Notes from a Fine Needle Thyroid Biopsy

 

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.

It hurt.

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.

It hurt.

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.

It hurt.

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.”

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…

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29 thoughts on “Notes from a Fine Needle Thyroid Biopsy

  1. Katherine says:

    I’ll have to say the lymph node biopsy I had several years ago was the worst 45 minutes of my life. Most. Pain. Ever. I also had a lovely 6 inch by 6 inch bruise on my neck that looked as if my worst enemy had spent the evening before attempting to suffocate me. Here’s hoping you won’t have to repeat that biopsy.

  2. Oh man, I had that same biopsy recently for a thyroid nodule and I feel your pain. Literally. The needle in the neck was awful, for real. The idea of “don’t breathe, don’t swallow” while the needle was in the neck was awful, too. Like you, I wanted to run screaming & cursing from the biopsy room. As if we haven’t suffered enough with breast cancer. But hey, cheers to benign results.

  3. diggingher says:

    I read your story and shudder. How distant we healthcare providers can be. On behalf of the entire community may I offer apologies. So glad the news was good. Be well.

  4. Sharp writing; and my apologies. I hate it that people have to experience cold professional behavior time and time again. It is one of the easiest things to change in health care and makes such an incredible difference.

    I’m also thrilled the news is good, Katherine.

  5. Thank you for this excellent account about a very bad, not to mention frightening, experience. I’m sorry for the insensitivity of the professionals caring for you that day. Empathy should be always be a top priority. I am really glad things turned out alright. Thanks for sharing about this, Katherine.

  6. Carrie says:

    The most wonderful part of your story…you OWNED your health care, and stopped the madness. Congrats on a negative pathology!

  7. M says:

    Sometimes a doc should just step in for the resident. I’m sorry you had such a bad experience. My thy nodule needle biopsy (was malignant) was very well done, and I had none of these problems. (despite being told umpteen times how skinny my neck was) Didn’t feel anything but the “weird pressure” they warned about and the experience was a bit surreal. Could also have been that my nodules were in easier locations, or that I had just a doc who did at least a couple of the procedures a day. (helped that DH was with me for support)

  8. Glad to hear you are fine, sorry to hear what you had to endure. Reminded me of the time I had to have an upper GI exam and after drinking the barium the technician started shaking me “to move it around” he said.What an ass! Wouldn’t it have been easier not to mention kinder to ask me to jump up down? I was a 20 year old athlete for Pete’s sake!

  9. Thyroid geek says:

    During your biopsy a needle struck the nerve and it caused involuntary swallowing (similar to the knee jerk reflex) so the resident should blame this on himself!
    Colloid nodules may grow at slow rate; the attention must be given if the nodule undergoes structural changes (develops microcalcification, for example).
    For best results the ultrasound must be done on the same machine (wave frequency is very important)

  10. Julie says:

    This is my most-hated medical procedure. I’ve had four. The first time, I passed out, had a seizure and stopped breathing– I was sitting up for that one and the nurse passed the full syringe right in front of my eyes. Just freaked me out. So naturally, every subsequent biopsy has me in a state of panic. Xanax helps a little tiny bit, but I’ve never been able to let them do more than two. I cry through the entire thing, and my doctor is really nice! I really wish we could have twilight anesthesia for this– it would make all the difference.

    • Thyroid geek says:

      Not sure if root canal procedure feels any different!
      You definitely needed to bring someone with you to this procedure
      Next time ask your doctor about PEI procedure if nodule is cystic or laser ablation if nodule is solid!

  11. Marina says:

    I had similar experience with my thyroid biopsy. It supposed to be quickly like 15 minutes and not painful, however it took more than 1,5 hours and I could feel all what the doctor was doing on my thyroid during the procedure.

  12. laurie powell says:

    I had a fine needle biopsy today at the hospital. The nursing staff did their best to put me at ease from the beginning, asking me if I wanted a Xanax….. YES please! My husband & I were in a small room like an out patient surgical room, tv, warm blankets. Dr. talked to me before hand. I had also been told it only feels like a bee sting & then you will feel nothing but pressure. WRONG. Yes, the numbing did feel like a bee sting. I didn’t feel the needles enter my skin but I did feel all the pressure & a LOT of pain. At one point he stopped & numbed it more, it still hurt. On one pass I had a pain from my stick to my clavicle & on another, pain almost to my shoulder, like a nerve had been hit. He did six passes. I don’t know if mine hurt because we knew it was solid & like a marble or what. Maybe fluid filled hurts less?? All I know is it HURT! They moved me back to the little room I was in before, put some ice on it, brought my husband & I something to drink. I was still having a lot of pain so they wanted to keep me longer than the normal 30 minutes. They even had some sandwich trays as it was after lunch that they brought us. When the pain didn’t subside they brought me an oxicodone. The pain I felt after was intense & actually felt like the needle was still in me digging around. I was told my the Dr. & the nurses that my pain during & after the procedure was not typical. This was by far one of the worst procedures I have ever had done BUT the attitude & compassion of the staff was wonderful. We didn’t ask for lunch etc but it was just something they did. They checked on me about every 5-10 minutes & gave a darn I was in pain. Compassionate doctors & nurses can make a huge difference. No, it doesn’t help the pain but knowing they cared did help a lot.

