Going Into a Thyroid Biopsy: What to Expect
Medically reviewed by Steffini Stalos, DO
A thyroid biopsy is a medical procedure used to diagnose problems with the thyroid gland. The procedure collects cells from the thyroid to test them in the lab. The thyroid is a butterfly-shaped gland in the neck that makes hormones. These hormones manage the body’s energy levels, temperature, and other functions.
A fine needle aspiration (thyroid FNA) approach, which may be guided by ultrasound imaging, is often the procedure used. It is less invasive, with the needle insertion causing minimal pain, discomfort, and scarring and allowing for a quick recovery.
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A thyroid FNA may be used to examine nodules or growths in the thyroid for disease or cancer. Most of the time, these nodules are benign (not cancerous). But your healthcare provider can’t know that until a thyroid sample is examined in the lab.
This article will discuss why you may need a thyroid biopsy, what it means to have a fine needle aspiration, if the biopsy hurts, how long recovery could take, and what thyroid biopsy results could mean.
Thyroid Biopsy and Pain: What to Expect
A fine needle aspiration biopsy of the thyroid gland should cause minimal pain and discomfort. You may feel a sting when the numbing medicine is injected.
This numbing procedure will reduce the sensation of the needle during the biopsy, which you will feel as some pressure. If it’s painful, let the healthcare provider performing your test know—it should not be painful.
During the biopsy, the healthcare provider will use an ultrasound probe to make sure they’re taking samples from the nodule, not the healthy thyroid. You’ll feel pressure as they press the probe into your neck.
After the numbing medicine has worn off, you may feel slight discomfort in your neck. There might be minor bruising or bleeding, as well.
Other Types of Thyroid Biopsy
A core needle biopsy or a surgical biopsy may be used when the results of an FNA are inconclusive. A core needle biopsy requires a bigger needle. A surgical biopsy is when a surgeon opens your neck and removes a piece of the thyroid gland. They may even remove half of it. You’d be asleep during the operation and would face a longer recovery.
Coping With Anxiety and Anticipatory Pain
While a fine needle biopsy is less invasive than other biopsy types, it may cause people with trypanophobia a bit of anxiety. Trypanophobia is a fear of needles. If you have a needle phobia, talk to your healthcare provider about additional steps you can take or modifications to the procedure.
It can be worrisoome to face a procedure that may hurt. This procedure is less invasive and quicker than many, and the healthcare provider can use numbing creams and shots to make it painless.
It may help to practice some relaxation techniques before the procedure. Avoid this approach if you faint at the sight of needles, though. Other treatments for trypanophobia include cognitive behavioral therapy (CBT) and medications.
You may also be feeling anxious about getting a cancer diagnosis. Finding a growth anywhere can be nerve-wracking as you wait for results. Know that most of the time, thyroid biopsies come back as benign. Also, thyroid cancers have excellent five-year survival rates, especially when caught early.
Purpose of Thyroid Biopsy
Thyroid biopsies can help diagnose thyroid issues and are used to examine the cells inside a thyroid nodule. Thyroid nodules are abnormal clusters of cells in the thyroid.
A thyroid nodule may show up on an imaging test you get for another reason, or your healthcare provider may feel the nodule during a physical exam. Nodules are mostly benign, but more tests are required to determine this.
If the nodule is big enough that your healthcare provider can feel it with their fingers (about 1 centimeter or one-third of an inch or larger), they’ll order a biopsy to check that it isn’t cancerous.
Thyroid nodules are very common. Ones large enough to feel with the fingers are found in up to 6% of the population. Up to 35% of people have a nodule when imaged with ultrasound. Even a larger percentage (up to 65%) of people are discovered to have a nodule on autopsy (surgical examination after death).
Day of Thyroid Biopsy
Benefits of a thyroid FNA include:
It requires little to no special preparation.
It is a quick outpatient procedure.
It usually is painless.
It requires minimal recovery time.
Before
Before you get a thyroid biopsy, ask your healthcare provider if you need to stop taking any medicines. Tell them if you have drug allergies, bleeding problems, or are pregnant.
You may need to stop taking blood-thinning medicines a few days to a week before your biopsy. This will decrease the risk of bleeding.
Because you're not being put to sleep, you won't need to fast (stop eating or drinking fluids) before your procedure. An FNA is usually done without a sedative, so you won't need someone else to drive you home.
On the day of the procedure, wear comfortable clothing, but avoid jewelry around or near your neck. During the procedure, you may get some ultrasound gel on your clothing or jewelry. It's water-soluble, nontoxic, and should wash out.
During
During a thyroid FNA, you'll be in a room in a clinic, healthcare provider's office, or hospital. You will lie on your back with your head tilted backward and your neck extended. You will be offered a pillow for under your shoulders.
The healthcare provider will clean your neck with an antiseptic, apply a topical anesthetic to the skin to numb the area, and use tiny needles to inject a local anesthetic.
An FNA may be done by your doctor, a pathologist (a specialist in laboratory analysis), or a radiologist (a specialist in imaging). Your doctor or a pathologist will do an FNA on a thyroid lesion that is readily visible.
