Internal medicine

  Thyroid Cancer Follow-Up: A Contemporary Review for the Clinician Who Wants to Do Better Than Guidelines Dr Neeraj Manikath , claude.ai Review Article | Internal Medicine & Endocrinology Targeted at Postgraduate Trainees, Registrars, and Practicing Consultants "A 34-year-old school teacher is referred to your clinic three years after total thyroidectomy and radioiodine ablation for a 2.2 cm papillary thyroid carcinoma (PTC) with a single ipsilateral lymph node metastasis. Her suppressed TSH has been maintained at 0.1 mIU/L. Her stimulated thyroglobulin (Tg) at one year was undetectable. Today, she brings her latest report — a serum Tg of 1.8 ng/mL on TSH suppression. She is anxious. Are you?" This vignette — deceptively simple, dangerously easy to mishandle — captures the essence of thyroid cancer follow-up. The disease is common, mostly indolent, yet riddled with clinical nuance. Done well, follow-up transforms outcomes and avoids over-treatment. Done poorly, it...

  Thyroid Imaging, Cytology, and Molecular Markers: From Nodule to Diagnosis — A Clinician's Master Guide Dr Neeraj Manikath , claude.ai Review Article | Internal Medicine & Endocrinology Targeted at Postgraduate Trainees (Residents/Registrars) and Practicing Consultants Author Note: This article synthesises current evidence from major society guidelines (ATA 2015, ACR TI-RADS 2017, BTA 2023), landmark trials, and the accumulated wisdom of bedside endocrinology practice. It is written in the spirit of a grand round — rigorous in evidence, but alive with clinical reasoning. Opening Vignette: The Nodule That Wasn't "Just a Cyst" A 38-year-old schoolteacher presented for a routine health check. She had no symptoms referable to the thyroid — no dysphagia, no voice change, no weight loss. Her TSH was 1.8 mIU/L — textbook normal. An incidentally detected 1.8 cm thyroid nodule on a neck ultrasound done for cervical lymphadenopathy was reported as "a simple...

  Thyroid Imaging, Cytology, and Molecular Markers: From Nodule to Diagnosis — A Clinician's Master Guide Dr Neeraj Manikath , claude.ai Review Article | Internal Medicine & Endocrinology Targeted at Postgraduate Trainees (Residents/Registrars) and Practicing Consultants Author Note: This article synthesises current evidence from major society guidelines (ATA 2015, ACR TI-RADS 2017, BTA 2023), landmark trials, and the accumulated wisdom of bedside endocrinology practice. It is written in the spirit of a grand round — rigorous in evidence, but alive with clinical reasoning. Opening Vignette: The Nodule That Wasn't "Just a Cyst" A 38-year-old schoolteacher presented for a routine health check. She had no symptoms referable to the thyroid — no dysphagia, no voice change, no weight loss. Her TSH was 1.8 mIU/L — textbook normal. An incidentally detected 1.8 cm thyroid nodule on a neck ultrasound done for cervical lymphadenopathy was reported as "a simple...

  Classic and Dysanaptic Airway Obstruction as Significant Risk Factors for Respiratory Disease: A Clinician's Perspective Dr Neeraj Manikath , claude.ai Review Article | Internal Medicine & Respiratory Medicine Targeted at Postgraduate Trainees and Practicing Consultants "The lung you inherit is not the lung you will always have — but it may already be working against you." — A guiding principle in modern airway biology Opening Case Vignette A 34-year-old non-smoking woman, a schoolteacher with no occupational exposures and no childhood history of asthma, presents to the respiratory clinic with a 2-year history of exertional dyspnea, recurrent lower respiratory tract infections, and persistent cough productive of mucoid sputum. Her spirometry reveals an FEV₁/FVC ratio of 0.64, an FEV₁ of 72% predicted, and a post-bronchodilator improvement of only 6%. Her CT thorax shows a centrally normal caliber trachea, but quantitative airway analysis reveals disproport...