Having a fine needle aspiration on a thryoid nodule. How scared should I be?

In My Humble Opinion
1

Important intro request: Please, please only respond if you’ve had thyroid FNA biopsy! In past threads, people (who I know were sincerely trying to help) responded to such questions with “I didn’t have a thyroid biopsy but I did have a breast/liver/kidney/bone biopsy and it was horrific!”

While I truly appreciate the impulse to talk about such experiences, because it sounds like they sucked, those procedures are quite different from thyroid FNAs; with breast/kidney/etc. tissue biopsies they use a larger needle and are taking out larger sections. So I’m not surprised if they were awful or at least highly unpleasant.

My genuine sympathies and I hope you’re better now! But in this thread, please stick to the thyroid stuff. I’m already a basket case and don’t want to be even more freaked out than usual. Thanks guys. :o

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So. I know this question’s been asked before, but I’m asking on my own because I’m very nervous about this. Hell, I already have panic disorder; I needed this on top of that like a hole in my neck. Ha.

Actually, a panic attack is what led to the discovery of a thyroid nodule. I’d gone to the ER for a high heart rate/blood pressure and, with no noticeable heart issues, the docs did a CAT scan to rule out a pulmonary embolism as the cause of my high heart rate.

My lungs were fine, but apparently the doc spotted a 3.3 mm thyroid nodule at the edge of the scan. (This seems to be a common way for such nodules to be discovered.) Since I also had an elevated TSH level (7) the hospital referred me to an endocrinologist. This was toward the end of March.

On April 21, when I finally got to see the endo, she ordered a sonogram and a second round of blood tests. This time the blood tests came back normal (the elevated level might have been caused by my high stress due to the panic attack).

However, the sonogram turned up another nodule that was 1.5 cm and also solid. My endo said anything of that size indicates a need for an FNA (fine needle aspiration) biopsy. So she scheduled me for the FNA for about June 2nd.

The delay scared me–isn’t it dangerous to have such a long wait if there’s something of concern in this larger nodule? But my doc insisted that she didn’t think it was that urgent; she promised if they thought it was really suspicious they’d have me come in the next day. I don’t know if that’s accurate but it’s too late now. (Oh by the way, this is at Weill Cornell/New York Hospital here in NYC. I only mention that because it seems to be a respected institution.)

I just realized there was no reference to doing a biopsy on the smaller nodule; not sure why.

So after all this preamble…

  1. Please tell me the odds of this being bad. My endocrinologist, very aware of my, shall we say, fragile mental state, tried to calm me by saying that it’s most likely nothing, most nodules are benign; further, even if it is “something” it’s also most likely in that situation that they’ll get rid of the “something” and I’ll be fine afterward. But, again, she may have been mollycoddling me. Oh, I’m 49, if that makes a difference.

  2. How likely is it that I’ll have a lot of pain during/afterward? In the threads here for those who’ve had the thyroid FNA, people are generally “oh it’s nothing much.” But then because I’m a total idiot masochist as well as a hypochondriac/panicky nut, I look at these horror stories where they’re like “it’s like being stabbed in the throat!” “I could hardly breathe, I swelled up so much!” “I cried and cried throughout the whole procedure!” and other encouraging messages. So what’s the real deal?

  3. Can I breathe during the test? I know I’m not supposed to swallow (and of course like the fruitcake I am, I’ve actually been practicing going for five - ten minutes without swallowing because once I read that I became paranoid that I wouldn’t be able to do it!). But now I’ve read that you’re not supposed to breathe either. And that scares me again because breathing is one tool I use to calm myself during panic episodes.

  4. Any chance I won’t be able to talk due to sore throat/discomfort? Well, I guess there’s always a chance, but what I mean is, how likely is it? The thing is, I’m supposed to have a phone consultation w/my editor the next day and I’m not sure whether I might need to postpone it.

  5. What else should I have asked you? If there’s anything else useful I should know but forgot to mention (or just didn’t think of it), please let me know!

Thank you very much for listening to (well, reading) my rambling. I’m always wordy, but when I’m this anxious I get an even worse case of logorrhea.

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Hey choie! I am sorry you are dealing with this.

