Thyroid cancer, the most common endocrine malignancy usually presents as a solitary nodule. FNAB is the best way for the diagnosis of cancer in patients presenting with thyroid nodules [5,6]. FNA cytology reports are classified as: Benign, Follicular lesion of undetermined significance and Follicular neoplasm, Suspicious for malignancy, Malignant and Nondiagnostic [26]. Unlike for papillary thyroid cancer, FNA biopsy cannot differentiate follicular thyroid cancer from follicular adenomas. These specimens are usually reported as indeterminate lesions, categorized as follicular neoplasm or follicular lesions of undetermined significance [7,8]. Pathologic evaluation of the thyroid after surgery confirms the actual diagnosis of follicular thyroid cancer. Treatment in benign and malignant group is straightforward, but in patients with cytology suggesting follicular neoplasm is controversial. Physicians usually perform thyroid scintigraphy and most patients with non autonomous adenomas should undergo surgery because 15 to 25 percent of them prove to be cancers [26]. Many procedures are under investigation to improve the diagnostic value of cytology alone for the assessment of follicular neoplasm. These include RT-PCR measurement of thyroglobulin mRNA, PET scans, cellular and molecular markers [9][10][11][12][13][14][15][16][17][18][19]. More recently, many studies have suggested that Serum TSH is an independent risk factor for predicting malignancy in a thyroid nodule [20][21][22][23][24][25]. Higher serum TSH levels also have been associated with advanced stages of thyroid cancer [23]. Many **data** support the role of TSH in thyroid cancer. Many studies have shown higher incidence of thyroid cancer in patients with Hashimoto's thyroiditis and Graves' disease, compared with control population [27,28]. Elevated TSH due to continuous progression to hypothyroidism in Hashimoto's disease and TSH receptor stimulation by TSH receptor antibody in Graves' disease may explain the higher rate of malignancy in these patients. The trophic effect of TSH on thyroid cancer growth also is well established [29,30] and TSH suppression by administering exogenous thyroid hormone is an independent predictor of recurrence of differentiated thyroid cancer [31]. An alternative explanation is that patients with lower TSH concentrations were developing autonomous function, which by itself is associated with lower rates of malignancy [32][33][34].