What imaging modalities are recommended for assessing thyroid nodules before referral to secondary care?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 14 August 2025Updated: 14 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Offer greyscale ultrasound with an established system for grading ultrasound appearance as the initial diagnostic test when investigating thyroid nodules for malignancy .

Use ultrasound to assess nodule features such as echogenicity, microcalcifications, border, shape, internal vascularity, and lymphadenopathy to guide further management .

Consider FNAC based on ultrasound grading, but ultrasound remains the primary imaging modality prior to referral .

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