I have had thyroid nodules for years and have had a number of these procedures, so many in fact that I don’t quite know the number. Good news: no cancer ever! the results have always been: yay, you’re fine! Bad news: it doesn’t feel great, however you can get through it.

  1. I don’t know the actual odds. Based on MY experience these nodules have never cancer.

  2. I think everyone is different, but my experience is the pain during and after has been significant. I have found getting a needle in my neck extremely unpleasant. Although they numb the skin with lidocaine or similar, that doesn’t really affect the pain below the skin, and this isn’t like a blood draw where the worst is the prick to get in. After the needle has gone in, there is a lot of pressure.

I have had doctors say: you can go back to work after, but I would not do this unless you have no choice. I would especially not do this if your work involves exertion or precision. I always plan to take the rest of the day off, not only from work, but from all activities, expectations and duties. It is not just the level of pain, which has not really been too great, but the location…there is just something so personal and vulnerable about the neck that leaves me feeling shaken and very emotional.

Ask you doctor about taking pain medication before the procedure. I think I’ve been told it’s fine to take Tylenol before and they say not to take ibuprofen.

  1. Breathing…hmm. I think I have breathed, but shallowly. You do need to stay still, and this is hard! I have felt like I was fighting every fight or flight instinct.

  2. I don’t remember ever having a sore throat. I think a phone consultation the next day will probably be fine. If I was having trouble talking it was just from general pain the day of.

  3. You should have asked me (and your doctor) **How about anti-anxiety medication? ** The first few times I had this procedure done I had ativan or valium prescribed and I think this would probably be a good idea in your case. It complicates logistics because you will need someone with you to drive you home…they wouldn’t do the procedure if I hadn’t brought someone with me. (After the first few times I decided I didn’t need the anti-anxiety meds).
    How many times will the needle actually go into my neck? They may only be biopsying the larger nodule or they may be doing both, or maybe I didn’t read thoroughly enough and there’s even more than two. To my dismay, at my first biopsy they said they did three “passes” at each nodule, to get a good sample. Since I was having three nodules done, this was nine times the needle went in!

Most times the doctor has done more than one “pass” on each nodule so most times this has been a more than one jab to the neck fun time. A few times the doctor felt like only one time was sufficient.
**
Choie** you can get through this! Don’t feel bad for feeling scared or for finding it painful and draining. In other threads on this topic I found a lot of people answering: “it was no big deal!”, but to me it HAS been a big deal. Please call your doctor to ask about anti-anxiety medication and pain medication before the procedure. Insist on getting a call back, don’t be afraid to be a pain in the neck (I crack myself up).

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I had one two years ago. My doc found a swelling during a routine physical. An ultrasound revealed a large (3.95 cm) nodule, so a FNA was scheduled. Your delay is not uncommon. I think mine was about a month after the ultrasound.

  1. Your endocrinologist is telling you the truth. It’s very likely benign. Even if it isn’t–mine wasn’t–it’s very, very treatable. I did have thyroid cancer. I had surgery to remove my thyroid, and now I take a daily pill. I won’t say it’s “nothing” (it’s surgery after all), but won’t change your life dramatically and it’s over in a few weeks. It likely will NOT be your diagnosis, but on the off chance it is, you’ll have a sucky month or so then get back to life.

  2. I think this is one of those things where everyone is different. I don’t remember mine hurting much at all. For me, it truly wasn’t worse than having blood drawn. For Carlotta, it was much worse. It may be that mine was easier because I had such a large nodule.

  3. I don’t remember being told not to breathe, just to lie still.

  4. I had no effects from mine. A friend had a sore throat for a couple days, but she didn’t have trouble talking. Just like having a bit of a cold.

  5. I agree that you should ask about getting an anti anxiety med for the procedure. You’ll need someone to drive you home, but you will probably want a friend along anyway if you’re anxious.

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Hi choie

Sorry you’re going through this! I had a fine needle aspiration biopsy about 15 years ago. I had quite a large lump. It was ‘suspicious’ and they advised removal. I had 7/8 of my thyroid removed and was on thyroid replacement medication for several years. These days I only need to take calcium. So…

  1. Yes, I think your endocrinologist is telling you the truth.

  2. I actually didn’t find the needle biopsy too bad and I’m not brave at all. The needle hurt a bit going in and there was pressure type pain when they were actually aspirating. It wasn’t nice but it wasn’t the worst thing in the world.

