TSH should be measured in all patients to rule out the possibility of a hyperfunctioning nodule.

If the TSH level is subnormal, then those nodules generally do not require biopsy because they are virtually always benign and a radioactive thyroid scan should be performed.

A higher serum TSH level, even within the upper part of the reference range, should also be concerning because it is associated with an increased risk of malignancy in a thyroid nodule.