well honestly my doctor seemed kind of annoyed with me. He said "well, we typically don't worry about nodules that are 1cm or less" and i acknowledged that and told him that it was the TIRAD 4 rating that had me concerned, so he kind of abruptly cut me off and said "ok i'll refer you to an ENT for a biopsy." told me i should hear about when my appt is from his office sometime in the next two weeks or so and then he hung up. Normally i have a very good relationship with him and i agree with him that i don't know if a biopsy is absolutely necessary but i do need a second opinion. So we will see how it goes.