I had a us of my thyroid and they found a hypoechoic nodule measuring 0.413 x 0.546cm. blood test came back normal tsh and free t4 really nervous. ?

Please don't worry: One of the next steps is usually a fine needle aspiration biopsy, which involves using a very skinny needle to remove cells from the nodule. In my experience, most of these cells are benign, especially give the size of your nodule. However, if they are malignant or suspicious, you will need thyroid surgery. Most thyroid cancer (papillary type) can be cured.

F/U recommended: A .546 x .413 cm (ie 5x4 mm) thyroid nodule is extremely common. With normal thyroid function (normal TSH and ft4), in my practice i would simply recommend a follow-up thyroid ultrasound in 12 months to ensure stability. Less than 1% chance the nodule is related to thyroid malignancy.

Very common: Thyroid nodules are very common. About 70% of the population has a nodule (many don't know it). About 5% of nodules are cancerous, which is why we care. Unless there were concerning characteristics on the ultrasound like microcalcifications, taller than wide or increased blood flow or you have a family history or radiation exposure, typically we just follow-up with an annual ultrasound.

Too small to worry: Generally nodules that small are usually just monitored. This is a very common finding as many people have nodules. 95% are benign. I would not worry at this point.