How and why a thyroid puncture is performed: consequences and possible complications, interpretation of the results. What is a thyroid puncture? Why is a thyroid puncture performed?
The director of the Institute of Clinical Endocrinology, vice-chairman, answers questions from readers related to this topic. Russian Association endocrinologists, academician of the Russian Academy of Medical Sciences, doctor medical sciences Galina Melnichenko.
For every fireman...
Despite this, my attending physician does not consider it necessary to prescribe me a puncture of this node. In what cases is this necessary?
Gennady, Izhevsk
Puncture followed by biopsy ( histological examination the obtained biomaterial. - Ed.) all newly found nodes with a diameter of 1 cm or more are subject to treatment. If the size of the node is small and the level of thyroid-stimulating hormone (TSH), secreted by the thyroid gland, and calcitonin (CT), which is produced in medullary carcinoma (another form of nodular goiter), is normal, and the ultrasound image does not indicate the likelihood of malignancy, a puncture is not required, and the solution to this issue can be postponed for 1-1.5 years.
But the modern realities of our healthcare are such that a practical endocrinologist has so little time to examine a patient that he prefers to send him for a puncture. Sometimes with nodes of 2-3 mm.
Experts consider this approach unjustified. Even if a small node has ultrasound signs of malignancy, competent doctors try not to puncture it, but to observe it.
Cancer or not?
They found a nodule in my thyroid gland and immediately sent me for a biopsy. Does this mean I have cancer?
Antonina, Kostroma region
Many of our patients ask this question. I hasten to reassure you: having discovered a palpable, limited formation in the area thyroid gland, in 85% of cases we are dealing with the so-called nodular colloid goiter - a benign nodular formation that will never, under any circumstances, turn into cancer. More often nodular goiters found in regions of iodine deficiency, which can lead to an increase in the size of the thyroid gland. Smoking aggravates iodine deficiency.
The age factor should not be discounted. The older a person is, the more likely it is that he will have a nodular colloid goiter, which doctors monitor for two reasons: in 30% of cases, the goiter can increase in size and cause physical and aesthetic discomfort. In another case, the node may become hormonally active and begin to produce thyroid hormone, which can lead to thyrotoxicosis (a disease accompanied by excess production of the mentioned hormone). However, the probability of such a development is about 5%.
Approximately the same percentage accounts for malignant neoplasms of the thyroid gland, which, even at an advanced stage, with properly prescribed treatment, have a very favorable prognosis.
There will be no harm
I will soon have a thyroid puncture. I'm worried. Tell me, is this procedure not harmful to the gland itself?
Tatyana, Moscow region
No, it's not harmful. Hypothetically, there is a danger of developing purulent thyroiditis ( acute inflammation thyroid gland), which, by the way, can occur on its own, without a puncture, but in my lifetime I have only encountered four such cases. The fact is that the thyroid gland contains a lot of iodine, which is the strongest natural antiseptic. The most that can happen after a puncture is a slight hemorrhage (bruise) at the puncture site, which quickly resolves. Pain during puncture is also minimal.
Dangerous - away!
Is it necessary to remove a thyroid nodule?
Galina, Vladivostok
Necessary if a node is punctured and cancer is found. You cannot do without surgery for follicular neoplasia - an intermediate group of tumor formations of the thyroid gland, 10% of which can be malignant. Sometimes the question arises about removing a benign colloid goiter if it reaches large sizes. In this case, not only the node, but also the entire thyroid gland is removed. All operations are performed through tiny incisions. Sometimes ethanol and laser destruction of colloid goiter are used. But these methods are so specific that they are used extremely rarely.
To clarify the diagnosis for some diseases of the thyroid gland, a cytological examination is required. Endocrine cells are examined under a microscope. The thyroid puncture is performed by a surgeon under ultrasound control.
How to do a puncture
Thyroid puncture is the collection of organ cells for examination. Indications for a biopsy are determined by an endocrinologist. If after talking with the patient, palpation, ultrasound, hormonal diagnostics, the information received is not enough, then a puncture is needed.
The endocrinologist gives a referral for examination. The patient either registers on a first-come, first-served basis at a regular clinic for a study under a compulsory health insurance policy, or goes to a commercial medical center.
