American Board of Family Medicine (ABFM) Practice Exam 2025 - Free ABFM Practice Questions and Study Guide

When evaluating a thyroid nodule greater than 1 cm, the recommended next step is to measure the Thyroid Stimulating Hormone (TSH) level. This step is crucial because the results can help determine the functional status of the thyroid and guide further management. If the TSH level is low, it may indicate hyperthyroidism, suggesting that the nodule could be toxic and potentially influencing the decision for further intervention. Conversely, a normal or high TSH level indicates that the nodule is likely non-toxic, which also affects management strategies.

This initial assessment with TSH measurement helps stratify the risk and necessity of further investigations, such as imaging and biopsy, ensuring that the patient receives appropriate care based on their thyroid function.

Other measures like performing a fine needle aspiration or referring to an endocrinologist are typically steps that follow the assessment of TSH, which helps clarify the functional status of the thyroid gland before deciding on invasive procedures or specialist referrals. Obtaining a thyroid ultrasound is also an important part of the evaluation process, but it generally follows the TSH measurement as part of determining the need for biopsy or follow-up depending on the results.