  3. I don’t remember being told not to breathe but perhaps that did happen. I had be still and I couldn’t talk or swallow while the needle was actually in place. That part of it wasn’t too bad. I don’t mind needles though so I wasn’t ‘scared’ of having the needle there. I can imagine it would be awful for those who don’t like needles.

  4. It was sore for a couple of days afterwards but I didn’t have any trouble talking.

  5. It’ll probably seem a lot worse if you’re anxious so I agree you should ask for something to take the edge off.

It sounds like there’s a few of us here who’ve had the same procedure so ask away if you think of more questions!

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I had an FNA on a thyroid lump that turned out to be a cyst, so I think the biopsy itself was probably a different sensation. Mine was similar to a blood draw. Maybe not even that much sensation.

In any case, my surgeon then and my sister’s surgeon later when she had the same procedure both said that thyroid cancers are very slow growing, so that’s why there’s very little risk in even long delays. And chances are very good it’s not a cancer at all. Hope this is helpful.

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Thanks very much, carlotta, MaddyStrut, Gullible’s Travels (great screenname) and jsgoddess! I really appreciate your taking the time to read all that and give me such thorough responses–including to the questions I forgot to ask. :slight_smile:

I really shouldn’t have been looking up that stuff late at night. It was just asking for rising fear and stress, which, sure enough, was the result. I’m so predictable.

Yeesh, I can totally understand that. I expect to be keeping my eyes tightly shut the whole time, whatever little good that may do.

Luckily my job is freelance proofreading, and I do have a weeklong assignment for my biggest client. If at all possible I’ll do the work once I return, assuming I don’t fall asleep since I know I won’t be sleeping the night before!

I’ll just hope that they won’t have much for me to do. (Sometimes with this client, they’ll book me for a day, and end up not needing my services. Too bad, they get charged anyway! :D)

That’s a great suggestion, and one I wouldn’t have thought of! Re: the anti-anxiety meds, I already take three Xanax a day (per my prescription… but I’ve pretty much reached tolerance withdrawal, which is where my body is so used to the meds that it feels as if I’ve lowered my dose and am thus seeing the return of some of my anxiety symptoms. I’ll be tapering off the Xanax soon… it would’ve been sooner but there is NO way I’m decreasing my meds while I’m dealing with this stuff.

Anyway I do have Ativan that I only use as-needed in a full-blown panic attack. Maybe the doc will recommend I take one. Or better, two. Driving won’t be an issue, both because I’m in NYC and cabs are plentiful, but also because I’ve never felt zonked or super-relaxed at all by any anti-anxiety med. They can sometimes calm me but they don’t make me flollopy or blissed out, the way some people describe 'em. I kinda feel ripped off, to be honest!

I should’ve probably mentioned that a small part of my nervousness is that despite my advanced age, I’ve never had any real medical procedure other than those cat scans and sonograms, which are non-invasive; I guess I’ve had three root canals, and one extraction, but I dunno if those count. Point is, this is pretty foreign.

Oy, that’s just great. :eek: Adrenaline and that fight/flight thing are both major aspects of my panic attacks. I wonder if they’ll allow my sister to come in with me? If she’s holding my hand and I’m closing my eyes, maybe I won’t feel as panicky.

Really sorry you had such difficult times, carlotta. Hopefully the cancer-free diagnosis made it all worth it!

Oofa! Yeah I am glad I did at least enough research to expect multiple passes. Thus far my doctor only mentioned the two nodules, and as far as I know it’s just the larger one they’re gonna be poking at. But maybe they’ll decide to go for the 3.3 mm one just in case. (Gosh that’s awfully small! I just realized I don’t know if this’ll be done guided by a sonogram. I sure hope so.)

:slight_smile: Thanks, carlotta! You’re very kind and have given me really good advice here.

Yipe, 3.94 cm… that’s bigger than an inch! Did it hurt or was it noticeable/palpable once your doc pointed it out? As it is I’m wondering how I don’t feel my 1/2 inch-sized nodule; seems like the throat is small enough that anything of that size would bring discomfort.

