What to do with incidental thyroid nodules on imaging? An approach for the radiologist

The incidental thyroid nodule is a common finding on cross-sectional imaging of the neck and chest. Although the majority of nonpalpable incidental nodules are benign, the radiologist must assess the risk of malignancy, intelligently report the finding, and potentially direct the subsequent workup. To do so, the radiologist requires an understanding of issues around thyroid cancer, costs of thyroid nodule workup, and suspicious findings for malignancy. This article describes the problem of the incidental thyroid nodule, reviews the imaging findings of malignancy, and discusses an approach to reporting the incidental thyroid nodule.