Check TSH. If low, check RAIU Thyroid US FNA for solid lesion > 1 cm and all lesions > 2 cm and all cold nodules. Repeat US in 1 year if FNA negative but suspicious. Purely cystic nodule < 1 cm do not need FNA, but monitor 6-12 mo for 2 years. Surgical excision for nodules > 4 cm.