<prompt> Answer this question truthfullyWhat is the first step in evaluating a thyroid nodule before performing TSH level or ultrasound?  <response>: <reason> The first step in evaluating a thyroid nodule is to take a detailed history and perform a physical examination, also known as a HP history and physical. During the HP, the healthcare provider will ask about any symptoms the patient may be experiencing, such as difficulty swallowing or a hoarse voice, as well as any family history of thyroid disease. They will also perform a physical examination of the neck to assess the size, shape, and consistency of the nodule. Based on the findings of the HP, further testing such as TSH level or ultrasound may be ordered to help diagnose and manage the thyroid nodule. 