Patients with an indeterminate FNAB result or a follicular neoplasm will undergo a total thyroidectomy as the initial surgical procedure, if they meet one of the following criteria: (i) TSHR mRNA > 1 ng/mcg, (ii) TSHR mRNA undetectable, biopsied thyroid nodule size ≥ 3.5 cm, and presence of one additional unfavorable US nodule characteristic, or (iii) TSHR mRNA undetectable, nodule size < 3.5 cm, and presence of 2 or more additional US features. This evidence concerns the gene TSHR and thyroid nodule.