When a thyroid nodule is found incidentally or on physical examination, the next test to be done is triple thyroid work. 1. For those with hypothyroidism TSH, continue with thyroid imaging. If a cold or cool nodule is found, biopsy is recommended. If hot nodules, radioiodine or surgery is recommended. For warm nodules, the next step of diagnosis and treatment will be decided according to ultrasound performance. For those with normal TSH, it is not necessary to perform thyroid imaging and direct biopsy can be considered. Those who do not want biopsy should be followed up by ultrasound every six months. 3, TSH increase with malignant nodules is very unlikely, ultrasound follow-up can be.