The puncture is made in outpatient setting, that is, hospitalization in a hospital is not necessary. A needle biopsy is performed by a specially trained doctor. This examination is usually performed by a surgeon. A doctor can also perform a puncture ultrasound diagnostics after advanced training.
The examination does not require pain relief. Sometimes the skin over the thyroid gland is treated with a local anesthetic (lidocaine ointment). A needle biopsy is not a very painful procedure. But the patient still experiences some discomfort. The puncture feels comparable to an intramuscular injection. It is painful to perform a puncture during emotional overexcitation (fear). Therefore, the most important thing for preparation is the right calm attitude.
The biopsy is in most cases performed under ultrasound guidance. Ultrasound is definitely needed for small formations in the thyroid tissue. In addition, ultrasound control allows you to avoid unpleasant consequences research: damage to surrounding tissues and blood vessels.
The patient lies down in a comfortable position on the couch. Be sure to place a pillow under your head (to relax the neck muscles). A sensor is placed over the thyroid gland area ultrasound machine. The image of the organ is displayed on the screen. The doctor selects a point above the node. Next, a puncture is made through the skin, subcutaneous tissue, thyroid capsule, neoplasm wall. The needle enters the thyroid nodule. The doctor then slowly draws (aspirates) the contents of the mass into a syringe. It hardly hurts. Very little material is needed for examination under a microscope. As soon as a small amount of tissue becomes visible inside the syringe, the puncture is completed. This avoids inaccurate sampling of material.
Typically, a thin needle (23G) and a 20 ml syringe are used for testing.
When is a puncture needed?
The main indication for fine needle aspiration biopsy is thyroid nodules. Puncture is needed for all large neoplasms of thyroid tissue. If, during examination of the patient or during ultrasound, a node larger than 1 cm in diameter is detected, then a biopsy is recommended. If the formation is less than 1 cm, then research is rarely required.
Indications for puncture for a small node:
- the neoplasm is located in the isthmus of the thyroid gland;
- the neoplasm does not have a clear capsule;
- there is active blood flow inside the node;
- the contents of the node are heterogeneous, there are calcifications;
- on the side of the tumor, the cervical lymph nodes are enlarged;
- it is painful for the patient to feel the area of the node;
- the patient had previously been in areas of radioactive contamination;
- the patient has an unfavorable family history of thyroid cancer;
- the patient has a history cancer.
All these indications are relative. Most doctors around the world consider a biopsy for a node up to 1 cm in diameter to be unnecessary.
Thyroid puncture is also needed for dynamic observation. If thyroid nodules grow rapidly (more than 5 mm in six months), then a biopsy is recommended. Sometimes a patient undergoes several tests.
If there are no nodes in the thyroid tissue, a biopsy is still sometimes needed. An endocrinologist sometimes prescribes this diagnostic procedure to confirm the diagnosis of subacute thyroiditis, diffuse toxic goiter, chronic autoimmune or painless thyroiditis.
What can a puncture show?
During the puncture, thyroid tissue is obtained for analysis without surgery. The cells of the material are examined by a histologist. Based on the microscopic picture, a morphological diagnosis is made.
A biopsy is primarily needed to detect cancer. In 1-5% of all punctures, cancer is found. Thyroid cancer occurs at approximately the same frequency throughout the world. In regions with iodine deficiency, among all nodes the proportion malignant neoplasms lower than in more favorable areas.
Based on the results of the puncture, not only the presence of cancer is determined, but also its shape. Up to 75% of all malignant thyroid tumors are well-differentiated cancer. This diagnosis can be called quite favorable, since such oncology progresses slowly and responds well to treatment.
Low-grade and aplastic forms, as well as medullary cancer, account for 25%. With such diagnoses, the prognosis is somewhat worse.
In addition to oncology, this study can show a benign tumor (adenoma), autoimmune thyroiditis, subacute thyroiditis, Graves' disease, colloid goiter with to varying degrees proliferation.
These diagnoses are quite favorable. Adenoma requires surgical treatment, and other diseases - observation and conservative treatment.
Possible consequences of puncture
Needle biopsy is a safe test. The thyroid gland is located superficially, so the puncture does not damage surrounding organs and tissues. Most often none negative consequences No.
