NOTE: I have noticed many people have found this entry because they have thyroid biopsy coming up or some concerns about thyroid cancer. Please take a look at ThyCa (Thyroid Cancer Survivor’s Association). You can find them at www.thyca.org. They have a very informative booklet “Thyroid Cancer Basics.” Request your copy by emailing thyca[at]thyca.org.
I wasn’t too worried when my oncologist suggested I have a thyroid ultrasound. My scans are good but a thyroid nodule has been seen and had never been checked out. “For the sake of completeness you should have an ultrasound,” my doctor said. “But at your convenience, there’s no rush.”
Still, I wanted to get it over with so I made an appointment. The technician was very nice and the ultrasound was soon over. I didn’t really think about the results. My thyroid is like Wyoming–I know vaguely where it is and a little bit about it, but it seemed like the real action was in the brain, heart, liver, lungs, etc. My thyroid was a small gland, a flyover organ on my personal continent, a puddle jumper destination if ever there was one.
Thyroid nodules are common in adults and typically 95% of them are benign. Of course, most breast lumps aren’t cancerous–but that’s not how it turned out for me. So I was alarmed when my oncologist called with results of the thyroid ultrasound. If my test results are good, the nurse calls. If my oncologist is calling, it isn’t to invite me over to join her mahjong group. The doctor explained that since my nodules (it turned out there were two) were solid they could not be dismissed as cysts. She recommended seeing an endocrinologist to discuss a biopsy, but she didn’t seem too concerned.
My thyroid blood test came back normal–although “normal” is a definition that is hard to pin down in thyroid circles. As the endocrinologist recommended, I made an appointment to get my nodules biopsied. Nodules generally aren’t biopsied unless they are 1 cm or larger. Mine were 1.5 cm–so not so big as these things go.
I tried not to think too much about the biopsy. I was wary–when I had a fine needle biopsy on my breast, the surgeon used something that looked like a lethal Super Soaker squirt gun or something you’d caulk your bath tub with, only with a needle on the end.
I was in twilight sedation for the bone biopsy–it didn’t hurt while it was being done, but it was definitely sore afterwards. I asked my oncologist if she could prescribe something for my biopsy jitters and she gave me one (1) Diazepam. In retrospect, this was like sending someone into a gun fight with a sword.
After I signed in, I waited only a few minutes before a technician ushered me to a procedure room. She was friendly and considerate of my comfort–asking me if I would like a sheet, a pillow, etc. She left the room–I may have peaked too early with my lone Diazepam because she was gone for what seemed like a long time and I think I feel asleep for awhile. She returned with a young resident. (My cancer center is part of a teaching hospital so I wasn’t surprised.)
I took an immediate dislike to the resident–she apparently learned her bedside manner from the Parris Island USMC Drill Sergeant School of Medicine. “Any prior biopsies?” she asked in the same tone a state trooper might say “License and registration?”
I said I had a fine needle breast biopsy and bone biopsy. “But no thyroid biopsies,” she said, still looking down at her clipboard, completely indifferent to how the results of these procedures had permanently altered my life. “I will do three to six passes per nodule. No talking! No swallowing!”
“Drop and give me 20!” was probably on the tip of her tongue, but then the “real” doctor came in…clutching a surgical mask over her face and saying, “Don’t mind me, I’m sick!”
I wanted to say “Shouldn’t you have stayed home?” and I almost DID say “Physician, heal thyself,” but it seemed prudent to remain silent.
Now, previously this procedure had been described as “like a bee sting” referring to the Lidocaine shots and a couple of quick pinches of the biopsy needle. When I was 10 years old and walking barefoot through my backyard, a bee stung me.
I cried–even after my mom applied a soothing paste made from baking soda and let me drink a Fresca, I still cried. Last year at an outdoor brunch, a yellow jacket stung me. It hurt. Only my pride, some swigs of wine and some ice cubes forestalled the type of display the Maid of the Mist could sail through.
The resident did the first biopsy.
No one offered any words of comfort or encouragement such as “Hang in there, we’re almost done,” or “Sorry, I know this isn’t any fun.” Just “No talking and no swallowing!” from the resident and technical suggestions from Typhoid Mary, MD, to the student: “Try it this way,” etc.
Tears were in my eyes when the resident finished and took the sample to the pathologist who was standing by to ensure she got a good specimen. In a few minutes she returned with good news–the first biopsy was successful.
The second nodule is behind the thyroid. I was asked to turn my head one way and the other as the doctor and resident sized up their options. The procedure was really uncomfortable—as though someone was pressing on my Adam’s apple as the resident swiveled her needle as a plumber might when snaking a drain. I wanted to jump off the table.
“You swallowed!” the resident said.
“I did NOT!” I wanted to yell. I may not have swallowed but I definitely moved–that much I will admit.
“Ma’am!” said the doctor. “Don’t swallow, ma’am.”
It costs about $1,000 (before insurance) to have a fine-needle biopsy at this hospital. If I spent $1,000 on a fine meal, my waiter/waitress would return my credit card with some artisan chocolates on a silver salver and say, “Thank you, Katherine, for dining with us. Have a lovely evening.” The restaurant staff would gather, Downton Abbey- like, and I would stroll through a gauntlet of bowing and curtseying personnel as I took my leave.
But this doctor, the one who supervised my throat pokes, couldn’t remember my name–despite my handy hospital bracelet and chart. Ma’am, indeed.
“That’s it!” I said as soon as the resident withdrew her needle. ” I’ve had it! I’m not doing that again. We’re through here. I’m not too worried about a thyroid nodule.”
The resident had to go give the sample–such as it was–to the pathologist. The ultrasound technician helped me sit up and gave me an ice pack. The doctor fluttered around the table so she could speak to me face to face. “Now of course it’s your body,” she said. “But your doctor wanted you to have these tests.”
I glared at her and got off the exam table as the technician helped me gather my things and pointed me to the waiting room. I wish I had said, “You can kiss my nodule goodbye, Ma’am!” but I was too busy sulking.
My pathology report came back in record time. Good news from the nurse: the nodule is benign. They will do another ultrasound on the second nodule in six months. Depending on the results, I might have another biopsy. But only if they ask me nicely and don’t call me ma’am…