What Is a Thyroid Biopsy?
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Medically reviewed by Do-Eun Lee, MD
A thyroid biopsy is a procedure that checks for signs of thyroid cancer. Thyroid cancer is a type of cancer that develops in the thyroid—the butterfly-shaped gland located at the front of the neck. Your thyroid is part of the endocrine system and helps to regulate the body’s metabolism.
Your healthcare provider may recommend a thyroid biopsy if you develop a thyroid nodule, or a growth or lump in or on the thyroid. Thyroid nodules are common and can develop due to cancer, infections, or other benign (non-cancerous) causes. Most providers recommend obtaining a biopsy of any nodule that is large enough to feel. Usually, the nodule is at least 1 centimeter large.
A radiologist (a medical doctor who performs the biopsy) uses a needle to obtain thyroid cells and tissue. If a larger sample is needed, a surgeon performs surgery to cut part of the thyroid gland. After the biopsy, your provider will send the sample to the lab. A pathologist (a medical doctor who specializes in diagnosing diseases) examines the sample under a microscope to look for cancer cells.
Purpose
The purpose of a thyroid biopsy is to determine the cause of a thyroid nodule. If you notice a lump on the front of your neck, your healthcare provider will examine it to determine if a biopsy is needed. Thyroid nodules are very common, especially in people assigned female at birth and older people.
The risk of thyroid cancer also increases if you have any of the following risk factors:
Nodules that are hard to the touch
Hoarseness in voice
Age younger than 20 or older than 70
History of radiation therapy to the neck
Family history of thyroid cancer
Types of Thyroid Biopsies
There are three different types of thyroid biopsies. Your healthcare provider will consider your symptoms, test results, and overall health when recommending which type of thyroid biopsy is right for you.
Most people who undergo a thyroid biopsy have a fine needle aspiration because this option is the least invasive. If the results of the biopsy come back inconclusive, your provider may recommend a different type of biopsy.
The types of thyroid biopsy include:
Fine needle aspiration (FNA): Removes a small amount of thyroid cells or tissue with a thin, hollow needle attached to a syringe from your thyroid
Core needle biopsy: Takes out thyroid tissue with a large, hollow needle attached to a spring-loaded tool
Surgical thyroid biopsy: Completely removes all or part of the nodule
How Does It Work?
During a thyroid biopsy, your radiologist, surgeon, or endocrinologist (a doctor who specializes in hormones) will numb the neck before removing part of the thyroid nodule tissue or fluid. Once your provider obtains a tissue sample, they will send it to a lab for a pathologist to review for cancer cells.
Before the Test
When you arrive for your thyroid biopsy appointment, you will likely be asked to fill out screening questionnaires and a treatment waiver. If your healthcare provider sent you the forms ahead of time, bring them with you.
The location for your appointment depends on the type of biopsy you’re having. A fine needle biopsy is the most common type of thyroid biopsy, and your provider will likely perform it in their office. If you need a different type of biopsy, your healthcare provider will let you know which location can complete the procedure.
It is common for radiologists to use imaging technology, like an ultrasound to guide the biopsy needle to the thyroid nodule. Your provider will likely ask you to lie flat on the exam table with your chin slightly up to expose your neck. Your healthcare team may give you a pillow to place under your neck to help the imaging tests get a clear picture of your thyroid.
To perform an ultrasound, your provider will apply ultrasound gel to the front of your neck. The gel may feel cold at first. Once your provider locates the exact area to biopsy, they will clean your neck and administer local anesthetic to numb the area. Keep in mind: the numbing medicine may sting at first, but this feeling goes away during the procedure. The entire procedure usually takes about 30 minutes.
During the Test
Once the front of your neck is numb, the radiologist will insert a small needle into the thyroid nodule and gently draw back the syringe to remove tissue and liquid. Your provider will then remove the needle from your neck and place a sterile dressing (such as a bandage) over it to stop any bleeding.
It is common to feel pressure during a thyroid biopsy but you should not expect to feel pain. During fine needle aspiration, you will not be sedated or drowsy and will be able to communicate with your healthcare team.
After the Test
Once your biopsy is complete, your healthcare provider will have you rest while they apply pressure to the site to stop any bleeding. Once your biopsy site is covered with proper bandaging, you will be able to sit up. Be sure to sit up slowly because you may feel lightheaded at first.
