Th yr oid Nodu le Diagn osis

Palpable thyroid nodule

or incidental nodule on
imaging

ABBREVIATIONS:
Perform history and physical
FNA: fine needle aspiration
Obtain thyroid ultrasound (if
TSH: thyroid-stimulating hormone
not already done)
Obtain TSH measurement

Is TSH Normal or
No
low? high TSH
* Ultrasound features
included in FNA criteria (note
Yes
that specific criteria vary by
guideline/organization):
Perform - Nodule
radionucleotide - Size
thyroid scan - Location
- Composition
- Echogenicity
- Margins
- Shape
Is nodule - Echogenic foci
Nonfunctioning
hyperfunctioning? No - Vascularity
nodule - Suspicious neck lymph
nodes
- Extrathyroid extension
Yes Do
ultrasound
features meet No
Evaluate and
criteria for
treat for
FNA* ?
hyperthyroidism

Yes

Perform thyroid Perform periodic

ultrasound-guided thyroid ultrasound
biopsy monitoring

REFERENCES: JAMA 2018 Mar 6;319(9):914?924 - Endocr Pract 2016 May;22(5):622?639 - Thyroid 2016 Jan;26(1):1?133 -
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