View Full Version : enlarged thyroid biopsy

04-27-2007, 02:06 AM
Please note, I'm not soliciting medical advice, just background information.

I am out of the US and my wife is preparing to join me. Last week she had a medical exam and the doctor thought her thyroid was enlarged. She had an MRI and it was enlarged, although according to the doctor in was on the low end of the enlarged scale (if that makes sense). According to her, the doctor didnt' think it would be a big deal, just a check to make sure.

She has a biopsy scheduled next week, after that we'll know if there is a problem. As I said, we are currently not in the same country, so her mom is going with her to the surgery. She is clearly trying not to worry me, and I don't want to worry her, so if any dopers with knowledge/experience can answer my questions, I'd appreciate it.

Is it really not that big of a deal? What is the procedure like? What is the worst case? Does anyone have recomendations for an online resource for me?

I just want to get a handle on things for my own peace of mind. She's working with her doctor, so I'm not asking for medical advice.

I found out today and I'm really shaken, but of course I don't want to convey that to my wife. How worried should I be?

04-27-2007, 10:40 AM
I do not know specifically about what the biopsy procedure is like. Your wife's doctor should readily answer the first three questions you asked here, and I would encourage you or your wife to ask.

My sister had thyroid cancer and ended up having her thyroid removed. I'll see if she can tell me about the biopsy.

An enlarged thyroid is called goiter, you can search on that. Cancer is not the only cause.

Thyroid cancer is not very aggressive, grows slowly, and I believe that recovery rates are very high. Treatment for cancer can involve, as it did in my sister's case, removal of the thyroid, following by radioactive iodine treatment to remove any bits that may have been left after the surgery. It's kind of a pain in the neck (no pun intended) because you have to avoid children for a few days. My sister stayed in a hotel. Then you take a thyroid hormone pill every day to compensate.

Just stay calm until you get the results of the biopsy. And we're all hoping for the best for your wife.

04-27-2007, 02:30 PM
I wonder if part of the information got garbled along the line. Specifically, for an enlarged thyroid per se, I can't think of a reason for biopsy. On the other hand, biopsies are routinely done when there is a thyroid nodule (which can occur in any sized thyroid gland).

The usual thryoid nodule biopsy takes about 3 minutes (literally) and involves taking an extremely thin needle (about the same size as for insulin) and inserting it into the nodule. Freezing of the skin is not necessarily done (I never did). By capillary action alone, some of the thyroid tissue gets sucked into the syringe. The cells so taken are then placed on a microscope slide, sprayed with "fixative" and, ultimately, examined under the microscope.

There are virtually no risks with the procedure. In theory, an infection or bleeding could result, but I've never seen either. It is a VERY common, VERY straightforward test which, as I said, takes about three minutes.

04-27-2007, 03:15 PM
I'm a pathologist who has performed and diagnosed a large number of thyroid fine needle aspirates. Karl is correct about the indications for the procedure (nodule or mass, especially a "cold" (i.e. hormonally inactive) nodule by radionuclide scan, or one that is enlarging or otherwise suspicious.

The procedure should not be especially painful, but it does involve a needle going into one's neck (repeatedly) and so a local anesthetic is not out of line (which will not make things painless, but might help).
It is a ...VERY straightforward test Relatively straightforward to perform, but can be very difficult to interpret. The difference between a goiter (benign), a benign neoplasm (follicular adenoma) and a low-grade carcinoma may be quite subtle and unable to be resolved based on an aspirate. You could wind up with a diagnosis of "favor goiter" and a recommendation to repeat physical examination and imaging studies somewhere down the line. Or the diagnosis could be "follicular lesion, cannot rule out/favor neoplasm", in which case surgery is an option. These recommendations also depend on factors like whether the thyroid is enlarged enough to make the patient uncomfortable or compromise breathing.

I should mention that some docs are doing a core needle biopsy on thyroids, which involves a larger needle and gets a slender core of tissue on a single needle pass, rather than a cell suspension.

04-27-2007, 07:42 PM
Jackmannii is, as usual, right. Interpretation of the biopsy can be quite probelmatic.

By the way, Jack, do you know the names Walfish and Rosen - they're the ones who gave me my thyroid biopsy training.

(Did this finally get through? After four hours of waiting?)

04-28-2007, 12:02 AM
Thanks everyone for the information. Communication can get garbled because I am in Indonesia and she is in the states. I just want to inform myself as much as possible without pestering my wife with a bunch of questions. Like I said, her mom will be with her. I appreciate people taking the time to respond.

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