Sometimes small vessels are injured during puncture.
This can lead to hemorrhages:
- subcutaneous (hematomas);
- inside the node;
- under the gland capsule.
The spilled blood quickly resolves. But for some time it hurts to feel the thyroid gland area.
Very rarely, puncture leads to inflammation. Cases described acute thyroiditis(suppuration). In addition, there are situations where a biopsy provoked transient paresis of the vocal cord and even an episode of severe tachycardia (decrease in pulse).
The majority of patients who have had to deal with thyroid diseases, at least once in their lives, have encountered such a procedure as puncture of the thyroid gland. A similar diagnostic procedure in some cases is called a fine-needle biopsy of the thyroid gland. Most people are afraid of the need for it, but it is necessary because it allows the doctor to make a diagnosis and also prescribe correct treatment. Many scientists agree that half of people over 45 years of age have one or more pathological thyroid nodules.
In addition, most often diseases of this body It is women who suffer, and the frequency of detection of malignant pathologies is about 7%. Even taking into account this level of malignancy, doctors proceed from the fact that this is a very low chance and the majority of formations are benign. Therefore, puncture of the thyroid node is used.
This procedure is sufficient simple method diagnostics, during which a sample of the affected organ is taken for examination. It is on the basis of the results obtained by this method that the doctor prescribes appropriate treatment, and, if necessary (inflammation or cysts), surgical treatment is prescribed.
It is also worth noting here that the thyroid gland is an organ with an extremely developed circulatory system. That is why, to exclude such consequences as hematoma or internal bleeding, a fine-needle aspiration biopsy of the thyroid gland is performed.
At the same time, thyroid biopsy today is carried out exclusively under ultrasound control, thereby reducing the chance that serious consequences.
Worth knowing! When choosing where to have this procedure done, it is recommended to give preference medical institutions, specializing in eliminating such pathologies.
Indications for testing
There are a number of reasons why this organ is punctured:
- Detection of a neoplasm (including nodes and cysts) larger than 1 cm in size and identified during palpation;
- Pathology in the form of a node, with dimensions of more than a centimeter and detected during ultrasound examination;
- When identified formations of appropriate size have signs of a cancerous tumor;
- Progressive development of thyroid cyst;
- When ultrasound data have clear inconsistencies with the clinical picture of the disease.
Contraindications
In addition to certain indications for performing a biopsy of a thyroid nodule, such a procedure also has contraindications when its implementation is impossible. These include:
- Problems with blood clotting;
- Refusal of the patient to carry out the appropriate manipulation;
- Presence of mental illness;
- Elderly age category;
- When a cyst or node reaches a size of more than 3.5 cm;
- Women who have malignant pathologies of the mammary glands, as well as people who have undergone multiple operations.
Based on this, we conclude that a qualified doctor, having carried out preliminary preparation to puncture the thyroid gland, may prescribe this procedure. Otherwise, there may be serious consequences for the patient's health.
Carrying out a puncture
Increase As for how the thyroid gland is punctured, a fine-needle syringe is used for this, and an ultrasound machine is used to control the actions. The patient is placed on his back, the sensor of the device detects the nodule, after which it is punctured.
If there is a pathology larger than 1 cm in size, it may be necessary to perform several punctures, and if less, then a biopsy is performed.
Due to the fact that thyroid puncture does not cause pain, there is no need to use anesthesia before the procedure. This is due to the fact that the procedure is trusted to be carried out only by highly qualified doctors.
In addition, a thyroid biopsy is performed under ultrasound guidance, which reduces the possibility of pain, as well as errors during the procedure, which usually lasts no more than half an hour.
Immediately after its completion, the patient can go home on his own, but the results of the thyroid puncture will need to wait several days.
After the procedure
Upon completion of the manipulation, most people feel satisfactory. But some people may have the following problems after it:
- The appearance of pain;
- Small hematomas that appeared at the site where the puncture was made;
- In the presence of osteochondrosis, there is a possibility that dizziness will appear after a sharp rise from a place;
- For several days after the procedure, pain of varying intensity may be present in the area of the cervical vertebrae.
