What is the next best step after a thyroid nodule is palpated and TSH levels are normal?

When a thyroid nodule is palpated and TSH levels are normal, the next best step is to perform a thyroid ultrasound. The ultrasound is crucial in evaluating the characteristics of the nodule, such as its size, composition (solid versus cystic), and whether there are any suspicious features that might increase the risk of malignancy.

Determining the nature of the nodule through ultrasound helps guide the decision on whether a biopsy is needed. If the nodule is larger than 1 cm or shows concerning features, a fine-needle aspiration biopsy may be warranted based on the ultrasound findings. However, in the context of normal TSH levels and the immediate next step, a thyroid ultrasound provides critical information that influences the management of the patient.

Other options may not be as appropriate at this stage. For example, a biopsy might be considered after the ultrasound if the findings warrant it, but it wouldn't be the immediate next step without first assessing the characteristics of the nodule. Follow-up TSH levels in 6 months would not provide additional relevant information on the nature of the nodule, and a CT scan of the neck is typically not a first-line investigation for thyroid nodules due to radiation exposure and lack of additional information beyond what an ultrasound would