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What is the Thyroid?

The thyroid is a gland at the lower front of the neck. It regulates the level of our body’s overall activity (or metabolism. The thyroid gland is prone to various conditions that are benign such as enlargement (goiter), cyst formation, and inflammation (thyroiditis). There are also different types of cancer that can form in the thyroid.

What is a Thyroid Biopsy? 

Thyroid biopsy is a procedure to remove a small piece of a suspicious area in the thyroid gland so it can be examined with a microscope.  This can tell if there is inflammation, enlargement, or cancer.

Why do I need to do this procedure?

You were diagnosed with at least one area of abnormality in your thyroid gland.  Thyroid abnormalities or nodules can often be felt during the examination, and sometimes they are only noticed because of an imaging test such as an ultrasound, CT, or MRI scan.  Many patients have undergone some sort of functional test like a thyroid scan.  If there is minimal function in the nodule, it is called a “cold” nodule – though that doesn’t distinguish a benign from a cancerous nodule.  Typically a biopsy is required to make that distinction.

How is the procedure performed?

  • If you are taking any blood thinner medications you may be asked to stop taking it prior to procedure.

  • You will be asked to lie on your back with your head tipped backward to extend your neck.  

  • You may be asked to avoid coughing, talking, swallowing, or making sounds during some parts of the procedure.

  • A limited ultrasound will be done to localize the thyroid nodule(s).

  • Procedure site will be cleansed and sterilized .  

  • A medication to numb the area will be administered.

  • A needle (fine or core needle) will be inserted into your thyroid, guided by ultrasound into the nodule.

  • The needle will be used to remove tissue or fluid samples as needed.

  • The samples will be sent to a lab for examination.

  • The needle will be removed and pressure may be applied to your neck to reduce swelling and stop bleeding.

  • Sterile skin glue will be applied to the puncture site.

  • If you receive moderate sedation then you will need to have an IV placed prior to the above.

Care at the procedure site:

The procedure is performed through a small puncture, and often we place a small bandaid or skin glue.   it is normal to have bruising, which could persist for a few weeks. It is safe to shower the day of the procedure.  If skin glue was used, it should fall off by itself in 1-2 weeks. You do not need to do anything. 

What are the possible complications of a thyroid biopsy? 

The main complication after a thyroid biopsy is bleeding.  This is not very common, and when it occurs it is typically controlled by pressure at the biopsy site.  It may lead to a bruise or swelling (hematoma) of the neck which may take several weeks to resolve.  Excessive bleeding is rare, but when it happens may require surgery to control.  If there is bleeding that starts to block the airway then immediate surgery with insertion of a breathing tube will be necessary.   

When will the results of the biopsy be ready?

 Since these specimens need to be processed, we will not be able to give you any results on the day of the procedure. The results of the biopsy are usually ready in 2-3 business days. They will be forwarded to your physician who referred you to us. However, although some preliminary results are available in this time frame, in more difficult cases, additional tests may be necessary and may take several days. Sometimes, we automatically send the samples for a second opinion at a separate institution (eg, Stanford, UCSF, Harvard or Mayo Clinic), which can also take a few days.  

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Can I get copies of the pathology reports and medical records? 

Absolutely. All the medical records are yours! You have the right to get a copy of all medical records, radiographic images, and pathology reports. Contact El Camino Hospital Medical Records at 650.940.7000.

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To get the radiographic images in a CD you should contact the radiology department at 650.940.7050.

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Can we send the pathology samples to a second opinion at a separate institution? 

Absolutely. In certain difficult cases, the pathologists can consult with experts at the best institutions. However, most of the time this is not necessary. The El Camino Hospital Pathology team is extremely experienced. But if you want a second opinion you should contact the department of pathology at 650.940.7000.

When should you call your physician?

● Increasing neck pain or swelling (go to the ER if this happens suddenly).

● Difficulty breathing due to neck swelling (Call 9-1-1 if you cannot get to the ER immediately)

● Severe lightheadedness and dizziness.

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You can reach your Interventional radiologist at 650-404-8445 during M-F 8-5pm or the physician can be reached through the operator after-hours or on weekends by calling 408 739-6000 and asking for the Interventional Radiologist “on call.”

General Instructions:

Sedation

  • If you received sedation during your biopsy, you should not drive, consume alcohol, operate heavy machinery or make any important decisions for the remainder of the day. Tomorrow you should be completely recovered and can go back to the normal routine

Activity

  • You may resume your regular activities (including driving) after 24h unless you have been restricted for another reason.

  • No exercising, lifting have objects or strenuous activity for the next 2 days.

Pain Management

  • Some pain or discomfort at the site of the procedure may be normal. However, it should not be getting worse. For the first day of the biopsy, an ice pack can help relieve some pain and limit any swelling.

  • You may use over the counter medication such as acetaminophen (Tylenol) or ibuprofen (Advil /Motrin) for minor discomfort unless you are restricted from taking these medications.

  • Usually, the pain is not severe and does not require stronger medications. If your pain is very severe it could indicate a bleeding complication.  For severe pain, contact your Interventional Radiologist (as below).

  • If you feel that Tylenol or Advil are not enough for pain control, please contact the Vascular and Interventional Radiology Clinic at 650-404-8445.  If it is after hours or on the weekend, call 408 739-6000 and ask for the Interventional Radiologist on call.

Diet

  • You can resume your normal diet.  You may have a slight sore throat after thyroid biopsy.

Shower

  • You can take a shower tonight. You can take a bath or swim tomorrow. 

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