What is the best way to evaluate thyroid nodules less than 1 cm in size?
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Subcentimeter thyroid nodules should be evaluated with thyroid-stimulating hormone (TSH) level measurement and high-resolution ultrasound (US). Fine-needle aspiration (FNA) biopsy should be considered in low-risk patients if US findings are suspicious for malignancy. (SOR C, based on expert guidelines.) Findings associated with malignancy include hypoechoic pattern, microcalcifications, a long/short axis ratio of <1.5, irregular margins, and intranodular vascular spots. (SOR B, based on cohort studies.) Some experts further recommend a serum calcitonin level in evaluating all thyroid nodules.
Evidence Based Practice 12(5): 07-08.