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Endocrine
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Thyroid Nodule Evaluation
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TSH + ultrasound; iodine scan only if TSH is low.
Decision
Outcome
Decision
Palpable thyroid nodule. Initial tests?
✓
TSH + thyroid ultrasound
✗
FNA first without checking TSH
Decision
TSH result?
✓
Normal or elevated → assess US features
✓
Low (suppressed) → radioactive iodine scintigraphy
Outcome
FNA based on size + US features (TI-RADS or ATA criteria)
TI-RADS or ATA risk categories guide FNA threshold sizes.
Decision
Scintigraphy pattern?
✓
Hyperfunctional ('hot') nodule
✓
Hypofunctional ('cold') or indeterminate → assess US/size for FNA
Outcome
Treat hyperthyroidism — hot nodules are essentially never malignant
Options: radioactive iodine, antithyroid drugs, surgery.