Snapshot A 22-year-old woman presents to her primary care physician after finding a "lump" on her neck. She denies any fever, flu-like symptoms, or sick contacts. She also denies any pain or discomfort in the neck; however, she notes an unintentional 8-pound weight loss. She does not have any significant medical history. Family history is significant for medullary thyroid cancer in her mother and parathyroid hyperplasia in her maternal grandmother. Physical exam is significant for a fixed hard mass in the right-side of the thyroid. A thyroid stimulating hormone level is decreased and thyroid scintigraphy is scheduled to be performed. Introduction Epidemiology Malignant risk factors < 30 or > 70 years of age family history of login to view 4 more bullets history of prior radiation to the neck cold nodule on radioactive iodine uptake cervical lymphadenopathy concerning findings on ultrasound login to view 4 more bullets Benign risk factors family history of login to view 2 more bullets hyper- or hypothyroidism nodular tenderness Approach to Thyroid Nodules Discovery of a thyroid nodule begin with a thorough history and physical exam login to view 1 more bullet thyroid stimulating hormone (TSH) levels should be checked in all patients with a thyroid nodule login to view 15 more bullets ultrasonography should be check in all patients with a thyroid nodule login to view 14 more bullets FNA findings and management benign login to view 1 more bullet indeterminate login to view 1 more bullet suspicious for malignancy login to view 1 more bullet malignant (e.g., papillary cancer, medullary thyroid cancer, and anaplastic cancer) login to view 1 more bullet