Hyperechoic thyroid is generally not malignant. Ultrasound suggests the following possibilities for malignancy: i) solid hypoechoic nodules; ii) very rich blood supply in the nodule; iii) irregular morphology and margins of the nodule; iv) tiny calcifications in the nodule; v) simultaneous enlargement of cervical lymph nodes. If a nodule is suspected to be malignant, further cytologic examination by fine needle aspiration of the thyroid gland is required to further evaluate the benignity or malignancy of the nodule in conjunction with the medical history, clinical presentation and ancillary tests. If there is a high clinical suspicion of malignancy and thyroid fine needle aspiration confirms a nodule of suspected malignancy or malignancy, surgical removal is required for treatment. Benign nodules that are too large and cause symptoms of pressure may also be considered for surgical excision. Benign nodules of the thyroid gland should also be followed up regularly.