I’m very very glad things are better for you now, MaddyStrut. How soon after the diagnosis did you have your surgery?

The timing is pretty bad for me. Despite my neuroses and semi-agoraphobia (I guess that can be bundled in with the neuroses), I somehow found the courage a few months ago to sign up for a weeklong writing workshop/retreat down in Virginia, and it’s scheduled for 2.5 weks after the FNA (June 19 - 26). Sigh. It was quite a coup to have had the balls to sign up, but now I’m worried that in addition to all the other angst about this thyroid thing, I won’t be able to go after all.

Then again, that’ll be the least of my worries if the diagnosis is, uh, ungood. I’ll get over the loss.

Yes, I definitely agree that’s a very good plan. Thanks again, MaddyStrut, and congratulations once more on making it through all this.

Whew congrats to you too, Gullible’s (if I may call you that!). I’m surprised you eventually stopped needing the replacement meds. I thought once they yanked most or all of your thyroid, something like Synthroid was a lifelong companion. Nice to hear things leveled out there!

:slight_smile: Thanks. Your descriptions (along with the others in the thread) are very helpful. Even if it is pressure/uncomfortable, at least expecting the discomfort/pressure/pain/whatever is better than going in there and thinking something’s terribly wrong because it’s causing pain.

I’ve gotten quite used to needle sticks after all the times I’ve ended up in the ER due to my damn panic attacks (which I thought were heart attacks), and they’re almost always much better than the nurses or docs warn me.

I do bruise a lot afterward, though, so I’m expecting to have quite the attractive throat decoration for a while. (Oy, my vanity should be the worst thing I worry about!)

Yeah, I think I’ve gotten needle-neutral for the reasons mentioned above. But OTOH, as Carlotta mentioned, getting jabbed in your throat could very well feel different, emotionally speaking. Hence those closed eyes!

Very grateful for your info, Gullible’s Travels!

That’s a fortunate situation! I’ll cross my fingers for that one. :smiley:

Yes, jsgoddess, thank you so much. I don’t know of anyone in my family who’s had thyroid issues, so I wasn’t able to turn to them for advice. I do have one friend who had thyroid cancer ten or so years ago, and she’s fine now. So… hopefully this is a tempest in a teapot and I’ll be able to look forward to my retreat soon.

I just remembered another question I need to ask my doctor: how long does it take to get results back? I really don’t want to go on the trip with this hanging over my head. I know the length of time varies significantly so I gather it’s not helpful to know what other patients have experienced.

I also want to ask my doc to have me come in no matter what the result; this way I don’t have to be certain it’s bad news.

Once more, thank you all so much for sharing your experiences and advice. It means a great deal to me.

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I couldn’t feel my giant nodule at all prior to the doctor finding it. After he pointed it out, I could feel some puffiness when I felt the area, but the nodule itself didn’t hurt at all. My surgeon said they are very slow growing, so I just didn’t notice it. Looking back at pictures from that time, I can actually SEE it. But it came on so gradually, I didn’t at the time.

I think my surgery was two to three weeks after getting the diagnosis that it was cancerous. With mine, the cells weren’t obviously cancerous, so they had to send the sample for a second review. That took extra time. The second team also said “not obvious but weird looking.” Confirmation that I am weird down to the cellular level! :stuck_out_tongue:

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Hi again guys. Thanks MaddyStrut for the follow-up!

My biopsy’s on Thursday morning and I finally contacted my endocrinologist to ask the various questions you all helped me with, plus one of my own. Here’s what I got:

  1. Will it be a sonogram-guided procedure? Yes.

  2. Can they give me anti-anxiety meds? No, they don’t usually do that, but she suggested I talk to my psych. doc to ask for a short-acting medication (which I already have) if there’s a concern re: a panic issue. Kinda disappointed there, the IV Ativan works so much better for me! Really I think now my pills are as effective as Flintstones vitamins.

