Thyroid nodule from 4x4x3 mm's to 653mm's in 1 year follow up . is that something to worried about size change? normal tsh's . do i need biopsy?

Less than 1 cm: Thyroid nodules are benign > 90% of the time. A small change of 2 mm may simply be variation in measurement. Additionally all tumors benign and malignant increase in size. In general growths less than 1 cm are usually monitored with ultrasound and a needle biopsy is performed if growing > 1 cm or sooner with concerning findings/calcifications on ultrasound.