A 57-year-old woman presents with a thyroid mass. What is the most appropriate next step in management?

In the evaluation of a thyroid mass, fine-needle aspiration (FNA) is the most appropriate next step in management. FNA is a minimally invasive procedure used to obtain a tissue sample from the thyroid nodule, which is crucial for determining the nature of the mass.

The indications for an FNA are particularly relevant in cases such as the one described, where the patient is 57 years old. At this age, the risk of thyroid malignancy increases, especially if the nodule is solid, exhibits abnormal characteristics on ultrasound, or if there are associated symptoms such as hoarseness or difficulty swallowing. The results of the FNA can provide critical information about whether the mass is benign or malignant, which will guide subsequent management decisions.

Other approaches such as reassurance may overlook the need for further evaluation, whereas a radionuclide thyroid scan, while informative in some cases, is not routinely employed as an initial step for thyroid masses. Total thyroidectomy is a more invasive procedure reserved for cases where cancer is diagnosed or highly suspected, making it an inappropriate first-line approach without a definitive diagnosis from FNA.

Thus, FNA stands out as a necessary and appropriate first step in managing a thyroid mass, especially in a patient with risk factors for