Thyroid nodule diagnostic study of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]


There is no definite diagnostic criteria for thyroid nodule. Different diagnostic methods can be used to diagnose thyroid nodules, based on their specific properties. Thyroid function should be assessed in all patients with thyroid nodules as the primary diagnostic step in all patients with a neck mass. The primary evaluation method that should be used in the thyroid nodule evaluation is thyroid ultrasound. Cytology differentiates between malignant and benign lesions. After a suspicion of thyroid malignancy based on ultrasound features, fine needle aspiration biopsy (FNAB) is the most appropriate method for further evaluation. Thyroid scintigraphy is used to determine the functional status of a nodule. Scintigraphy utilizes one of the radioisotopes of iodine (usually I-123) or technetium-99m pertechnetate.

Diagnostic Criteria

Diagnostic approach

The following approach is based on  American Thyroid Association (ATA) guidelines for assessment of thyroid nodules, the latest version was released in 2015.[4]

Thyroid nodule found clinically or incidentally
Normal or elevated
Radionuclide thyroid scan
Nodule not up taking the radionuclide
Cold nodule
Nodule is non-functional
Nodule up taking the radionuclide Hot nodule
Nodule is functional
Ultrasound evaluation
Check thyroid hormones
Free T4 and T3 check
Meets the criteria
Does not meet criteria
Subclinical hypothyroidism
Thyroid adenoma
Management of the underlying disease
Rule out other differential diagnosis

Abbreviations: TSH: Thyroid stimulating hormone, FNA: Fine needle aspiration, FLUS: Follicular lesion of undetermined significance, AUS: Atypia of undetermined significance.


  1. Lingam RK, Qarib MH, Tolley NS (2013). "Evaluating thyroid nodules: predicting and selecting malignant nodules for fine-needle aspiration (FNA) cytology". Insights Imaging. 4 (5): 617–24. doi:10.1007/s13244-013-0256-6. PMC 3781256. PMID 23712566.
  2. Maia FF, Zantut-Wittmann DE (2012). "Thyroid nodule management: clinical, ultrasound and cytopathological parameters for predicting malignancy". Clinics (Sao Paulo). 67 (8): 945–54. PMC 3416902. PMID 22948464.
  3. Hou H, Hu S, Fan R, Sun W, Zhang X, Tian M (2015). "Prognostic value of (99m)Tc-pertechnetate thyroid scintigraphy in radioiodine therapy in a cohort of Chinese Graves' disease patients: a pilot clinical study". Biomed Res Int. 2015: 974689. doi:10.1155/2015/974689. PMC 4387899. PMID 25879041.
  4. "ATA Professional Guidelines | American Thyroid Association".