How should a cold nodule larger than 1 cm be treated?

When dealing with a cold nodule larger than 1 cm in the thyroid, a biopsy via fine-needle aspiration (FNA) is crucial for proper diagnosis and management. Cold nodules, which are nodules that do not take up iodine during a radioactive iodine scan, carry a higher risk of malignancy compared to hot nodules, which are hyperfunctioning and typically benign.

The purpose of the biopsy is to evaluate the cellular characteristics of the nodule to determine whether it is benign, malignant, or indeterminate in nature. The decision to perform an FNA is based on both the size of the nodule and its cold status, as larger size increases the likelihood of possible malignancy. For nodules larger than 1 cm, the recommendation is to proceed with FNA to obtain tissue samples for cytological analysis.

Other management options listed, such as observation, radioactive iodine therapy, and thyroid hormone replacement, are not appropriate first-line treatments in this scenario. Observation might be acceptable for smaller nodules or those deemed benign without further evaluation. Radioactive iodine therapy is typically indicated in cases of hyperthyroidism or specific thyroid cancers, while thyroid hormone replacement is prescribed for hypothyroidism, but none of these directly address the need for evaluation of