How often should a thyroid nodule be biopsied/

[skooter63]

I had a biospy of a thyroid nodule in 2004 as directed by an endo doc.  It came back benign.  Recently I had another ultrasound (since a 2004 ultrasound). It noted a heterogenous predominately  solid lesion with numerous course and microcalcifications.  The interpreting radiologist recommended a biopsy.  My endocrinologist said that if I thought my first biopsy was a good one that he did not think another biopsy was needed.  I had my other biopsy at a different facility, with a different endocrinologist.  As far as I know it was a good biopsy.  I really don't know how to tell.  Since my new ultrasound report notes different types of calcifications, should I try to find an endocrinologist that will biopsy it?  My first ultrasound did not mention calcifications.  My nodule currently measures 2.9 x 1.3 x1.4 cm. The isthmus measures 0.3 cm.  This is down from my 2004 ultrasound.  I have only had one slightly abnormal lab result that the doctor said was indicative of hyperactive goiter.  This lab result was also in 2004.  A nuclear medicine test in 2004 indicated a multinodular goiter.  Thanks for your time and info.

[Mark Lupo, M.D.]

My approach is to re-biopsy a nodule like this given its size and 6 years since initial biopsy- especially if I don't know the quality of first biopsy.  However if the nodule is clearly smaller than in 2004 (is this what you meant by the ultrasound report?), then observation without repeat biopsy is reasonable.

[Mark Lupo, M.D.]

Would repeat FNA w/ presence of coarse and microcalcifications in a nodule this size.  the occupational exposure is not yet thought to increase risk.

[skooter63]

Thanks so much for your response Dr. Lupo.  My thyroid ultrasound in 2004 read as follows:  Right lobe of thyroid gland measures 5.1x1.8x1.2 cm. There is a small hypoechoic lesion within the rt lobe measuring 2.8x2.6x3.4mm.  This most likely represents a simple cyst.  The left lobe measures 5.2x2.3x2.0cm and contains a heterogeneous lesion measuring approximately 3.7x1.6x1.9cm.  This most likely represents a solid nodule.  However, a cyst with significant internal debris might have a similar appearance. Further eval with nuc med thyroid study recommended.  My endocrinologist at that time had radiology do a biopsy with us and it came back benign.
My 2010 thyroid ultrasound read as follows:Real-time sonography performed of  thyroid gland and jugular chains bilaterally.  The rt thyroid lobe measures 4.2x1.1x1.1cm and contains several subcentimeter  nodules, the largest measuring 0.5cm. The lt thyroid lobe is  enlarged, measuring 5.3x1.4x2.6cm.  A heterogenous, predominantly solid appearing mass measuring 2.9x1.3x1.4cm is visualized within the mid to lower lobe.  Numerous coarse and microcalcifications are visualized within this lesion.  The isthmus measures 0.3 cm in thickness.  No adenopathy is seen in either jugular chain or supraclavicular region.  Impression:  1. Dominant left thyroid lobe mass.  US guided fine needle aspirate is recommended.  2. No adenopathy is seen in either jugular chain or supraclavicular region. How often would you perform ultrasounds on this type of case?  How often would you recommend biopsy, dependent on changes in ultrasound appearance?  The endocrinologist that I have went to for the last several years (I had to change due to an insurance change back in 2005) has never ordered a re-biopsy or an ultrasound.  The 2010 ultrasound was ordered by my primary doc when I went to her office wondering if I had mononucleosis due to what I thought was a prolonged period of tiredness.  I have been going once a year as directed to the endocrinologist and he orders a yrly TSH that has been normal.  That may be all that is warranted, I guess I was just a little confused by the microcalcifications on the 2010 us.  My mother and my sister have both had estrogen positive breast cancer and I have had several breast biopsies myself due to microcalcifications on mammograms.  I guess it is not as troublesome to find microcalcifications in a thyroid nodule.  Also my sister has hypothyroid, but no nodules.  l, myself was an xray tech for about 9 years.  If I understand correctly that doesn't really increase my chances of getting thyroid cancer, correct?  I am a 47 yr old who has had a complete hysterectomy  about 2 years ago. Hope this is not too much info.  Thank you so much for your time and information.