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Does A Thyroid Needle Biopsy Hurt

What Are The Risks Of Thyroid Fine Needle Aspiration Biopsy

Thyroid Biopsy

Thyroid fine needle aspiration biopsy is a very safe procedure, but it does carry some slight risks. These include:

  • Bleeding at the biopsy site
  • Infection
  • Damage to the structures near the thyroid

Because most healthcare providers use ultrasound to guide the procedure, this last complication is rare.

There is also a small risk that the fine needle aspiration biopsy will not show for sure whether the nodule is cancerous. If this happens, you might need a repeat biopsy.

Do I Need A Biopsy Or Surgery For My Thyroid Nodule

Jul 17, 2018 | Head and Neck, Your Health

Thyroid nodules are very common. These masses within the thyroid gland are composed of tissue and/or fluid and are estimated to be present in more than 50 percent of those aged 50 and older. ;Nodules can run in families, are more common in women, and increase in frequency with age.

Patients diagnosed with a thyroid nodule often ask if their nodule needs to be biopsied or surgically removed. Sometimes the answer is yes, but often the answer depends on a number of patient and nodule-related factors. Catherine Sinclair, MD, FRACS, head and neck surgeon at Mount Sinai West, explains why your nodule may, or may not, need special attention.

How do you know if you need a biopsy?

More than 95 percent of thyroid nodules are non-cancerous, although a family history of thyroid cancer in a first-degree relative or whole-body/neck/chest radiation exposure may increase the risk. Nodules have a low cancer risk, so whether to biopsy depends on the size and ultrasound appearance of the mass.

How is risk measured?

What are the symptoms and treatment for thyroid nodules?

In summary, a thyroid nodule may require an operation if there is a high risk of the nodule being cancerous or if the non-cancerous nodule is large and causing symptoms.

When Can I Expect The Results Of My Thyroid Fna

The pathology result generally takes a few days to be available to your doctor.The time that it takes your doctor to receive a written report on the test or procedure you have had will vary, depending on:

  • the urgency with which the result is needed;
  • the complexity of the examination;
  • whether more information is needed from your doctor before the examination can be interpreted by the specialist;
  • whether you have had previous X-rays or other medical imaging that needs to be compared with this new test or procedure ;
  • how the report is conveyed from the practice or hospital to your doctor .

It is important that you discuss the results with the doctor who referred you, so that they can explain what the results mean for you.

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Thyroid Fine Needle Aspiration Biopsy: What You Need To Know

Thyroid nodules are clumps of soft tissues within the thyroid gland. In rare cases, they can be cancerous or interfere with the proper functioning of the thyroid. In such cases, the nodules need to be treated. At UVA, interventional radiologists perform fine needle aspiration biopsy , an image-guided procedure to diagnose thyroid growths.

Does A Needle Biopsy In The Neck Hurt

Thyroid Biopsy by Alexander Shifrin, MD
  • Does a Needle Biopsy in the Neck Hurt? Center
  • A needle biopsy is a minimally invasive procedure and does not require a large incision. Therefore, it is less painful compared to the standard surgical biopsies. Most patients experience mild pain after the procedure, which can be managed with painkillers. This pain is even lesser if local anesthesia is used during the procedure. Needle biopsy provides the advantage of faster recovery. However, sometimes the biopsy may need to be repeated if the sample fails to capture the cells from the affected area.

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    What Is A Thyroid Fine Needle Aspiration

    The thyroid is a soft gland in the front of the neck, in front of the trachea, or windpipe. It has two lobes , each about the size of a small egg, joined by a thin bridge of tissue called the isthmus of the thyroid.

    The thyroid gland is important, because it produces hormones that control metabolism, or the rate at which the body uses fuel. A fine needle aspiration is a test that samples a small amount of tissue from the thyroid with a very thin needle.

    What Happens During A Thyroid Fna

    An ultrasound machine will be used to locate the nodule or nodules to be sampled and show images or pictures of the nodule or nodules onto a screen.

    The ultrasound will be carried out by a technologist or a radiologist , or both.

    The FNA procedure will then be explained to you. Instructions about what you can and cannot do after the procedure will be given to you at this time as well. You will be asked to sign a form indicating that you understand what will happen, the small risks involved, and that you agree to have the procedure done. The explanation will generally be provided by the doctor carrying out the procedure. You will have the opportunity to ask any questions at this time.

    You will generally be lying on an examination couch for the procedure.

    Your neck will be washed with antiseptic.

    The procedure is then over. The needle puncture site in your neck will be compressed for a couple of minutes by the doctor who did the FNA or a nurse who assists the doctor. An ice pack may be put on your neck to help reduce swelling and bleeding. You may be taken from the ultrasound room into an observation area for a short time to ensure that you are well enough to go home.

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    What Should I Expect After The Procedure

    • A healthcare provider will watch you for about 30 minutes to see if you have any swelling or bruising.
    • A cold compress or ice bag may be placed on your neck to ease swelling and discomfort.
    • Ask how and when you can find out the results of your biopsy. Ask if you need any other follow-up visits, tests, or procedures.