  13. […] Notes from a Fine Needle Thyroid Biopsy | ihatebreastcancer […]

  14. Lion with an Achille's heel says:

    I also had an FNA procedure done. According to what I’m reading on here, I was incredibly fortunate. Mine was done with ultrasound and in person by the Radiology Dept. Head. It could be because I made such a huge stink over potentially being their first patient to either pass out or vomit or both from anxiety during the procedure. I was so worried, I asked for Lidocaine gel so I wouldn’t feel the Lidocaine injection before the biopsies.This from a guy who experienced passing a kidney stone at age 12! I was told by no fewer than 4 hospital staff that the gel wasn’t needed. I didn’t trust them; they were right! He was incredibly light handed and calm. Between pokes, I had the wherewithall to remind them to tell me when not to speak or swallow which they did. I kept my breathing pattern so shallow, you’d have to hold a mirror to my nose to know I was alive. That’s how stressed out I was. UNNECESSARILY. I did communicate my discomfort by humming, going from low pitch upwards as needed. When I felt the Xylocaine wearing off, I’d ask for more and they gladly shot me up with more. I didn’t like feeling the pressure of the needle but honestly, it just felt like a snake was squirming around pushing near my adam’s apple. My only wish was not being told that the samples were hard to extract and that I’d need a ‘bigger guage needle and if that didn’t work, a core biopsy, which you wouldn’t like.’ All told, 12 separate jabs later, including the core biopsy which I didn’t even feel, it was done. I asked to see the needles; the guage in my case was from 22 to 27, apparently. The samples looked like very pale swamp water. Ubercreepy! I can’t believe I complimented the doctor and said ‘beautiful’ when he said it was over. I left feeling so embarassed and like a total wimp when I didn’t need to be. I now know that I can handle it if he has to do a re-do. I also recenlty read on Medscape that there’s been an increase in thyroid cancer overdiagnoses and many are undergoing unnecessarily risky and long term treatments for cancers which are typically slow growing. Look it up, don’t take my word for it but please also don’t take it to be medical advice either; just nerd stuff. Mine was done by Dr. Moritz at USC-Verdugo Hills Hospital. Two thumbs up…….pending the outcome. I pray for you all as I pray for my own health. My only sibling is a longterm epileptic and If I’m not around to watch over him when my parents are gone, there will be no one else. I’ve held it together pretty well so far, except for a stream of tears over that last sentence, dang-it!

  15. Brooke says:

    Just had mine today to see if I was the only one who felt pain. I have a high pain threshold I’ve had jaw surgery and other broken bones and never had to take pain meds. When it came to this however they told me I would only feel pressure. It took three lidocaine shots to numb my neck surface. I had three samples and the pain was unlike any other I felt. At first I felt it go from my neck and to my ear. As they started to do a lot of jerking around to get the actual sample I felt a huge sting in the center of my throat. It was so bad it caused my hands and feet to shake uncontrollably. I don’t know if they hit a nerve. The staff looked at me like I was crazy. He just said I was more “sensitive” than others and there are really no nerves in that area. Will never get that procedure done there again :/ I would rather have surgery. The neck soreness is absolutely nothing compared to what I felt during the ordeal.

  16. marianna says:

    I really do not understand why do they not give the patient for FNA some form of good sedation or pain conterol such as Versed or Demerol or both?This is a very painful,uncomfortable and scary procedure.Many yearsago it was same with colonoscopies, no sedation. It was frightfully painful. Finaly now they decided to change that and sedate the patient to comfortable level.

  17. Jen says:

    I’m having a core needle biopsy in 5 days and was told I can have conscious sedation. I’m very relieved about this! The first hospital that my family dr wanted to send me to said they never use sedation so I asked to be sent to the hospital 20 minutes further from home. I think it’s worth it.

