Goitre is diagnosed based on the following: physical examination is performed by a doctor who examines for signs related to thyroid enlargement, such as the size of the gland or nodule, its firmness, mobility and tenderness; blood tests are performed to check for thyroid hormone levels and specific antibodies. The patient is identified to have an underactive thyroid if the TSH is elevated. Some patients with goitre may have normal thyroid hormone levels; if the thyroid nodule is larger than 1.0‑1.5 cm in diameter and with TSH level of normal or high, then the patient is advised a fine needle aspiration biopsy. The biopsy may reveal a benign nodule, thyroid cancer, or an uncertain diagnosis. In some cases, an inadequate specimen may be obtained; ultrasound scan or a radioactive iodine scan is performed. A thyroid sonogram or ultrasound sends inaudible sound waves into the neck in such a way that the returning echoes determine the structure of the thyroid and surrounding tissues. A radioactive scan determines if the nodule is a hot nodule (a hyperactive nodule that takes up more radioactive iodine) or a cold nodule (a hypoactive nodule that takes up less radioactive iodine). Cancerous nodules appear as cold nodules on a radioactive thyroid scan, though some benign nodules may also appear cold.
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