Assess thyroid function to exclude hyperthyroidism.
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Test for circulating thyroid antibodies to help differentiate nodular goitre from autoimmune thyroiditis.
Ultrasonography and aspiration cytology
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Ultrasonography is the gold standard assessment when performed by a suitably trained and experienced operator.
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Fine-needle aspiration cytology is required for a nodule with concerning ultrasonographic features. This need not be the largest dominant nodule.
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Perform the biopsy under ultrasound guidance to ensure that the correct nodule is sampled.
Assessment of compression
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When swallowing or breathing symptoms are present, CT of the chest and neck is the best modality for assessing tracheal or oesophageal deviation or compression.