Increase Having found out what puncture of formations such as thyroid cysts is, as well as when it is performed, it is worth noting that you should not be afraid of carrying out such a procedure. No serious preparation is required for it; moreover, errors during the execution process are practically eliminated due to the use of ultrasound.
All likely consequences caused only by their own mistakes medical workers, or the characteristics of the patient’s body.
Possible consequences
Often, a thyroid puncture is a harmless procedure that is performed without anesthesia or pain. When an experienced doctor performs such a manipulation, the only thing that can worry the patient is minor painful sensations, comparable to those that arise due to an intramuscular injection.
But if the doctor acts incorrectly during the emptying of the thyroid cyst, some problems arise. The consequences that a thyroid puncture can bring are as follows:
- Trachea puncture;
- The appearance of bleeding;
- Damage to the vocal cords.
In addition, complications may arise due to poor sterile processing of instruments or the affected area where the puncture was made. Therefore everything possible consequences completely depend on the level of professionalism of the doctor performing this procedure.
If it is implemented correctly, when all the rules are fully followed, the likelihood of negative results is practically reduced to zero.
Decoding the results
As soon as the result data is received, the transcript has such wording options as:
- Goodness;
- Malignancy (cancer);
- Betweenness;
- Lack of information.
So, in the latter case, with uninformative results, this will indicate that there is no need for repeated diagnostic procedure. If, according to the results of the study, a complete clinical picture, then there is no need to perform the puncture again.
Based on these data, the doctor will prescribe appropriate treatment. If a small benign formation is detected, the treatment strategy will be only dynamic monitoring of the development of such an anomaly, as well as the health of the patient. When the node has, which happens in about 85%, then it has an extremely low chance of malignancy.
Doctors recommend carrying out examinations to monitor the condition at least once a year, although it may be necessary more often. If detected during this time strong growth formation, there will be a need to repeat the puncture.
If a malignant or intermediate form is detected, surgical treatment with complete removal neoplasms. In some cases, after surgery, patients experience hypothyroidism, for the treatment of which a special hormone therapy replacement type.
That is why, if there is even a slight suspicion of a formation in the thyroid gland, it is important to go to the hospital in time to study the nature of the pathology. It is a timely puncture that makes it possible to identify and prescribe the correct treatment for pathologies of this organ. If we talk about the prevention of thyroid diseases, then you need to exclude alcohol and smoking, and also choose proper diet. We invite you to watch an informational video on the topic of becoming.
In order to find out what the thyroid nodule consists of, patients are prescribed a fine-needle biopsy with aspiration, during which the resulting material is taken for examination. This method helps determine the likelihood of a malignant process and choose a treatment method.
If the node has reached 10 mm, then its biopsy is mandatory. It determines the composition and properties of cells with 90-95% reliability, distinguishes benign formations from malignant. Ultrasound control helps to increase the accuracy of the procedure.
Advantages of a biopsy:
- complications rarely occur;
The limitations of the study are:
- if the size of the node is up to 0.5 cm and its location in an area with difficult access, false results may occur;
Timely puncture of the gland helps to identify tumors and other pathologies on the early stages when treatment brings maximum results.
Indications:
- there is a cyst, a node measuring 10 mm or more or growing by 0.5 cm over 6 months of observation;
- single palpable or non-palpable node with;
- multinodular goiter;
- there is a suspicion of any size;
There are no absolute contraindications to puncture. It can be postponed with individual pathological conditions until they are cured or compensated.
There are no special preparation requirements. In the morning you can drink tea and eat light breakfast. It is recommended to eat no later than two hours before the biopsy.
How to perform a thyroid puncture under ultrasound guidance:
- The patient lies down on the couch, with a pillow placed under his head.
- The doctor examines the area of the gland projection for moles, scars, rashes and palpates the lobes and isthmus. During palpation, the subject makes several swallowing movements to better definition gland size.
- An ultrasound is performed and a node is detected, it is punctured, and the contents are slowly and effortlessly drawn into a syringe. If the biopsy is performed in the presence of a cyst, then its cavity is completely emptied. Punctures are carried out in different areas of the node - from two to four points.
- The material taken is placed on a glass slide, and the resulting smear is examined in the laboratory.
