BACKGROUND The routine use of ultrasonography in ENT to investigate the lymphatic system of the neck leads to a number of incidentally found thyroid nodules. METHODS After reevaluating our patients from 7/95 to 12/98 we searched the relevant literature for a reasonable diagnostic pathway for these findings. RESULTS 67 patients had one or more incidentally found thyroid nodules. 23 were followed sonographically. 8 patients had fine needle biopsy as a first diagnostic step. One nodule was cytologically suspect for papillary carcinoma, which was confirmed later histologically after resection. CONCLUSIONS Autopsy studies showed a 5% malignancy rate in the occult thyroid nodules. Most of these occult growths are papillary carcinomas with a relatively good prognosis, especially when they measure less than one centimeter. We recommend performing a fine needle biopsy in any patient with a thyroid nodule > 1 cm, with a history of prior irradiation of the neck or with medullary carcinoma in the family. Clinical and sonographic follow-up should be done after 6 to 12 months in the rest of the cases.