Thyroid Nodules and Thyroid Cancer

Meet the patient

A 45-year-old woman is referred after her general practitioner felt a lump in her neck. She is well, has no compressive symptoms, and is anxious because an aunt had thyroid cancer. Ultrasound shows a 2 cm solid hypoechoic nodule with microcalcifications.^[1]

The question that decides her next six months is not whether it is cancer but what the Bethesda cytology says — so the fine-needle aspiration is already booked. Hold that question and the whole workup below slots into place.^[1]

References10ShowHide

1. [1]Haugen BR, Alexander EK, Bible KC et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer Thyroid : official journal of the American Thyroid Association, 2016.PMID 26462967
2. [2]Ringel MD, Sosa JA, Baloch Z et al. 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer Thyroid : official journal of the American Thyroid Association, 2025.PMID 40844370
3. [3]Shapira-Zaltsberg G, Miller E, Martinez-Rios C et al. Comparison of the diagnostic performance of the 2017 ACR TI-RADS guideline to the Kwak guideline in children with thyroid nodules Pediatric radiology, 2019.PMID 31154502
4. [4]Hoang JK, Middleton WD, Tessler FN Update on ACR TI-RADS: Successes, Challenges, and Future Directions, From the AJR Special Series on Radiology Reporting and Data Systems AJR. American journal of roentgenology, 2021.PMID 33112199
5. [5]Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer Thyroid : official journal of the American Thyroid Association, 2009.PMID 19860577
6. [6]Todsen T, Bennedbaek FN, Kiss K et al. Ultrasound-guided fine-needle aspiration biopsy of thyroid nodules Head & neck, 2021.PMID 33368812
7. [7]Keskin L, Karahan D, Yaprak B Comparison of thyroid fine needle aspiration biopsy and ultrasonography results Medicine, 2023.PMID 37390290
8. [8]Papazian MR, Dublin JC, Patel KN et al. Repeat Fine-Needle Aspiration With Molecular Analysis in Management of Indeterminate Thyroid Nodules Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2023.PMID 35412868
9. [9]Francis GL, Waguespack SG, Bauer AJ et al. Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer Thyroid : official journal of the American Thyroid Association, 2015.PMID 25900731
10. [10]Torshizian A, Hashemi F, Khoshhal N et al. Diagnostic Performance of ACR TI-RADS and ATA Guidelines in the Prediction of Thyroid Malignancy: A Prospective Single Tertiary Center Study and Literature Review Diagnostics (Basel, Switzerland), 2023.PMID 37761339