Thyroid nodules are extremely common findings with a low likelihood of harboring a clinically significant malignancy. Ultrasound is highly sensitive at identifying which nodules warrant further workup with fine needle aspiration (FNA) biopsy. FNA should be performed based on US findings and risk categories. The Bethesda system should be used to classify FNA results. Molecular testing may be offered if the results are likely to change the therapeutic approach. Clinicians should be keenly aware of the potential for overtreatment and should make a concerted effort to factor patient values into the decision-making process.