J Korean Med Assoc.  2009 Apr;52(4):405-416. 10.5124/jkma.2009.52.4.405.

Diagnostic Approaches to Patients with Thyroid Nodules

  • 1Department of Internal Medicine, Chonnam National University Medical School, Korea. drkang@chonnam.ac.kr


Thyroid nodules are epidemic with the rising use of high-resolution thyroid ultrasonography for health screening. The primary aim in investigating a thyroid nodule is to exclude the possibility of malignancy, which occurs in about 5% of nodules. Initial history taking and physical examination should focus on the clinical risk factors associated with thyroid cancer. Measurement of thyroid stimulating hormone (TSH) is the only biochemical test routinely needed to exclude autonomously functioning nodules. Thyroid ultrasonography-guided fine needle aspiration biopsy (US-FNA) is the most accurate standard diagnostic test for most thyroid nodules. Ultrasonographic features of nodules associated with increased risk of thyroid cancers include hypoechogenicity, microcalcification, irregular spiculated margin, taller-than-wide, Doppler signal in the nodules, and suspicious cervical lymphadenopathies. These findings are helpful in risk stratification of the nodules and in deciding which nodule should be sampled in multinodular goiters. The success of the procedure heavily depends on the experience and expertise of the clinicians. Knowledge on basic US-FNA techniques and some tricks is very important to improve overall diagnostic yields. Practically critical issues related to US-FNA are emphasized based on several guidelines and author's experiences.


Thyroid nodule; Thyroid cancer; Thyroid ultrasound; Fine-needle aspiration biopsy

MeSH Terms

Biopsy, Fine-Needle
Diagnostic Tests, Routine
Mass Screening
Physical Examination
Risk Factors
Thyroid Gland
Thyroid Neoplasms
Thyroid Nodule
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