In most cases, you will be able to go home after your biopsy. Most people do not need to stay in the hospital overnight after a fine needle biopsy. After your biopsy, your provider will send your tissue sample to a lab for a pathologist to review.
Risks and Precautions
Every medical test comes with certain risks and possible side effects. Risks of thyroid biopsies may include:
Infection: It is possible to experience an infection at the biopsy site. Signs of infection may include redness, swelling, pain, and pus.
Bleeding: Bleeding after a thyroid biopsy is rare but possible. Bleeding can occur in or around the thyroid, as well as near the trachea (windpipe). If your biopsy site does not stop bleeding once you go home after your biopsy, call your healthcare provider.
Trouble breathing: If you experience bleeding around your trachea, it can affect your ability to breathe. If you notice any trouble breathing, seek medical attention right away.
How to Prepare for a Thyroid Biopsy
Going in for a thyroid biopsy can feel scary. Knowing what to expect may help. Consider the following factors when preparing for a thyroid biopsy:
Location: A needle biopsy usually takes place in an outpatient clinic or doctor’s office. A surgical biopsy may take place in the hospital’s operating room.
Attire: When you arrive for your biopsy appointment, you will likely have to change into a hospital gown. Plan to wear loose, comfortable clothes to your appointment. Avoid wearing any necklaces or jewelry around your neck.
Food and drink: You can continue to eat and drink normally before a needle biopsy. If you are having a surgical biopsy that requires sedation, your surgeon will likely recommend fasting (not eating or drinking) for several hours before the biopsy.
Medications: If you are currently taking any medication that causes your blood to thin such as aspirin, your healthcare provider will likely recommend stopping it before your biopsy.
Items to bring: When going to your biopsy appointment, plan to bring your driver’s license or identification card, insurance information, and any forms that were mailed to you.
Emotional support: If you are having a surgical biopsy, you will need to arrange for a ride home after the procedure. Ask your healthcare team where your friend or family member can wait during your biopsy.
Cost and insurance: Before your biopsy, plan to call both your insurance company and hospital billing department to ask about coverage and copays.
Results
Your thyroid biopsy results will determine if you have thyroid disease or cancer. When the results are ready, the pathologist will send a report to your healthcare provider. Your provider will then contact you via the phone, email, or an electronic medical record to discuss your results. Results from a thyroid biopsy may take a few days to two weeks to come back.
Interpreting Your Results
The results of your biopsy will either be malignant, benign, or inconclusive. Here is what that means:
Malignant result: A malignant result means that the pathologist saw cancer cells in your tissue sample. This means that you have thyroid cancer. The next step will be to see an oncologist (a doctor who specializes in cancer) for further testing and a treatment plan.
Benign result: A benign result means that there were no cancer cells in your sample, and the pathologist does not believe you have cancer. If the pathologist sees any changes in the thyroid tissue or other signs of thyroid disease, they will note that in the report.
Non-diagnostic result: The pathologist found abnormal cells in your sample, but these cells are not enough to diagnose you with a thyroid condition. In most cases, you'll need to test again with a second biopsy.
Indeterminate result: An inconclusive test result means that the pathologist did not detect cancer but also cannot rule it out. If you receive an inconclusive result from a fine needle aspiration biopsy, your provider may recommend a core needle biopsy or surgical biopsy.
A Quick Review
A thyroid biopsy is a diagnostic test that looks for signs of thyroid disease or cancer. The thyroid is a small, butterfly-shaped gland located at the front of the neck. The thyroid is part of the endocrine system and is responsible for secreting thyroid hormones.
The most common reason for needing a thyroid biopsy is if you have a thyroid nodule—or, a lump or growth on the thyroid gland. Thyroid nodules are common and may be caused by cancer, thyroid disease, infection, or other less harmful reasons.
In most cases, your healthcare provider will perform a fine needle aspiration for your thyroid biopsy. During this procedure, a radiologist uses an ultrasound exam to guide a thin, hollow needle into the thyroid nodule. Once the radiologist obtains a sample of cells, they will remove the needle and apply pressure to the site to stop any bleeding. They will then send the sample to the lab for a pathologist to review. Once the results are ready, you can expect your provider to discuss them with you.
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