Fine needle aspiration biopsy

[ceegee]

I have been treated for hypothyroidism for just over a year.  I am currently taking 88 mcg a day of synthroid.

During my regular check-up the doctor felt something else in my neck that he thought might be a cyst.  I had an ultra-sound and the results stated that a thyroid uptake scan should be done.  

My doctor is skipping this and going straight to an ultrasound guided FNAB.  In your opinion can you tell me what he might have seen that would have made him go straight to a biopsy with out doing the uptake scan first?  I did have an uptake scan last year when I was first diagnosed and it came back okay.

Any insight you could give would be very helpful, as I forgot to ask this yesterday when they called and my doctor is only in this office on Thursdays.

Thank you.

[Mark Lupo, M.D.]

Scan is not indicated -- you are on synthroid for hypothyroidism no clearly this is not a HOT nodule (the only situation in which FNA would be deferred).

Procede with the FNA.  

By the way, the "results stated I should have a scan" -- this is by the radiologist whose group also would likely get paid to do and read the scan.....

[rusalka]

I had several scans before my fna. It is about hot and cold and growth. I was scared but in the end it was better than getting a needle in my butt. My encrinoligist is very careful and watches before meds and checks all is necessary. I call him whenever I feel a change and he runs blood and scans when necessary. The fna was negative. Most thyroid cancers are curable if it is. Take care rusalka

[ceegee]

Thanks for your comment.  I am not sure about the drs answer when he mentioned it not being hot. Do you know if the radiologist can tell if a nodule is hot or cold with the utrasound?  I thought that you had to have an uptake scan to tell if the nodules are hot or cold.

[rusalka]

The uptake scan only shows the size and function of your thyroid. Detecting cancer can only be by a fna. My fna was done because my nodules changed rapidly over a 6 month period.

[Mark Lupo, M.D.]

Ultrasound does not tell hot/cold -- but your history pretty much eliminates it being "hot" as you are on Synthroid (ie, hypothyroid).  Hot nodules produce hyperthyroidism.....

Again, no scan needed.  FNA is next step.

[ceegee]

Thanks for coming back and clearing that up for me.  I will have the FNA tomorrow.  Thanks again you have been very helpful.

[ceegee]

Had the FNA biopsy today.  The doctor performing the procedure told me he was getting tissue samples from two lesions on my thyroid.  One on the isthmus and one on the right gland.  The pathologists were in there to assure he had enough tissue.

Has anyone had an experience like this and if so what was the outcome?  The doctor said these biopsies are usually benign, but that is also what the doctors told me three years ago when they did a biopsy of calcifications in my breast, which came back malignant.

Thanks for any comments anyone may have.

[rusalka]

Hope you are feeling good! My test came back negative but before I had it I discussed the issue of breast cancer with the doctor because sometimes with a biopsy on the breast the cells spread or can aggravate not sure and cancer spreads. It happened to my mother.  He assured me that the thyroid was different, though they are testing for cancer cells. But as I said earlier cancer of the  thyroid has a good success rate.  Read through the page some people have had their thyroid removed. Waiting for the results is always the hardest so be patient and positive.