choice given a non-suppressed TSH. Imaging – Ultrasound and radioiodine scanning. Thyroid scan 85% of nodules are cold nodules, and 5–8% of cold and warm nodules are malignant. 5% of nodules are hot. Malignancy is virtually non-existent in hot nodules. Surgery Surgery (thyroidectomy) may be indicated in the following instances: Reaccumulation of the nodule despite 3–4 repeated FNACs Size in excess of 4 cm in some cases Compressive symptoms Signs of malignancy (vocal cord dysfunction, lymphadenopathy) Cytopathology that does not exclude thyroid cancer Minimally-invasive procedures Non-surgical, minimally invasive ultrasound-guided techniques are now being used for the treatment of large, symptomatic nodules. They include percutaneous ethanol injection, laser thermal ablation, radiofrequency ablation, high intensity focused ultrasound (HIFU), and percutaneous microwave ablation. HIFU has recently proved its effectiveness in treating benign thyroid nodules. This method is noninvasive, without general anesthesia and is performed in an ambulatory setting. Ultrasound waves are focused and produce heat enabling to destroy thyroid nodules. Focused ultrasounds have been used to treat other benign tumors, such as breast fibroadenomas and fibroid disease in the uterus. Treatment Levothyroxine (T4) is a prohormone that peripheral tissues convert to the primary active thyroid hormone, triiodothyronine (T3). Hypothyroid patients normally take it once per day. Autonomous thyroid nodule An autonomous thyroid nodule or "hot nodule" is one that has thyroid function independent of the homeostatic control of the HPT axis (hypothalamic–pituitary–thyroid axis). According to a 1993 article, such nodules need to be treated only if they become toxic; surgical excision (thyroidectomy), radioiodine therapy, or both may be used. See also Thyroid adenoma References External links Thyroid disease