• High resolution ultrasound can detect thyroid nodules in 19-68% individuals. Approximately 1 in 2 people may have incidental thyroid nodules.
• The frequency is higher in the elderly and in females.
• Indeterminate nodules continue to challenge and tease those who wish to separate the chaff from the grain.
• There remains a significant percentage of nodules with ambiguity.
• Commercially available molecular markers: Afirma – relies on mRNA microarray sequencing and has high sensitivity/NPV and low specificity/PPV; ThyroSeq GC is a DNA- and RNA-based next-generation sequencing (NGS) with high specificity/PPV and high sensitivity/NPV; ThyGenX + ThyraMIR combination – overall performance is moderate.
• Artificial intelligence algorithms decrease the subjectivity of medical image interpretation.
• More often one “errs” in favor of surgery than uncertainty.

Newer techniques refine the accuracy but do not entirely eliminate the uncertainty and are currently in “not for you” category.