Do I need a biopsy for a nodular mass at my thyroid?
Hi doc, I had a thyroid ultrasound last week. They found a solid mass lesion in the inferior left lobe with hypervascularity and calcifications. Doc prescribed me a levothyroxine. Do I need to go for biopsy to check for the mass? Thank you.
Welcome to our QnA. From what you’ve told us, presumably, your doctor must have recommended that you go for a fine needle aspiration biopsy because of the ultrasound findings.
Levothyroxine was likely prescribed because your blood test showed that you were producing too little thyroid hormone. This may be a separate issue that’s unrelated to the nodule.
Thyroid nodules are very common – they exist in about 50% of the population. The vast majority of them (95%) are non-cancerous.
However, a biopsy is often necessary to help a doctor differentiate non-cancerous nodules from cancerous thyroid nodules.
The word “biopsy” is scary to some patients as they imagine a major surgery and lots of cutting, but in the case of a thyroid biopsy, doctors can use a small needle to remove cells. This is known as a fine needle aspiration biopsy.
The needle is placed into the nodule several times, and cells are aspirated into a syringe. The cells are then placed on a microscope slide, stained, and examined by a pathologist.
I’d suggest proceeding with whatever the doctor has recommended for you (as he will have more pertinent information about your findings), and if you are still unsure about the necessity of further investigations he has recommended for you, do raise this in your follow-up appointment with him.
Thank you for your question. I agree with Dr Ethan that the thyroid hormone tablets you were given is likely for treatment of low thyroid level and not for treatment of the thyroid mass.
Thyroid nodules (or mass) are very common and most of the time they are benign (non cancerous).
The need to have a sample of cells from your thyroid nodule taken and sent for analysis in the lab (a procedure called fine needle aspiration and cytology – FNAC as explained by Dr Ethan) depends on:
- The size of the nodule
- The appearance of the nodule on ultrasound of the thyroid gland
If your thyroid nodule is larger than 1.5 cm or have features on ultrasound that may be suspicious for cancer (e.g. irregular border, hypoechoicity, microcalcifications, internal vascularity etc) your doctor will need to perform an FNAC of the nodule to exclude cancer.
A FNAC is a relatively quick and simple procedure done in the clinic. The analysis of the cells by the pathologist in a lab can take up to a week, and sometimes longer if special staining of the cells is required.
It is best that you discuss with the doctor who ordered the ultrasound of the thyroid for you if your mass needs an FNAC. A thyroid biopsy (a piece of thyroid tissue removed for analysis) is rarely done as a first line investigation.
Hope this helps.