Feeling super overwhelmed by thyroid nodule workup (TSH and ultrasound first) rn, any tips that actually stick?

Ngl I thought I had thyroid nodule workup (TSH and ultrasound first) down cold after my first pass of qbank, but my last two blocks proved me completely wrong lol. The stems keep testing checking serum TSH first: low TSH -> radioiodine uptake scan (hot nodule rarely malignant, no FNA) and normal or high TSH + suspicious US features (microcalcifications, hypoechoic, taller-than-wide) -> FNA biopsy in super subtle ways.

How are you guys spotting never doing FNA before checking TSH bc autonomous hot nodules look follicular on cytology fast enough on timed mode without getting baited by ordering thyroid scan on a patient w/ elevated TSH?

Context: currently during weekend error-log review looking back at my flagged 50/50s.

I had the exact same issue w/ thyroid nodule workup (TSH and ultrasound first) when I was during weekend error-log review. What finally fixed it for me is never doing FNA before checking TSH bc autonomous hot nodules look follicular on cytology.

Whenever you see checking serum TSH first: low TSH -> radioiodine uptake scan (hot nodule rarely malignant, no FNA) in the stem, pause for two seconds and look specifically for normal or high TSH + suspicious US features (microcalcifications, hypoechoic, taller-than-wide) -> FNA biopsy before peeking at the answer choices. That way ordering thyroid scan on a patient w/ elevated TSH cannot bait you looking back at my flagged 50/50s. Once I started doing that on every block, thyroid nodule workup (TSH and ultrasound first) went from my worst section to basically free points.

One extra clinical pearl for thyroid nodule workup (TSH and ultrasound first): whenever they mention normal or high TSH + suspicious US features (microcalcifications, hypoechoic, taller-than-wide) -> FNA biopsy during weekend error-log review, always double check the vitals and timeline bc ordering thyroid scan on a patient w/ elevated TSH is their favorite way to trick people looking back at my flagged 50/50s.

Can confirm as a PGY-1 now, never doing FNA before checking TSH bc autonomous hot nodules look follicular on cytology is not just high yield for the exam on thyroid nodule workup (TSH and ultrasound first) during weekend error-log review, you literally use checking serum TSH first: low TSH -> radioiodine uptake scan (hot nodule rarely malignant, no FNA) on the wards all the time looking back at my flagged 50/50s.

Bruh ordering thyroid scan on a patient w/ elevated TSH got me twice this week during weekend error-log review looking back at my flagged 50/50s lol. Writing checking serum TSH first: low TSH -> radioiodine uptake scan (hot nodule rarely malignant, no FNA) at the top of my scratch pad before clicking an answer finally broke the habit.

If you are during weekend error-log review looking back at my flagged 50/50s, dont beat yourself up over thyroid nodule workup (TSH and ultrasound first) misses rn — missing normal or high TSH + suspicious US features (microcalcifications, hypoechoic, taller-than-wide) -> FNA biopsy on qbank today means you will spot it immediately on exam day.

100% agree w/ the first reply on thyroid nodule workup (TSH and ultrasound first). Doing never doing FNA before checking TSH bc autonomous hot nodules look follicular on cytology when I was during weekend error-log review looking back at my flagged 50/50s saved me at least 3-4 points on my next form, especially on stems testing checking serum TSH first: low TSH -> radioiodine uptake scan (hot nodule rarely malignant, no FNA).

My senior resident taught me never doing FNA before checking TSH bc autonomous hot nodules look follicular on cytology on rounds last month and I swear every thyroid nodule workup (TSH and ultrasound first) question on normal or high TSH + suspicious US features (microcalcifications, hypoechoic, taller-than-wide) -> FNA biopsy during weekend error-log review looking back at my flagged 50/50s felt 10x easier after that.