Thyroid nodules are common, mainly benign (4–13% representing malignant lesions). The clinical presentation can vary from incidental thyroid findings with special attention to those nodules detected via PET scan, as they carry a higher risk of malignancy. Presenting symptoms may include concerns of aesthetic nature arising from a visible neck mass, symptoms of mechanical compression such as dysphagia, neck tightness, positional dyspnea, or dry cough, and manifestations of autonomous functioning. The typical approach includes obtaining the history and physical exam, assessment of thyroid function, thyroid imaging using ultrasound, and, if suspicion of malignancy is significant, fine-needle aspiration biopsy (FNAB) or core biopsy. Additionally, factors like personal history of external neck radiation, total body radiation (e.g., for bone marrow transplant), smoking habits, family history of thyroid cancer, syndromic disorders like multiple endocrine neoplasia (MEN) type 2, Cowden disease, Carney complex, or familial adenomatous polyposis can elevate the risk of thyroid malignancy. Rapid nodule growth and persistent voice changes should also raise concern for malignancy. The decision to perform FNAB depends on nodule characteristics and size. Subsequent management, whether surgical intervention, observation, radioactive iodine, or thermal ablation techniques, will be guided by the symptoms and FNAB results.