Nodular thyroid disease is common in the United States and throughout the world. Although most thyroid nodules are benign in nature, certain clinical, radiographic, and cytologic features are associated with an increased risk of malignancy. A clear understanding of these risk factors assists in the decision-making process when evaluating a patient with a thyroid nodule. It is this process that ultimately determines whether or not a patient is referred for surgery. This article provides a framework for clinicians to risk-stratify and appropriately manage patients with thyroid nodules.