Is a 4.2x1.6x2.5cm heterogeneous complex nodule w/increased vascularity in midportion of the thyroid always cancer.?

Not always. Increased vascularity in a thyroid nodule doesn't always predict malignancy. I'm a firm believer in having the endocrinologist and an experienced head and neck surgeon collaborate in these cases in providing best advice and follow-up.

A thyroid nodule of this size should be removed. An alternative option is to do a needle biopsy to check the nature of this growth. It is not always Cancer as benign goiter is quite common cause of nodules in the thyroid gland.