Fine needle aspiration biopsy of the thyroid

About 5 to 10 percent of adults may have palpable lump in their thyroid. This means that it can be felt with the fingers during a physical or self-examination. However, ultrasound imaging is much more sensitive than a pure palpation and able to discover many smaller nodules that cannot be felt with the fingers. With the use of ultrasound, in certain age groups (especially in adult women - thyroid nodularity is much more common in women that in men!) nodules can be found in as much as 40-50 percent of cases! Fortunately, majority of such nodules are benign.

If one or more nodules are detected on ultrasound within the thyroid gland, we will examine the features of these nodules – shape, vascularity, calcifications, diameter, and density in comparison to surrounding normal thyroid tissue. Some features are strongly suggestive that a nodule is benign in nature, and some raise concern that the nodule may be a cancer. In some cases it is impossible to distinguish between benign and malignant nodules with complete certainty. A fine needle aspiration biopsy and review of tissue under a microscope may be recommended for further evaluation, but sometimes a repeat sonogram after a few months looking for stability may be sufficient.

A fine needle aspiration biopsy is technically quite simple and many patients describe it less painful than a common blood draw from a vein. In almost all cases, an ultrasound is used to help guide the biopsy.

Patient requires almost no preparation. There is no need to fast or to withhold medications. Occasionally a patient may be asked not to take blood-thinning medication on the day of the biopsy. As there is very little discomfort during the procedure we do not recommend the use a local anesthetic. Since the needle used for fine needle aspiration biopsy is very fine, anesthesia will simply result in another unnecessary poke. If you are particularly concerned and nervous, we can apply topical anesthetic preparation, which takes 10 to 20 minutes to work. Again, most patients undergoing fine needle aspiration biopsy forego the use of any anesthetic and do very well.

Most patients do not have any problems after fine needle aspiration biopsy. There may be some discomfort in the area for a few hours after, which is usually relieved with regular painkiller. Some patients like to put an ice pack over the area when they get home, but most do well without such measures. Potential risks of fine needle aspiration biopsy of the thyroid include minor bleeding and cyst formation, but these complications are exceedingly rare. If procedure is done by experienced thyroid (head and neck) surgeon who is trained in more complicated thyroid procedures (like total thyroid surgery), any potential complication of the fine needle aspiration biopsy can be easily managed!

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Sasa Janjanin M.D., Ph.D. is double European Board-certified in ENT and Facial Plastic Surgery. He extensively trained in complete surgical and medical treatment of patients with disorders and diseases of the head and neck. However, his major expertise is in facial plastic, aesthetic and reconstructive surgery; problems related to thyroid and parathyroid glands; skin cancer; kid’s ENT problems; nose, sinus and snoring complaints; and sport and diving-related ENT problems.