Step II Thyroid nodule, TSH/T4 normal. What now?

[Freddie Mercury]

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Getting mixed answers from my sources.

34 year old woman comes in, nodule noted on thyroid. TSH and T4 ordered, within normal range.

USMLE-Rx says next step would be ultrasound (QID 21413). UpToDate seems to agree. However, MTB2 (and I believe UWORLD as well, although I can't find the Q) say the next step would be FNA.

Wat do

 

[Nabin]

I think U/S would be a better choice before performing an FNA. We want to properly assess the nodule and see the anatomy of it, also look for any other nodules which could be present. UpToDate says the next step should be FNA if someone with nodule has normal thyroid test results. Maybe they are talking about a U/S-guided FNA directly?

 

[dimmyt]

Nobody does FNA without US guidance for thyroid nodules. So you physically will not perform an FNA without first performing an US.