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Ultrasound (US) is the primary tool for thyroid nodule assessment, identifying features and guiding Fine Needle Aspiration (FNA). US-guided FNA collects cells for analysis, determining malignancy to guide treatment and avoid unnecessary surgery. Their combination significantly improves diagnostic accuracy. For indeterminate FNA results, molecular tests enhance risk stratification. Thyroid Scintigraphy, for abnormal TSH or functional status, differentiates "hot" (benign) from "cold" (malignant) nodules, used alongside US and FNA.

Ultrasound (US) – Thyroid Ultrasound
Ultrasound (US) is the main imaging method used for thyroid nodules and the first-line tool in thyroid nodule assessment. US shows nodule size, tissue type (solid or cystic), and suspicious characteristics like hypoechogenicity, irregular borders, and calcifications.
Nodules with suspicious features are more likely to be malignant, and US helps identify nodules for Fine Needle Aspiration (FNA) to make accurate prebiopsy decisions.

Fine Needle Aspiration (FNA) – Fine Needle Aspiration Biopsy
When FNA is conducted under US guidance, a very fine needle is used to collect cells for microscopic analysis to decide if the nodule is cancerous or benign. It is a tool for determining the treatment plan (monitoring or surgery), increasing diagnostic accuracy, and helping to avoid unnecessary operations.

Combined Approach: Ultrasound + FNA
The combination of US and FNA yields additional benefits regarding sensitivity and specificity. US identifies suspicious nodules, and FNA confirms if these nodules are malignant or benign. This method reduces both misdiagnosis and underdiagnosis and allows for more efficient use of medical resources.

Molecular Testing
Molecular tests are a helpful adjunct when the cytology report is indeterminate (Bethesda III & IV). These tests detect mutations like BRAF and RAS, improving risk stratification and helping in choosing the appropriate treatment.

Thyroid Scintigraphy / Radionuclide Scan
Scintigraphy is a complementary test to thyroid function tests and is performed when TSH is abnormal or when it is necessary to know the functional status of a nodule. “Hot” nodules are usually benign, “cold” nodules are more likely malignant, and it is often done alongside US and FNA.