Epithelial thyroid cancers (TC) comprise two differentiated histotypes, the papillary TC (PTC) and the follicular TC (FTC) which, following dedifferentiation, progress toward the poorly differentiated TC (PDTC) and the highly aggressive anaplastic TC (ATC). Even though TC mortality rate has not changed, its annual incidence has increased over the last two decades, largely due to the improved ability to diagnose malignant transformation in small non-palpable thyroid nodules. Even though the prognosis of DTC patients is favorable, aging patients frequently experience aggressive disease type and a higher disease-specific mortality. Of relevance is the greater prevalence of thyroid nodules in aged patients, being higher than 90% in women over 60 yr, and 60% in men older than 80 yr. Therefore, an accurate diagnosis of thyroid nodules in these patients is of crucial importance. To date the gold standard in the diagnosis of thyroid nodules is represented by the cytological analysis on samples obtained by ultrasound-guided fine-needle aspiration cytology (FNAC). However, despite the overall accuracy of FNAC reaching 84%–95%, about 20% of FNAC diagnosis is indeterminate or suspicious for malignancies because cytopathologists cannot discriminate between benign nodules that can be simply monitored clinically, from malignant nodules requiring surgery. Therefore, the identification of novel diagnostic strategies is urgently needed. Over the last few years, substantial advancement made in the comprehension of the underlying molecular mechanisms involved in DTC progression has begun to enter into clinical practice. Here, we will attempt to review epidemiological and clinical features of thyroid nodules and TCs in the elderly, and we will focus on new molecular and ultrasound approaches, that are currently being evaluated to ameliorate the diagnosis of thyroid nodules.