    Is It Cancer Or Just A Benign Nodule

    What to expect after an FNA (thyroid)

    This page is written assuming you have read the introductory page on thyroid nodules first. If you have not, please do so because it will make this page easier to understand.

    Thyroid nodules increase with age and are present in almost 10% of the adult population. Autopsy studies reveal the presence of thyroid nodules in 50% of the population, so they are fairly common. 95% of solitary thyroid nodules are benign, and therefore, only 5% of thyroid nodules are malignant.

    Common types of the benign thyroid nodules are adenomas , thyroid cysts, and Hashimoto’s thyroiditis.

    Uncommon types of benign thyroid nodules are due to subacute thyroiditis, painless thyroiditis, unilateral lobe agenesis, or Riedel’s struma. As noted on previous pages, those few nodules that are cancerous are usually due to the most common types of thyroid cancers that are the differentiated thyroid cancers. Papillary carcinoma accounts for 60%, follicular carcinoma accounts for 12%, and the follicular variant of papillary carcinoma accounts for 6%. These well differentiated thyroid cancers are usually curable, but they must be found first. Fine needle biopsy is a safe, effective, and easy way to determine if a nodule is cancerous.Thyroid cancers typically present as a dominant solitary nodule that can be felt by the patient or even seen as a lump in the neck by his/her family and friends. This is illustrated in the picture above.

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    Fine Needle Aspiration Of The Thyroid

    What Is Fine Needle Aspiration of the Thyroid?

    The thyroid is an important organ in your endocrine system. It releases hormones that regulate many of the functions in your body. The thyroid gland is near the base of the neck, just below the Adams apple. Sometimes small nodules, or lumps, appear on the thyroid. When this happens, the doctor may order a test known as fine needle aspiration , or fine needle biopsy, to obtain tissue samples from the thyroid for analysis.

    Your doctor may order this test if you have:

    • a persistent cough, hoarse voice, or unexplained sore throat for a long period
    • nodules, or lumps, on your throat that you can feel or see
    • lumps that are detected on a routine ultrasound
    • a cyst, or fluid-filled lump, on your thyroid

    Fine needle aspiration is the only nonsurgical way to find out if any lumps or nodules are benign or malignant.

    What Is The Difference Between A Core Biopsy And A Needle Biopsy

    There are a few differences between the two. A core needle biopsy is done with a larger needle and a small incision is made in the skin above the area to be biopsied. The incision allows for easier insertion of the needle, but is not needed when performing an FNA because the needle used is very thin.

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    General Conditions For Best Outcome A Synopsis

    Clinical assessment before FNB is essential to select patients at greater risk for complications and choose the best technique . It is suggested that the physician should previously describe the procedure and its potential complications to the patient and reassure him for the simplicity of the procedure and the rarity of serious complications.,

    If rapid cytological evaluation during the procedure is not feasible, multiple passes should be performed. There are not enough data to assess the role of the number of passes on diagnostic accuracy and safety. However, no more than 5 passes are recently recommended, because of the small increase in adequacy rate and the potential increase in morbidity and trauma with additional passes. Since increasing diameter of the needle increases the incidence of complications,, without affecting adequacy rate, the use of a 25-G needle with or without aspiration is recommended for solid nodules. FNC may be a better choice for complex nodules. A 23-G needle should be used in cystic nodules, to evacuate as much of the fluid as possible.

    Expertise in any level of the procedure is critical for good results. In medical centres with long-standing experience diagnostic accuracy is increased., , Not only may lack of expertise be accompanied by a high complication rate, but may also lead to a high failure rate, which in turn increases surgery rate and associated complications and morbidity.

    Preparation For Thyroid Biopsy

    Fine Needle Biopsy of Thyroid Nodules
  • You will be asked to remove your clothing from the waist up and dress in a gown.
  • Next you will have to lie on your back on an exam table or in a reclined medical chair and tilt your head back.
  • A disinfectant will be applied on your neck skin to clean the area of biopsy.
  • Local anesthesia may not be given due to pain and burning sensation. In most cases ice pack is enough because the procedure is short. If you are concerned about pain, then better discuss with your doctor this issue before going to the procedure.
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    Needle Tract Seeding Of Medullary Thyroid Carcinoma Or Thyroid Lymphoma

    Despite the alarming in vitro observations, needle track seeding is very rare in vivo. Tumor cells released into the surrounding tissues or circulation after FNB are probably destroyed by the host immune response or other mechanisms before giving rise to clinically apparent metastases. Implantation may be facilitated in cases of immunodeficiency or untreated carcinomas. Post-FNB cutaneous or muscular seedings have been described in papillary , follicular and anaplastic thyroid carcinoma .

