Thyroid nodules
Check TSH first, scan hot nodules instead of needling them, use ultrasound risk (TI-RADS) and size to decide on FNA, and act on the Bethesda category.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Nodules are found on ultrasound in up to two-thirds of adults and are palpable in about 5%. About 5 to 15% are malignant, nearly all differentiated (papillary) thyroid cancer.
- The work-up has three steps: TSH, then ultrasound with a risk category (ACR TI-RADS or the ATA patterns), then FNA if risk and size justify it.
- Low TSH: scan first. A hot nodule doesn't need FNA.
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Sources
- 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancerAmerican Thyroid Association (Haugen et al., Thyroid 2016;26:1-133), 2015 (nodule recommendations still current; the cancer sections were replaced by the 2025 ATA DTC guideline, checked November 2026)
- 2025 American Thyroid Association management guidelines for adult patients with differentiated thyroid cancerAmerican Thyroid Association (Ringel, Sosa et al., Thyroid 2025;35(8):841-985), 2025
- 2023 European Thyroid Association clinical practice guidelines for thyroid nodule managementEuropean Thyroid Association (Durante et al., Eur Thyroid J 2023;12:e230067), 2023
- ACR Thyroid Imaging, Reporting and Data System (TI-RADS), white paper of the ACR TI-RADS CommitteeAmerican College of Radiology (Tessler et al., J Am Coll Radiol 2017;14:587-95), 2017
- The 2023 Bethesda System for Reporting Thyroid CytopathologyAli SZ, Baloch ZW, Cochand-Priollet B et al., Thyroid 2023;33:1039-44, 2023 (third edition)
- Endocrinology (Therapeutic Guidelines)AU/NZTherapeutic Guidelines Ltd
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy