Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android

  • • Very common and most are not cancer

    • Central diagnostic question is whether the lesion is benign or malignant


  • • Present in about 5% of the population

    • 5% of nodules represent thyroid cancer

    • 2-fold more common in females, although malignant nodules slightly more common in males

    • Risk of malignancy greater in persons older than 60 or in children younger than 15

Symptoms and Signs

  • • Often asymptomatic, and discovered as a nodule on routine physical exam or exam for another head/neck pathology

    • Occasional pain

    • Hoarseness

Laboratory Findings

  • • Serum thyroid-stimulating level (TSH) level (low in solitary toxic nodule, normal or elevated in nonfunctioning nodules)

    • Fine-needle aspiration biopsy can have the following results:

    • -Malignant




Imaging Findings

  • US

    • -Can distinguish size of nodules and assess for presence of nonpalpable nodules

      -Also can distinguish solid from cystic nodules

    Thyroid scintigraphy: Not routinely indicated; sole remaining indication is in patients with hyperthyroidism and thyroid nodule.

Rule Out

  • • Thyroid cancer

  • • Complete history and physical exam

    • -Focus on duration of swelling, recent growth, local symptoms (dysphagia, pain, voice changes), and systemic symptoms (hyperthyroidism, hypothyroidism); the patient's age, sex, place of birth, family history, and history of head/neck irradiation are most important

    • Thyroid function tests

    • Cervical ultrasound to assess thyroid and regional lymph nodes

    • Fine-needle aspiration biopsy; ultrasound-guided has a higher diagnostic rate

    • Observation, medical therapy, or surgery

    • Thyroid scintigraphy only if patient hyperthyroid (rare)



  • • Obstruction of the aerodigestive tract

    • FNA biopsy with malignant or indeterminate result

    • 3 successive inadequate biopsies

    • Recurrence of cyst after 2 aspirations


  • • TSH suppression with l-thyroxine if patient hypothyroid; may arrest nodule growth


Cooper DS et al: Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2006;16:109.  [PubMed: 16420177]
Wong CK et al. Thyroid nodules: Rational management. World J Surg. 2000;24:934.  [PubMed: 10865037]

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.