1. Alternatively one can begin with an FNA.
   
   
2. Cysts are found in and adjacent to thyroid neoplasms. Always beware and if concerned repeat the FNA.
   
   
3. Observation is a life long responsibility. The TSH and thyroid must be watched, thyroid medications adjusted, and the nodule monitored. Should it regrow a repeat FNA is indicated.

Overview of Thyroid Nodule

The thyroid is not an easy organ to examine, but if a nodule is discovered, an evaluation is required. In all cases this begins with thyroid function tests. Both hyperthyroidism and hypothyroidism need to be diagnosed and both require treatment. More and more we rely on the TSH, but the best chemical examination is one which measures both TSH and T₄.

The real controversy exists in the evaluation of the euthyroid or hypothyroid nodule. Assuming no other signs or symptoms point towards malignancy, three months of suppression with thyroid hormone is recommended. If this fails to suppress the nodule, further evaluation is required. Options include ultrasound, thyroid scans and fine needle aspirations. Fine needle aspiration is highly accurate in diagnosing malignancy. It is easy, safe and almost painless to perform. Most other pathways ultimately finish with fine needle aspiration and so many who treat thyroid disease now recommend this as the first diagnostic test. If positive for tumor, the patient is referred for thyroidectomy. If the fine needle aspiration is benign, then continued suppression and observation are indicated. If on suppression the nodule grows, a repeat fine needle aspiration is indicated. If the FNA is non- diagnostic, a scan to rule out multi-nodular goiter is recommended. If, it is indeed a solitary nodule, the patient deserves an evaluation by a head and neck surgeon or an endocrinologist and probably should undergo a thyroidectomy.