- At the end of the puncture, the skin is processed antiseptic solution, the puncture site is sealed with a sterile bandage. It is allowed to be removed no earlier than after 2 hours.
The taken material is placed on a glass slide The entire diagnosis takes approximately 15-20 minutes and is carried out with local anesthesia. the patient can return to normal detail; no restrictions are required. It is recommended to keep the skin clean after piercing to avoid infection.
- Thyrocytes and colloid were detected - this means a normal structure, a benign neoplasm in goiter, adenoma, adenomatous node.
- There are signs of inflammation. This indicates thyroiditis of autoimmune, infectious or traumatic origin.
- In the biopsy, there is a node with proliferation (tissue growth), follicular epithelium with atypia (atypical, abnormal) cells, and neoplasia (newly formed tissue). Regarded as an indeterminate result and suspicion of a malignant process.
- Carcinoma cells (papillary, anaplastic, medullary, follicular) are a cytological diagnosis of cancer.
- The analysis is uninformative (little material, a lot of blood, fluid from the cyst), a repeat biopsy is needed.
Possible complications from the diagnostic procedure: with excessive fear, loss of consciousness is possible, mild swelling persists for some time, and discomfort is noted when swallowing and moving the neck. Less common: hematoma, bleeding, laryngeal spasm, damage to the recurrent nerve, hoarseness, trauma to the trachea.
Read more in our article about thyroid puncture.
Read in this article
Should I puncture a node or cyst?
In order to find out what the node found with is made of, patients are prescribed a fine-needle biopsy with aspiration, during which the resulting material is taken for examination. This method helps determine the likelihood of a malignant process and choose a treatment method. After puncture (puncture) with a needle, the contents of the node are drawn out with a syringe and sent for analysis to the laboratory.
If the node has reached 10 mm, then its biopsy is mandatory. It determines the composition and properties of cells with 90-95% reliability and distinguishes benign from malignant formations. To establish a diagnosis, in addition to a biopsy, only surgery can be more informative. Ultrasound control helps to increase the accuracy of the procedure. The advantages of this technique include:
- relatively low morbidity;
- there is no pronounced pain during puncture;
- no need to go to the hospital for research;
- complications rarely occur in specialized clinics;
- it does not take much time to get results;
- you can precisely hit the node or nodal part of the cyst without damaging neighboring tissues.
Disadvantages of the study are:
- cells are taken only from a limited area;
- if the size of the node is up to 0.5 cm and its location in an area with difficult access, false results may occur (the needle did not hit the desired area);
- the contents may contain blood or cystic fluid, which makes it difficult to analyze the cellular composition;
- It can be difficult to pierce the tissue due to the presence of fibrous fibers.
Timely puncture of the gland helps to identify tumors and other pathologies in the early stages, when treatment brings maximum results. Therefore, it is irresponsible to refuse a scheduled biopsy.
Indications for use
Based on examination of the patient, palpation, ultrasound data and blood tests, the endocrinologist decides on the need for a fine-needle biopsy. It is indicated in the following clinical situations:
- there is a cyst measuring 10 mm or more or growing by 0.5 cm over 6 months of observation;
- cystic or nodular formation in a young patient;
- single palpable or non-palpable node in thyrotoxicosis;
- multinodular goiter;
- there is a suspicion of malignant tumor any size;
- enlarged cervical lymph nodes.
Contraindications
There are no absolute contraindications to puncture. It can be postponed for individual pathological conditions until they are cured or compensated:
- severe heart rhythm disturbances;
- decompensation of heart failure;
- hypertensive crisis;
- acute violation of coronary or cerebral circulation;
- shock or collapse ( a sharp decline pressure);
- angina;
- fever;
- injuries, recent neck surgeries;
- spicy inflammatory process in the thyroid gland.
acute inflammatory process in the thyroid gland Preparation for the procedure
There are no special preparation requirements. Patients can lead a normal lifestyle and take prescribed medications. In the morning before diagnosis, you can drink tea and eat a light breakfast - cottage cheese, yogurt, oatmeal. It is recommended to eat no later than two hours before the biopsy.
