Ultrasound-Guided Thyroid Biopsy

What Does the Thyroid Gland Do?

 
The thyroid is part of the endocrine system that affects the metabolism, growth, and metabolism of the body. It is a small butterfly-shaped gland that lies in front of the trachea. The thyroid’s primary function is to produce hormones that make many cells in your body function correctly. Its proper or improper function can affect our
  • Energy level
  • Ability to sleep
  • Muscle and digestive function
  • Brain function
  • Mood
  • Ability to maintain a healthy heart rate
  • And bone density health.
 

What Kinds of Thyroid Problems Are There?

 
The thyroid gland may enlarge and scatter or become a conglomerate of symmetric nodules to maintain adequate hormone production. We call this condition Compensatory Thyroid Enlargement or Multinodular Goiter.
 
Some autoimmune conditions such as Graves disease or Hashimoto’s Thyroiditis can also cause the thyroid gland to become larger. If the gland is actively inflamed accompanied by an abrupt change in function, neck swelling, or redness of the neck, this condition is called toxic thyroiditis.
 

How Does a Thyroid Ultrasound Work?

 
Ultrasound of the thyroid uses the same technology regardless of whether we are evaluating the thyroid, breast, or uterus. The technologist uses a small hand-held transducer (wand) that emits sound waves produced by special crystals sent to and from the transducer to the thyroid gland. Those sound waves (called ultrasound) reflect back to the crystals in the transducer to display images of the gland. The technologist and specialized radiologist use these images to interpret the findings. This technology is also called sonography and the procedure is called a sonogram.
 
We look at the size of the thyroid gland, the texture, nearby lymph nodes, and whether there are any nodules.
 
We check the vessels of the thyroid gland which can give us more information on the health or function of the gland. A thyroid gland with excess vascularity can indicate hyperthyroidism while low vascularity to the thyroid can be seen with hypothyroidism.
 
Radiologists use thyroid ultrasound to check any physiologic change in your clinical examination. Radiologists may also order an ultrasound for symptoms you notice internally such as difficulty swallowing or hoarseness. Ultrasound is not typically indicated with a normal-sized gland with physiologic conditions such as hypothyroidism. Sometimes a single thyroid nodule enlarges and not the whole gland. This may need a Thyroid ultrasound-guided biopsy of the thyroid gland.
 
Although most nodules of the thyroid have characteristics that appear benign (noncancerous), some have suspicious characteristics such as an irregular shape or suspicious calcifications that need a thyroid needle biopsy.
 

How is a Thyroid Ultrasound-Guided Biopsy Performed?

 
We first sterility cleaning the neck with an antiseptic solution called Hibiclens. If you have any allergies to topical solutions or medication, please let us know. Hibiclens is pink so rarely do people have an allergy to pink dyes. We don’t typically use betadine because allergies are more common with that. The radiologist may use a small amount of lidocaine to anesthetize the skin to minimize any discomfort from the procedure. Most people feel a small pinching sensation and possibly pressure from the biopsy, but experiencing pain is uncommon.
 
An ultrasound transducer or probe is then used to localize the thyroid nodule.
 
The radiologist will then use a fine needle (smaller than you have probably seen before) to take the sample. The procedure is sometimes called a Fine Needle Aspiration (FNA) or a Fine Needle Biopsy (FNB), larger needles were standard to take a tissue block, but the sampling was not as representative. As a result of this finding, the Fine Needle method is now standard. The radiologist directs the fine needle under ultrasound guidance to the nodule. The radiologist does several passes with the fine needle to gather cells for further analysis. The radiologist will watch the entire procedure in real-time as he or she is performing the procedure. This ensures that the targeting and sampling are precise.
 
We prepare the cells on slides in preservative solutions for additional evaluation by the pathologist.
 
We place a small amount of the sample in an extra collection tune in case the pathologist needs to perform extra testing. The pathologist or cytologist is a medical specialist who studies the structure and function of cells and analyzes the cells. Cytologists look at the cells under the microscope to determine if they are normal (benign), atypical or look suspicious. Sometimes, the specialist needs more information. The specialist will test the extra tube of cells for the genetic makeup of the cells. This secondary process is not as rapid and may take seven to ten days to return.
 

What to Expect After a Fine Needle Aspiration Biopsy of the Thyroid:

 
We recommend not taking blood thinners such as Aspirin or Motrin as they can increase bruising. We will provide you with Tylenol and a small portable ice pack to apply to the fine needle aspiration/biopsy site if needed. Complications from a Fine Needle Aspiration/ Biopsy of the Thyroid are very rare. If you were to experience any bleeding or increased swelling or sudden change of voice, please call us or seek medical attention.
 

When will Results be Available?

 
The results of the Fine Needle Aspiration Biopsy of the Thyroid are usually available within two working days. That means if you have a biopsy on a Tuesday, the results would be available on a Thursday. If you have a biopsy on a Thursday, the results will be available on the following Monday. The results may take longer in some cases if the pathologist needs more time for testing. The length of time needed to complete the evaluation is not related to the final result.
 
We allow the time necessary for the pathologist to make an accurate diagnosis. The results usually return as benign (normal). Sometimes the findings return as suspicious for malignancy (cancer).
 
Occasionally, the thyroid biopsy results may be atypical. If the results prove to be atypical or malignant, then your doctor will advise a consultation with a specialist in thyroid surgery. The surgeon may recommend removing part of the thyroid gland or observation.
 

Is There Any Follow-Up Recommended?

 
We do request a thyroid ultrasound follow-up within six months time from the procedure date. The follow-up ensures the stability of the finding that we biopsied, even for a benign result. Your Care Team at The Women’s Imaging Center ensures the continuity of screening to diagnosis to treatment when indicated. The Care Team and navigator coordinate your care with other specialists based on the recommendation of your referring clinician and within the continuity of care following the National Comprehensive Cancer Network (NCCN) guidelines.