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Thyroid nodule — USMLE Step 3 MCQ

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HardSurgery (post-operative, follow-up)Thyroid noduleUSMLE Step 3

A 45-year-old has a 1.8-cm solid hypoechoic thyroid nodule with irregular margins and punctate echogenic foci. TSH is normal, and there are no compressive symptoms. Which next step is best?

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Correct answer: E — Perform ultrasound-guided fine-needle aspiration of the thyroid nodule

A nodule at least 1 cm with suspicious ultrasound features requires fine-needle aspiration. Surveillance alone delays diagnosis, whereas PET-CT, hormone suppression, and surgery before cytology are not the appropriate initial pathway.

Reference: American Thyroid Association, Thyroid Nodules: https://www.thyroid.org/thyroid-nodules/