  18. ConnieW says:

    I had this done today and for all those people who have been reading patients’ opinions online about it and are in fear from the horror stories, please don’t be afraid, there’s nothing to it! Piece of cake! I started out with one nodule, then it became three, and one had grown a bit, so I was sent to a head/neck cancer surgeon. Good looking, Too, I might add! He felt my neck quickly and asked if the nodules bother me, which they dont. He said 95% of the time, the nodules are benign, no cancer….and he leaves them alone unless they are bothering me. He did a very fast ultrasound, then took a sample with a needle. It took just one stick, it actually did not hurt at all, I barely felt anything but a tiny bit of pressure for a second. The needle is so teensie-tiny-thin, you wont hardly feel a thing! If you are a diabetic on insulin, you know how little the needles are. And it did not feel long at all! Trust me! It took about 5 seconds! I swear! The guy’s a pro! He said it was a good sample and he didnt need to do anything else, and I was sent on my way with a follow-up appointment for next week to find out the results. I don’t know why some call this a “surgery”! This is not a surgery! Now, if you were getting all or part of your thyroid removed, that would be a slight surgery!

    All the people that wrote the online posts on various sites about it being painful or exscrutiating, I don’t know if they’re just lieing to scare you, or are really big babies that love to exaggerate, but they scared the crap out of me with their stories, then it turned out to be a 5-second piece of cake! And all their comments about “they had to make 7, 8, or 12 “passes” (whatever that means)…….all I can say is HUUUUUHHHHHH????? Dont know what they are talking about! Many said their throats were sore afterwards, and they could hardly swallow, etc. I cant even tell he DID anything! NO soreness at ALL! It looks like I have a little round hickey but thats all. i immediately went to Culver’s for a burger, fries, and Coke!

    Some talked about the numbing being as bad or worse than the needle aspiration. Well, I wasn’t even offered it, nor would I have needed it at all. It’s crazy to think you’d need to be numbed for something that painless! Just please rest assured that this is a walk in the park, and don’t be afraid. NO FEAR!

    • Sally says:

      I’m glad your experience was “so amazing”, but don’t belittle others because ours wasn’t as great. My doctor was wonderful. He knew I had a fear of needles, so he numbed me first with a spray. The first attempt resulted in a bent needle so he had to do it a second time. I’m a girl with five tattoos, and I was shaking and sweating. I broke into sobs when he finished. Honestly? It wasn’t the pain so much as the pressure and fear. Yes, it did hurt, but not unreasonably so. But I was damn glad it was over.

      • ScaredyCat says:

        This was not bad at all, in my experience. Very fast, no real pain, and only felt a bit of pressure when he withdrew the needle. I was lucky. I had a doctor that does it all the time and is really good at it. Sounds like some of you got some incompetent, clumsey doctors. Everyones pain threshold is different, but it’s mainly the skill of the doctor that makes the difference.

  19. XrayK says:

    It’s technologist, not technician.

  20. katherinembc says:

    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 http://www.thyca.org. They have a very informative booklet “Thyroid Cancer Basics.” Request your copy by emailing thyca[at]thyca.org.

  21. Ruth Stevens says:

    I had a FNB done by a Radiologist. I was given Lidocaine, but found it odd that the biopsy procedure started almost immediately after the injection, instead of waiting for the numbing to take place. It hurt. I was stabbed 3 times. I shifted my eyes to observe material from my thyroid being placed in a specimens cup. I saw no material come out of the needle. Pain shot through my left ear, like an ice pick had been stuck in it. The doctor said, “Oh, I hit your Vagus Nerve.” “Crap,” I said, “That’s not good, that’s the biggie.” Then he snapped, “Are you a nurse?” “No, but I’ve taken Anatomy and Phisiology.” Now every time I swallow anything with consistency or with a crunch, I have spasm coughing. I’m on chemo for breast cancer, but I haven’t heard of others suddenly soiling their clothes with feces. My ear still has episodes of stabbing pain continuing, but have spaced out. To top it all off, there were no results, as there was no thyroid tissue in the specimen cup. I knew that. I have to have the test repeated. I have insisted that I will NOT go back there. Send me somewhere else. I think the guy wanted to go to lunch.

  22. non amato says:

    My problem is panic attacks, and lidocaine causes my heart to race it feels like its coming out of my chest. Which causes more anxiety. I had half my thyroid removed six months ago it was cancer now have 3 swollen lymph nodes. I’m use to pain had pancreitis an gallbladder attacks at same time refused pain meds due to family members who have adictions that started with pain meds. I dread this procedure more afraid of a heart attack then pain.

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