EVALUATION OF THYROID NODULES DETECTED BY PALPATION OR IMAGING

Diagnostic US with LN assessment

History, physical examination, TSH

Normal or high TSH

Low TSH

Nodule(s) detected on US
Do FNA based upon US imaging features and size

Evaluate and Rx for hyperthyroidism

Radionuclide scanning

Nodule not functioning

Hyperfunctioning nodule

End

Results of FNA cytology

Repeat US-guided FNA

Follow

Consider molecular testing

Repeat US-guided FNA or consider molecular testing

Nondiagnostic

Close follow-up or surgery

Surgery

Bethesda System Cytology Reporting

Nondiagnostic

Malignant

Suspicious for PTC

Follicular neoplasm

Atypia or follicular lesion of undetermined significance (AUS/FLUS)

Benign

Surgery if indicated

Surgery if indicated

FNA, fine-needle aspiration; LN, lymph node; PTC, papillary thyroid cancer; TSH, thyroid-stimulating hormone; US, ultrasound.