How to perform a thyroid puncture under ultrasound guidance
The entire diagnosis takes approximately 15-20 minutes and is carried out with local anesthesia. The patient lies down on the couch, with a pillow placed under his head. The doctor examines the area of the gland projection for moles, scars, rashes and palpates the lobes and isthmus. During palpation, the subject makes several swallowing movements to better determine the size of the gland.
Then an ultrasound is performed and the node is detected, it is punctured, and the contents are slowly and effortlessly drawn into the syringe. With a low intensity of punctate collection, there is less risk of cell destruction and blood penetration. If the biopsy is performed in the presence of a cyst, then its cavity is completely emptied.
To increase the diagnostic value of the study, punctures are performed in different areas of the node - from two to four points. The material taken is placed on a glass slide and the resulting smear is examined in the laboratory.
At the end of the puncture, the skin is treated with an antiseptic solution, and the puncture site is sealed with a sterile bandage. It is allowed to be removed no earlier than after 2 hours. After the biopsy, the patient can return to normal detailing, no restrictions are required. It is recommended to keep the skin clean after piercing to avoid infection.
Result and interpretation of the analysis
The obtained cytological data may contain the following descriptions:
- Thyrocytes and colloid were detected - this means a normal structure, a benign neoplasm in goiter, adenoma, adenomatous node. The operation is performed only in cases of significant size of the goiter and compression of surrounding tissues; in all other cases, conservative treatment is necessary.
- There are signs of inflammation. This indicates an autoimmune, infectious or traumatic origin. Drug therapy.
- In the biopsy, there is a node with proliferation (tissue growth), follicular epithelium with atypia (atypical, abnormal) cells, and neoplasia (newly formed tissue). Regarded as an indeterminate result and suspicion of a malignant process. Surgery is recommended and during its course a histological (tissue) analysis of the node is necessary.
- Carcinoma cells (papillary, anaplastic, medullary, follicular) are a cytological diagnosis of cancer. Cytological examination of thyroid gland material is indicated
Only an endocrinologist who observes the patient can evaluate the results obtained, since it is important to compare the data from the puncture and other types of examination.
Possible complications from the diagnostic procedure
Fine-needle biopsy, when performed professionally, is comparable to intramuscular injection on pain and consequences. Ultrasound guidance allows you to limit the puncture area, and the location of the thyroid gland usually allows for minor needle penetration. However, with excessive fear, loss of consciousness is possible in particularly impressionable patients. In such cases, sedatives are used before diagnosis.
Watch the video about thyroid puncture:
Learn more about thyroid injuries.
A puncture of the thyroid gland is indicated when a nodule larger than 1 cm is detected. An endocrinologist may also recommend it for smaller sizes to clarify the diagnosis. The method is quite informative and accurate, has low morbidity, and is not accompanied by complications when carried out properly. The procedure takes place on an outpatient basis.
The result obtained should be assessed only by the attending physician, who chooses further treatment tactics taking into account the cellular composition of the node.
The thyroid gland is a very small organ, but it has a unique role. This gland is an important part of the endocrine system, located on the front side of the larynx and produces hormones - thyroxine, triiodothyronine, calcitonin. Very often, malfunctions of the thyroid gland occur due to a lack of iodine. There are many various diseases, including tumors that can affect this gland. To reliably detect them, a puncture with the collection of biopsy material is used.
What is a puncture?
In almost half of the population over fifty years of age, various nodules can be found on the thyroid gland. They are most often detected in women, since during this period menopause occurs and severe hormonal changes occur. Among all cases, only 4–7% turn out to be oncological, which means that most neoplasms are benign in nature and do not lead to severe complications.
A puncture is a small puncture that is made in the required area of the thyroid gland to study the cells and establish a diagnosis based on the material obtained. This procedure is very important; with its help, it is possible to determine the presence of oncological tumors in the early stages and begin treatment on time to avoid their growth. Under no circumstances should you refuse a puncture if it was recommended by your attending physician. This procedure can save life, but patients experience the greatest fear before it is performed, as they are afraid of strong painful sensations. In fact, the procedure is very simple, it does not cause severe pain and feels similar to a regular injection.
Previously, surgeons used fairly thick needles to biopsy the thyroid gland, which increased the number of complications and made the procedure very painful. Currently, all modern clinics use very thin needles.