  3. How many nodules do I have, and is it possible the doctor will find more during the procedure and will have to biopsy them, too? Apparently there were three nodules, not just the two I’d known about. The first two are in the middle part of the thyroid and are very small (one of them was the 3.3mm nodule I knew about, so I guess the 2nd is roughly the same size) and don’t need to be biopsied; the third is on the right lobe and is the 1.5cm one they’ll be testing.

The doc said that the earlier sonogram is much more thorough than the one used during the procedure, so she says it’s not at all likely there’ll be something unexpected. So it’ll just be one nodule.

  1. Will I get any local anesthesia? No, they usually don’t do that, since the needle that administers the lidocaine is bigger than the biopsy needle and would cause more pain than the biopsy. I’m dubious about that, but what can you do. Shoot, I just realized I forgot to ask her if I could take a Tylenol beforehand.

  2. Who’s doing the surgery? Another regular Endocrinologist. The only reason my doc doesn’t doing it is that the other doc graduated a year before her. I didn’t have the courage to ask, “how many of these procedures do they do?” even though I was kinda dismayed that they only have a year’s more expertise than she does. She graduated in 2014 so… it’s not exactly a lengthy career in either case.

However, they usually have a cytologist on hand to make sure the samples are useable.

  1. *Finally the big question: How long will it take to get the results? *She said it’ll take “within a week” to get the results, and they’ll call me with them. That’s going to be a long frickin’ week. :eek:
    So that’s it. I hope I didn’t leave anything out. Each day my nerves are getting more and more taut, like someone tuning a guitar string. I’m not even buying any luggage or stuff for my trip later in January, because I’m afraid I won’t be able to go. Oy, give me strength! Thanks again to everyone for your support.
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choie, I’m so sorry this is so stressful. I know from anxiety, so no pooh-poohing will be coming from me!

All I can say is that sometimes the dread is worse than the event. Hang in there. You don’t have to buy luggage if that adds to your stress. Your imagination is probably your friend in a lot of circumstances, but less so right now. Consider binge watching Very Silly TV. I recommend “The New Girl” and “Revenge”!

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I also had an FNA a few years ago. I’m sorry for the delay in responding; I didn’t see this thread earlier. I don’t have much new to add, but my personal experience was essentially painless and trouble-free.

My concerns beforehand were a bit more comical. The doctor ordering my test used a pre-printed general form, with a series of check-off boxes to indicate which part of the body was to be biopsied. My problem was that he made an X through “thyroid” that was so large and erratic, he had basically also checked the box below it, “trans-rectal prostate.” The latter requires sticking a spring-loaded needle gun up the patient’s back entrance and firing, and I had visions of being mildly anesthetized and unable to protest while they mistakenly probed me like a UFO abductee. My wife suggested that I write “wrong end” on my bottom, but then didn’t offer to help me.

In the end, as it were, everything was fine. They went after the correct area of the body, and I didn’t feel a thing.

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:slight_smile: Your wife’s idea was hysterical, Tom Tildrum. A good woman to have in a crisis.

Thanks to you and jsgoddess! Your encouragement is very kind.

As we get near the 24 hour countdown I’m finding myself getting into a fear spiral. I do try to distract myself, I promise, it’s just I can’t figure out whether to be afraid of the pain (which is described as ranging from ‘a minor bee sting’ or ‘being stabbed by a miniature version of Satan’s pitchfork’ even when people get the local anesthesia) or… everything else.

It’s my catastrophizing of some unforeseen complication like my gagging or having the needle pierce my larynx and then I can’t ever sing again, or worst of all, having some kind of Joan Rivers experience and ending up choking to death during what’s supposed to be a minor operation. Oh and then there’s the whole “is it cancer?” thing, let’s not forget the whole reason for doing this.

Yeeeah, jsgoddess, you’re definitely right in saying it’s not always great having a highly active imagination!

Sigh. Anyway. Thank you all very much for tolerating my panicky whining, and helping me through this angsty time.

I’m trying to figure out how Jackmanjii (I think that’s his screenname?) missed this thread–IIRC he’s a cytopathologist, or maybe an Endocrinologist? Either way he’s done thousands of these operations and from reading the archives, he always seems to appear when anyone talks about thryoids. Maybe it’s cloudy and he can’t see the “Thyroid Signal” (which looks like a butterfly rather than a bat, I guess) I’m sending out. :slight_smile: Or more likely he’s just sick of answering the same questions!

