Poster Presented at the ACP Indiana Chapter 2022 Annual Scientific Meeting, October 2022.

Case Presentation:

• A 60-year-old male presented with new onset atrial fibrillation and hyperthyroidism.

• His past medical history was significant for germline TTN mutation and recurrent ventricular tachycardia status post implantable cardiac defibrillator placement.

• He had been treated with amiodarone for two and a half years and had stopped the medication eight months prior to presentation.

• Laboratory workup was done (table 1) and an ultrasound of the thyroid gland showed a multinodular goiter with subcentimeter cysts and a right lower lobe nodule.

• A follow-up thyroid ultrasound twelve months later showed a new 11 mm nodule in the left lower lobe and a stable 5 mm nodule in the right lower lobe.

• Fine needle aspiration of the left nodule was suspicious for follicular neoplasm with suspicious Afirma Genome Sequence Classifier testing (corresponding to ~ 50% risk of malignancy).

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