this is a fairly large nodule - if there is a significant amount of cystic fluid, this could be drained and may alleviate some of the symptoms.
Repeat FNA is a good idea, if this is not clearly benign, then surgery.
May end up needing surgery -- there should not be significant increased risks with an experienced surgeon -- you may want to check out university hospitals, etc around your area for a thyroid surgeon to discuss this with.
TSh needs to be closer to 1.0