotherapy, which improved her symptoms. However, after discontinuing carbimazole, she experienced a relapse of hyperthyroid symptoms, including weight loss, palpitations, heat intolerance, and worsening tremors. Examination reveals persistent goiter and mild residual exophthalmos.
What would be the best intervention to consider at this stage?

A 39-year-old woman presents with a palpable mass in her right breast. Clinical examination reveals a firm, irregular mass in the upper inner quadrant and a second lesion at the central aspect of the same breast. Imaging and core biopsy confirm two invasive carcinoma lesions, measuring 2.5 cm and 1.5 cm, respectively. Axillary examination reveals palpable lymphadenopathy, and fine-needle aspiration cytology of the lymph node confirms malignant cells.
What is the best course of action?

A 30-year-old woman with a recent diagnosis of Graves’ disease underwent incision and drainage of a pilonidal abscess three hours ago. Shortly after the procedure, she becomes agitated, confused, and is noted to be jaundiced and sweating profusely. Her temperature is 39°C, pulse 152 beats per minute, and blood pressure 95/60 mmHg. An ECG shows an irregular ventricular rate with absent P waves. Laboratory tests reveal elevated liver enzymes and hyperbilirubinemia.
After initial resuscitation, what is the most appropriate next step in management?

A 72-year-old woman presents with a painless breast lump that she recently noticed. On clinical examination, there is a firm, irregular, non-tender mass measuring approximately 4 cm in diameter in the upper outer quadrant of the left breast. No skin changes, nipple retraction, or axillary lymphadenopathy are noted. A mammogram reveals a spiculated mass with microcalcifications, and a core biopsy is performed.
What is the most likely diagnosis?

A 45-year-old woman presents with a 2 cm mobile breast mass. On clinical examination, the mass is felt to be smooth, mobile, and non-tender. A mammogram reveals an indeterminate result (M3), and the ultrasound shows benign changes (U2). Despite these findings, clinical examination is indeterminate (P3), meaning the lump is palpable, but its features are not entirely typical for a benign mass. The patient’s family history is non-contributory, and there are no other concerning symptoms such as skin changes or nipple discharge.
What is the next most appropriate course of action?