What is the best next step for a patient with a thyroid nodule?

In the evaluation of a thyroid nodule, the most appropriate next step involves assessing the characteristics of the nodule, which often begins with measuring the Thyroid-Stimulating Hormone (TSH) level and performing a neck ultrasound.

Determining TSH levels is crucial as it helps differentiate between hyperthyroid and hypothyroid states, guiding further management of nodules. If the TSH is suppressed, it raises the suspicion for a malignancy, potentially leading to more immediate interventions. On the other hand, if the TSH level is normal or elevated, ultrasound imaging is essential to evaluate the nodule's size, composition, and any suspicious features such as microcalcifications or irregular margins, which indicate the need for further investigation such as fine needle aspiration (FNA) biopsy.

While FNA is a common next step after ultrasound findings and is vital for obtaining cytological analysis of potentially malignant nodules, it is typically informed by the results of both the TSH and ultrasound. Therefore, initially obtaining TSH levels and performing an ultrasound provides a comprehensive assessment to inform subsequent steps, including whether FNA is necessary.

CT scans are not standard in the initial evaluation of thyroid nodules unless there are specific concerns regarding the local invasion of a