Thanks again and have a good night, guys.

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Oh dear choie, I wish I could say something that would help reduce the worry. Deep breath if you can and I hope it’s nowhere near as bad as you’re imagining! Good luck and all the best, will be thinking of you :slight_smile:

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I know you asked for no comments from people who haven’t had a thyroid FNA. I myself have *not *had one, but I’ve *done *numerous. I have a suggestion or two for you at the end; you can skip down there if you find me too long winded here.

Different places do things differently, so your experience may vary somewhat from what I will tell you:

Firstly, as you already know, most thyroid nodules are benign. We do not biopsy most nodules, yet even the vast majority of nodules that are “scary enough” to biopsy (based on size, presence of calcifications, and other features) yield benign results. Results come back in several “flavors”, but basically boil down to “benign”, “intermediate”, and “cancer or possibly cancer”. “Benign” nodules usually get followed with ultrasound (with the possibility of re-biopsy if there is significant growth or other suspicious features develop). “Intermediate” nodules are usually re-biopsied. The last group includes “thyroid carcinoma” and “suspicious for carcinoma”; this group is excised (usually with at complete or hemi-thyroidectomy), but it is worth noting that some of these will not turn out to be cancer in the end. The most common kind of thyroid cancer *usually *responds well to treatment.

BTW, assuming that your 1.5cm nodule is being biopsied based on size alone (and lacks other suspicious features), it is only just large enough to warrant biopsy by radiology standards. Endocrinology standards permit biopsy of smaller nodules, presumably at the cost of more negative biopsies. This is kind of irrelevant, since you qualify for biopsy on nodule size alone by both standards and size is the least important criterion, but it may give you some comfort to know that your nodule is indeed on the small side (around 1/2 inch).

(Radiology standard- see table 2 on pg234 http://c.ymcdn.com/sites/www.sru.org/resource/resmgr/docs/2005_consensus_conference_st.pdf )

(Endocrinology standard- see fig 1 on page7 https://www.aace.com/files/thyroid-guidelines.pdf)

The FNA itself is frequently done with very skinny needles (usually 25g or 27g, for those keeping score). This is the same size as most numbing needles, and because the numbing itself stings a bit, many do not use local anesthetic. I do multiple passes per nodule (usually 3-5passes per nodule), so I myself do use local anesthetic, after which patients may feel “pressure”, but rarely report pain. But, yes, with me, the numbing is the “painful” part of the procedure- this varies with different patients.

When the FNA is done, you will leave with a small “bandaid” on the neck. Restrictions are usually minimal; I restrict patients to light activity for the rest of the day and ask them to hold aspirin for the next 24 hours, probably in an excess of caution. It would not be unlikely to have a bit of neck soreness, especially with swallowing, afterward.

The most common risks include:
-bleeding: rare, less than 1%. Rarely, a hematoma (“superbruise”) may form, unlikely to be dangerous in the FNA setting, but associated with more “soreness” in the following days
-infection: extremely rare
-non-diagnostic biopsy and false-negative: this risk partly depends on the skills of those doing the biopsy and those reading the slides, but it really is the biggest risk, especially if you include the indeterminate biopsies in this group, which many people don’t. Basically, you may be referred for re-biopsy if there are not enough cells for diagnosis in first biopsy, if the cells are “indeterminate”, or even if you have benign results but your nodule was “very scary looking” or later develops “scary” features. (The reason I do multiple passes per nodule is to minimize this risk.)
Suggestions:
-The suggestion of a pre-procedure bump to your anxiolytic meds is a good idea.
-Discuss your anxiety to the doctor performing the biopsy (and their staff).
-If you can, bring along a portable music player with relaxing music, and ask if you can play it during the biopsy.
-Some people do better with a washcloth or other blinder over the eyes.
-Many doctors will tell you what they are doing through the biopsy; some patients don’t want to hear it, but I strongly believe that this really helps with anxiety throughout the procedure; (Knowledge is power!) and (No one like surprises in the doctor’s office.)
-Some people swear by essential oils (scent of lavender) to mitigate anxiety; I haven’t used it, so I can’t attest to it myself
-Lastly, understand that when this is done, you will wonder what you were worrying about. Just think about poor Tom Tildrum and the prospect of surprise prostate biopsy!

