When should a biopsy be done for a thyroid nodule?

Hello,

Welcome to icliniq.com.

I have read your query and understand your concern.

Based on the findings of the ultrasound report (attachments removed to protect the patient’s identity), it comes under the low suspicion category in the sonographic risk stratification of the thyroid nodules.

In the low suspicion category, the recommended FNA (fine needle aspiration) is at size (largest dimension) greater than or equal to 0.59 inches. But in the USG (ultrasonogram) report, the size is 0.5 inches.

We need to calculate TI-RADS (Thyroid Imaging Reporting and Data System) points, and based on the TI-RADS points, FNA is advised.

Kindly answer the following questions.

1. What clinical symptoms do you have?

2. What is your serum TSH (thyroid stimulating hormone) level?

3. Have you done FT3 ( free triiodothyronine), FT4 (free thyroxine), and TSH level tests before or after the USG examination?

In any case of thyroid nodule finding, the doctor initiates evaluation by looking at serum TSH level to recommend further tests based on the TSH level.

So kindly reply to the above to guide you further.

Thank you.

Hello,

Welcome back to icliniq.com.

Your thyroid profile test is normal with values in the normal range.

Based on the USG (ultrasound) findings, TI-RADS (Thyroid Imaging Reporting and Data System) point is calculated and it stratifies nodule characteristics into five risk levels, from TR 1 (benign) to TR 5 (highly suspicious). It converts USG feature patterns into a discrete number of points along five feature dimensions namely nodule composition, echogenicity, shape, margin, and echogenic foci. The total accumulated points determine the ultimate TI-RADS level. The TI-RADS level, in turn, determines size-based recommendations for biopsy or surveillance.

In your USG report, nodule composition (solid), echogenicity (isoechoic), and echogenic foci (no calcification) features are present, and others (shape and margin) are not mentioned. Based on available information from USG the TI-RADS point is 3 and it comes under TR 3. For TR 3 FNA biopsy is recommended or advised if the size is greater than or equal to 0.98 inches, and follow-up is recommended if the size is greater than or equal to 0.59 inches.

I hope you are able to understand the above explanation as I have tried to explain based on current guidelines on how to proceed with thyroid nodules.

I would suggest a follow-up with the USG thyroid gland as advised by your treating physician.

Please follow up if you have any further related queries about it.

Thanks.