Found thyroid nodule, is CNB the correct method to determine if benign or malignant?

I am a 33 y/o Caucasian female with no family medical history of thyroid issues or thyroid cancer (family medical history: my father has diabetes and bipolar disorder, my sister and I myself have bipolar disorder, and there are no other significant medical issues in the family). In May 2016, my GP suggested I get an ultrasound for a thyroid nodule on the right side of my thyroid that she discovered during a routine physical exam. I had the US in June. According to the US report, “The right thyroid lobe measures 5.1 x 2.1 x1.9 cm. The left thyroid lobe measures 3.3 x 1.1 x 1.6 cm. There is a 4 mm nodule in the right mid gland. There is a 2 cm nodule in the lower pole of the right thyroid lobe. Impression: A 2cm nodule in the lower pole of the right thyroid lobe. Ultrasound guided fine needle aspiration suggests an established diagnosis.”

I then had a fine-needle aspiration biopsy (FNA) in July. The results came back “atypical” (I don’t have them on hand right now, but I can send them to you). I then consulted with a thyroid specialist, who recommended a partial lobectomy to establish a diagnosis. I have been doing some research into the medical literature (via PubMed, etc) and it sounds like perhaps a core-needle biopsy (CNB) may provide a more definitive diagnosis and help me determine if I should go the surgical route or not (if the nodule turns out to be cancerous or precancerous, I will of course go with surgery, but since it’s atypical and it could turn out to be malignant or benign, I would like to exhaust any other options available in determining the diagnosis before electing to have surgery). I also had blood work done in May. TSH and (TPO) Ab and T4, Free (Direct) were in normal ranges (TSH was 1.420 and (TPO) Ab was 9 IU/mL and T4 was 1.36) and TgAb was a little high (2.1 IU/mL). Everything else (CBC w/diff, CMP, lipid panel) came back normal. Can you help, please? Happy to send you the US and FNA results. My question is: Would you recommend CNB or some other method to determine if the nodule is benign or malignant besides surgery? I just want to exhaust all my options if I can.


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Dr Ahmed Fawzy
Member
Dr Ahmed Fawzy

In my opinion you should just wait and reckeck TgAb , T4 and TSH + ultrasound
To check for any size change

If size changes even in benign tumour you should remove it

Good Luck

Dr. Ayman Darrag
Member
Dr. Ayman Darrag

Clinically, it is well known that malignancy of thyroid is very very rare and specially in your age.
Most thyroid nodules are benign.
So doing further tests without treating the problem itself (big sized atypical nodule) whether it is benign or malignant..is a waste of time and more complications ..
For me ..I think you can get the ultrasound done once more and if there is a change in size or the hormones in blood then you can go directly for surgery to prevent its manifestations and complications on your body.
Thanks..

Dr Mahaveer
Member
Dr Mahaveer

hi
this needs to be confirmed and the best method for doing this is CNB.
Its a simple procedure and causes very less pain.
The tissue that is removed through CNB is sent for histopathology and confirmed for malignancy.
This is “the ” confirmatory test.
thanks

shw12
Member
shw12

HI
CNB IS A MINIMALLY INVASIVE TECHNIQUE CAUSING A BIT OF PAIN.
INSTEAD,IF YOU DESIRE FOR TOTALLY NON INVASIVE TECHNIQUE,THEN YOU CAN GET TUMOR MARKERS CHECKED AND A HIGH RESOLUTION ULTRASOUND SCAN DONE.
IF TUMOR MARKERS ARE RAISED,THEN THERE ARE HIGH CHANCES OF MALIGNANCY.

Dr Masr
Member
Dr Masr

I need to see the FNA result please..

mrsshalini14
Member
mrsshalini14

hello there
it can be either CNB or excisional biopsy (meaning complete excision of the nodule and sending it for histopathology).
excisional biopsy is a major surgery and i would suggest you to prefer CNB over excisional biopsy.

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