    However, needle tract seeding of medullary thyroid carcinoma , thyroid lymphoma or other primary thyroid malignancies have not be reported in the literature yet. A possible, albeit hypothetical, explanation is that the patients with MTC are subjected to total thyroidectomy and extensive nodal dissection, shortly after the cytological diagnosis of MTC. Furthermore, patients with residual disease after surgery may be subjected to radiotherapy and/or cytotoxic chemotherapy, which might destroy any potential post-FNB implantation. Similarly, the patients with thyroid lymphoma are subjected to radiotherapy and/or cytotoxic chemotherapy, which might further limit the already minimal risk of needle tract seeding. As in the cases of needle tract seeding of differentiated thyroid carcinoma, we believe that, given the easiness and effectiveness of surgical removal of the seedings, the application of FNB on thyroid nodules should not be deterred, when indicated.

    Comparison Between Fna And Fnc

    It has been proposed that FNC reduces trauma to cells and tissues, resulting in less pain, less haemorrhage and specimens of higher quality; however, this was not proved in all studies. Similarly, some authors found higher, while others comparable adequacy rates between FNA and FNC. In a meta-analysis, no method was found superior to the other. No study has directly compared the complication rate between FNA and FNC.

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    What To Expect During The Procedure

    FNA is done with such thin needles that local anesthesia is usually not necessary and discomfort is minimal. However, if the biopsy area is particularly sensitive, local anesthetic can be injected to numb the area of the neck to be biopsied. Though the procedure is quite easily tolerated without the use of numbing medicine, its readily available should you need it.

    During the procedure, your endocrinologist will:

    • Have you lie on your back and place a pillow under your shoulders to extend your neck.
    • Clean the site of the biopsy with an antiseptic solution.
    • Insert a thin, hollow needle into the nodule using ultrasound imaging to ensure the needle remains on target.
    • Extract a sample of cells from the nodule into the needle, which is withdrawn after 15-30 seconds.
    • Apply pressure to the biopsy site, after collecting an adequate sample.

    FNA of a single nodule takes between 10-20 minutes. Each nodule requiring evaluation is normally aspirated twice in this manner.Since the needles are so thin, bleeding is usually very minimal and a Band-Aid is not usually necessary. You may feel soreness at the biopsy site for one to two days.

    How Do Doctors Perform A Fine

    Thyroid Biopsy Experience, How Was it?

    In most cases, if the nodule can be felt, a biopsy can be performed in the doctor’s office. In some cases, an ultrasound may be needed to help guide the biopsy, .

    Once the patient is ready, a small, fine-gauge needle is inserted into the nodule. The needle is smaller in diameter than the needle used in most blood draws . The patient holds his breath while the needle is rocked gently to obtain as much tissue as possible. The needle is then withdrawn and pressure is applied over the thyroid area to minimize bleeding. This procedure is usually repeated four to six times to ensure that an adequate amount of tissue has been collected. After the procedure, pressure is applied over the neck area for 5 to 10 minutes to assure that the bleeding has stopped. The pressure also helps to reduce any swelling that may occur. The entire procedure usually takes less than 20 minutes.

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      What To Expect During A Thyroid Biopsy

      What to expect during a thyroid biopsy will depend on which thyroid biopsy technique your doctor has chosen for you. Although most patients receive a fine needle aspiration biopsy, your doctor may also order a core needle biopsy or surgical biopsy.

      Fine needle aspiration

      A fine needle aspiration is a type of thyroid biopsy that is performed while you are awake. Most patients do not need any anesthesia during this procedure. During the test, your doctor will use imaging guidance to thread a small needle into your neck and remove a sample of thyroid tissue for testing. Your doctor may remove several samples from various areas of the thyroid, nodule or the lymph nodes near the thyroid. The procedure is performed in a clinic setting and lasts approximately 30 minutes. You will be able to resume your daily activities after leaving the clinic.

      Core needle biopsy

      A core needle biopsy is similar to a fine needle aspiration but involves using a larger needle. It may be performed if the fine needle aspiration does not produce enough information to make an accurate diagnosis.

      Surgical biopsy

      Rarely, a surgical biopsy on the thyroid is necessary. During a surgical biopsy, your surgeon will cut an incision in the neck to remove the nodule. In some cases, you may need to remove part of the entire thyroid.

      Why Might I Need A Thyroid Fine Needle Aspiration Biopsy

      You might need the test to see whether your nodule is cancerous. You might have noticed the nodule yourself, or your healthcare provider might have noticed it during an exam or on another test.

      Researchers do not know what causes most thyroid nodules. They are very common, though. Certain problems with the thyroid gland, like Hashimoto thyroiditis, may increase your chances of getting a thyroid nodule. Thyroid nodules are much more common in women than in men. Nodules tend to grow during pregnancy. People who have had radiation treatments to their neck are also more likely to develop nodules. Your risk of developing thyroid nodules or thyroid cancer is increased if members of your family have already had thyroid and certain other cancers.

      Only a small percentage of thyroid nodules turn out to be cancer. It is important to identify a cancerous nodule as soon as possible, so that you can begin treatment quickly.

      Not everyone who has a thyroid nodule needs a fine needle aspiration biopsy. Your healthcare provider may start with an ultrasound or computed tomography scan of your neck. Sometimes, this provides enough information to know that the nodule isnt due to cancer. Blood tests of thyroid levels also may provide helpful information. If your healthcare provider cant tell for sure, youll probably need a thyroid fine needle aspiration biopsy.

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