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

Offer greyscale ultrasound with an established system for grading ultrasound appearance as the initial diagnostic test when investigating thyroid nodules for malignancy ².

Use ultrasound to assess nodule features such as echogenicity, microcalcifications, border, shape, internal vascularity, and lymphadenopathy to guide further management ².

Consider FNAC based on ultrasound grading, but ultrasound remains the primary imaging modality prior to referral ².