Although thyroid nodules are a common clinical entity, few (5% to 10%) are malignant and require surgical treatment. Most nodules are discovered incidentally in patients undergoing surveillance for medical reasons unrelated to thyroid disorders. Therefore, a systematic approach to their evaluation is important to avoid unnecessary surgery. High-resolution ultrasonography and fine-needle aspiration have resulted in substantial improvements in diagnostic accuracy, cost reductions, and higher malignancy yield at the time of surgery. In this article, the authors present practical guidelines and a suggested management strategy for the effective diagnosis and management of incidentally discovered thyroid nodules.