If a radiologist is doing your thyroid FNA, they will likely use an ultrasound machine to see where the nodules are. This painless imaging procedure uses sound waves to see inside the body. A transducer and gel are used on the area to make the images seen on a video monitor.
The needle used during a thyroid FNA is very thin—smaller than that used in a blood draw. It may be attached to a syringe in a plastic or metal holder.
The healthcare provider performing your test will insert the needle through the skin into the thyroid nodule using ultrasound images to guide them. Removing the sample itself will only take seconds.
The needle is removed, and a new needle is used to take another sample. The provider may take two to six samples to make sure they get the nodule and have a good number of cells to analyze in the lab. If the nodule has fluid inside, the sample will be drained.
While the sample is taken, remain as still as possible. You'll be asked to avoid coughing, talking, or swallowing. The sampling procedure will take less than 30 minutes. When the healthcare provider is done taking the biopsy samples, they will apply pressure to the area. This decreases the risk of bleeding. They'll place a bandage but no stitches.
After
After the procedure, you will be assisted in sitting up slowly so you don't get light-headed. You should feel relatively normal and be able to resume your usual activities. You won't need someone to drive you home unless you were given a sedative. You can remove the bandage after a few hours.
Side Effects and After Care
Recovery from thyroid biopsy should be quick. You may feel soreness in your neck for one or two days. Take over-the-counter (OTC) pain relievers if you need them, including Tylenol (acetaminophen) or Advil (ibuprofen). An ice compress may also help.
The risks from a thyroid FNA are minimal and rare. There might be some bleeding from the puncture site, within the thyroid, or nearby areas. Severe bleeding is rare but could put pressure on the windpipe. It’s possible, but rare, that the wound could get infected. It’s unlikely but possible that structures around the thyroid could be injured.
After the biopsy, the samples are examined in the lab. It may take a few days to two weeks to get your results. You may need to do the biopsy again if the samples don’t contain enough cells.
Understanding Thyroid Biopsy Results
The main results from a thyroid biopsy would indicate whether the nodule is cancerous. They can also tell you if you have a thyroid disease, like goiter (enlarged thyroid) or thyroiditis (inflamed thyroid). Most thyroid nodules are benign. Only about 5%of thyroid biopsies show cancer.
Related: Thyroid Testing and Diagnosis
If the thyroid tissue looks normal under the microscope and the cells do not appear to be cancer, your biopsy results are considered normal.
Thyroid biopsy results are typically categorized using the Bethesda System for Reporting Thyroid Cytopathology. It uses six possible results, as follows:
Noncancerous thyroid tumor: Up to 70% of samples are classified as benign. In this category, there is a less than 3% risk that the tumor will become malignant. A healthcare provider will monitor and recheck the nodule in 18 months.
Malignant thyroid cancer: About 3% to 7% of thyroid biopsies show cancer. It’s often papillary thyroid cancer. The next step with a cancerous nodule often is surgery (thyroidectomy).
Suspicious: A nodule may be labeled suspicious if the sample doesn’t show for sure that it is either normal or cancer. There’s about a 60% to 75% chance that these nodules are cancer. You may need another biopsy or additional testing. But in these cases, the next step is often surgery.
“Indeterminate” atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS): The lab may find worrisome features as well as normal features. About 5% to 15% of these end up being cancer. The next steps include another biopsy and genetic testing.
“Indeterminate” follicular neoplasm or suspicious for follicular neoplasm: About 15% to 30% of these are cancer. But it is hard to tell without surgery to remove them or additional genetic testing.
Nondiagnostic sample: When there are not enough cells in the sample, it may be labeled as nondiagnostic. The biopsy should be repeated.
In addition to a pathologist examining the cells in the lab, your healthcare provider may want to look at genetic changes in the sample. They might do this test if the results are unclear, indeterminate, or suspicious from the pathology exam.
The test looks for BRAF, RET/PTC, or NTRK gene changes. These changes would indicate cancer but may also mean that targeted treatment could work well.
Summary
A thyroid biopsy is a medical procedure used to diagnose issues with the thyroid gland. It involves collecting cells from the thyroid for laboratory testing. Most thyroid nodules are noncancerous. A biopsy is necessary to rule out cancer, though.
Fine needle aspiration (thyroid FNA) guided by ultrasound imaging is a common procedure. Thyroid FNA is less invasive than open surgery, with minimal pain and a quick recovery. People who fear needles (trypanophobia) may experience anxiety during an FNA. Healthcare providers can use numbing techniques to make the procedure painless.
You will not likely need to do any special preparation on the day of the biopsy. The procedure is quick, and you can go home right after. You may feel mild neck discomfort for one or two days. Take over-the-counter pain relievers. The risks of complications from the biopsy are minimal and rare.
The biopsy can detect if the thyroid nodule is cancerous. It can also reveal thyroid diseases like goiter or thyroiditis. Most thyroid nodules are benign. Only a small percentage are cancerous.
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