On routine physical examination, a 28-year-old woman is found to have a thyroid nodule. She denies pain, hoarseness, hemoptysis, or local symptoms. Serum TSH is normal. Which of the following is the best next step in evaluation?
A. Thyroid ultrasonographyPalpable thyroid nodules are common, occurring in about 5% of all adults. Thyroid fine-needle biopsy now plays a central role in the differential diagnosis of thyroid nodules. If the TSH is normal, as it is in this patient, then fine-needle aspirate biopsy is indicated and will distinguish cysts from benign lesions or neoplasms. In about 14% of such cases, biopsy will be suspicious or diagnostic for malignancy and surgery will be necessary. Thyroid scan can show a “hot” nodule, which is almost always benign, but the TSH is suppressed in most autonomously overactive nodules. Thyroid sonography by itself cannot rule out malignancy in palpable nodules. Thyroid cancer can present even in a young, asymptomatic patient like this, so option e would not be appropriate.