14

Hey Gullible’s Travels, I’m so grateful for the support. I’ve got a rough week ahead–well, hopefully that’s all I need to get through. I’ll do my best to relax if at all possible. Thanks!

Blue Blistering Barnacle (boy I hope that’s not what my thyroid nodule looks like!)! When I issued my caveat above, I definitely didn’t mean to rule out those who’d performed FNABs on thyroids! Your answer is extraordinarily thorough and, wow, I’m immensely appreciative that you took the time to respond in such helpful detail.

FWIW, looking at my lab results it doesn’t seem that the size alone was the worrying feature. I’ll stick the details in a spoiler box so people can avoid 'em if they want.

[spoiler]Thyroid gland: Normal in size. Mildly heterogeneous in echotexture. Normal vascularity.

Isthmus
Thickness: 0.2 cm

Nodules:

  1. Junction with right mid pole, 0.8 x 0.5 x 0.9 cm, mixed solid cystic with isoechoic solid component, no suspicious calcifications
  2. Junction with left mid pole, 0.7 x 0.3 x 0.6 cm, mixed solid cystic, no internal calcifications

Right lobe
Size: 4.5 x 1.7 x 1.7 cm
Nodules: None identified.

Left lobe
Size: 4.3 x 1.5 x 2.1 cm

Nodules:

  1. Mid pole, 1.5 x 0.9 x 1.2 cm, heterogeneously isoechoic with thin hypoechoic rim, few punctate internal echogenic foci

Lymph nodes: No abnormal lymph nodes in the bilateral level II, III, IV,V and VI regions.

IMPRESSION:

  1. A 1.5 cm solid left midpole nodule with few punctate internal echogenic foci which may represent microcalcifications, a suspicious sonographic feature. Tissue sampling may aid in further
    characterization.

  2. Few nonspecific subcentimeter mixed solid cystic isthmic nodules.

So there are a few troublesome elements, like the presence of possible microcalcifications and so on, which increase the risk factor 3x or so. At least the lymph nodes are normal, from what they could see on the US anyway. [/spoiler]

Anyway, your suggestions sound very helpful, especially asking the doctor to tell me what he or she is doing. I need to be prepared, especially since apparently (to the contrary of what I’d read earlier) patients are often told not to hold their breath. I’d imagine that’s because you tend to close/tighten your throat muscles when holding your breath? If they just jab me with the needle there’s no way I’m not going to freeze up/react to it.

And I most certainly will be closing my eyes! :slight_smile:

Thanks again, BBB, for your highly informative and helpful post.

15

Sounds like a mixed bag, but not terrible, and anyway, you are doing what you can to take care of this.

Internal echogenic foci are worrisome for microcalcifications, which are a problem and do warrant biopsy.

Benign colloid cysts also have echogenic foci, and although the texts, papers, and lectures imply that these are easily distinguished, I think that there is considerable overlap in appearance.

The thin hypoechoic rim is a “halo” and is usually a favorable sign (but unfortunately, this good sign is trumped by the others).

16

Good luck tomorrow, I’m sure you’ll do fine.

17

Thanks very much, Blue Blistering Barnacle.

Yeah, given the presence of microcalcifications and the other noteworthy elements, I’m prepared for a cancer diagnosis.

I’m very grateful for your help and good wishes.

18

I had one a couple of years ago: scariest part was being “upside down” in that chair, while they did it. I have a kind of phobia related to that. No cancer. I’m sure you’ll be fine.

19

My sister had to have half her thyroid removed a few years back. It was a very uneventful procedure. No fun, of course, but it was in an ambulatory surgery center, a short procedure, and an uneventful recovery.

I hope it doesn’t come to that, but if it does, chances are good it’ll be uneventful. And that’s a great word, when it comes to medicine! :slight_smile:

Sending good thoughts your way for tomorrow.

20

You will be fine. Just breathe (for now). Here’s hoping yours is as near painless as mine. You really will be fine!