Some patients have the misconception that if a cancerous tumor is “disturbed” by a puncture, it begins to grow sharply and increase in size. On this moment no such cases have been reported, and early detection illness increased the chances of recovery.
Another name for thyroid puncture is fine-needle aspiration biopsy (FNA).
Advantages and disadvantages of diagnostics
This method has many advantages:
- minimally invasive;
- minimum procedure time;
- low cost;
- rare complications;
- high reliability of the results obtained.
It is very difficult to identify the disadvantages, perhaps among them is the fear of the procedure.
Next to the thyroid gland are the laryngeal and recurrent nerves, carotid artery, esophagus, trachea and vocal cords. This fact complicates surgical manipulations in this area and requires special care from the doctor. The blood circulation of this endocrine gland is so active that it exceeds the volume of blood supply to the muscles.
Indications and contraindications
The reasons for performing a biopsy are the following factors:
- family predisposition to cancer diseases thyroid gland;
- radiation exposure in places of environmental disasters;
- treatment of other cancers using ionizing radiation in the head and neck area;
- nodular formations larger than 1 cm, identified by palpation or ultrasound;
- nodular formations less than 1 cm, if malignancy is suspected;
- cystic formations of the thyroid gland;
- discrepancy between ultrasound results and clinical symptoms.
Since this procedure is quite safe, there are very few contraindications:
- hypertensive crisis or disorders heart rate on the day of surgery;
- DIC syndrome (disseminated intravascular coagulation), in which the permeability of the vascular walls is impaired;
- mental illness;
- frequent surgical interventions;
- young age (may be required general anesthesia to prevent sudden movements of the child during the puncture);
- period;
- pregnancy and lactation.
Elena Malysheva: what are the dangers of thyroid nodules - video
Preparing for the examination
The patient should prepare in advance for thyroid puncture. For one week, you must stop taking medications that reduce blood clotting and anticoagulants (Aspirin, Heparin, Warfarin). Also, before the procedure, you need to take blood tests (necessarily on an empty stomach) for biochemistry and hormone levels in order to identify accompanying illnesses thyroid gland. If there are problems with blood clotting, a coagulogram is prescribed. It is not advisable to eat immediately before the procedure, but even eating should not affect the biopsy.
The key to a successful puncture will be the patient’s calm state, so it is important to understand that FNA is practically painless, to calm down and completely trust the attending physician.
How is thyroid puncture performed?
At the patient's request, they can conduct local anesthesia. If the nodule is located at a remote distance, more serious treatment may be required. surgical intervention, in which an incision is made in the anterior wall of the larynx, then interfering tissue is moved away and a collection is made required material. These cases are quite rare, and in most situations FNA is performed as follows:
- The patient is placed on a couch or operating table, a small pillow is placed under the head and asked to swallow saliva several times. At the same time, they are investigating thyroid gland using palpation to accurately determine the correct puncture site.
- The ultrasound machine is placed against the throat, and under its control, a puncture is performed in the desired area using a thin needle. It is injected strictly at a certain distance, sufficient to puncture the tumor. From one to three injections are given to eliminate errors in the tests and avoid false negative results.
- The needle is attached either to an empty syringe or to a special “gun” that automatically draws when a button is pressed. The latter method is the most modern and allows the doctor to avoid unnecessary movements.
- The contents of the nodule are aspirated through a needle and then either placed in formalin or applied to glass slides for further examination.
- After the procedure, the puncture site is disinfected and sealed with a special plaster. Within a few hours you can return to your normal lifestyle and even wash yourself.
The operation is carried out very quickly and takes no more than twenty minutes, including preparatory stage. The puncture itself lasts from five seconds to several minutes in particularly severe cases or if multiple formations are present.
Thyroid biopsy - video
Possible consequences
Since the thyroid puncture procedure is minimally invasive, complications occur extremely rarely, but sometimes the following phenomena are observed:
- hematoma at the puncture site;
- suppuration;
- slight bleeding;
- inflammation;
- pain in the neck for several days after the puncture;
- damage to the vocal cords;
- short-term cough;
- enlarged cervical lymph nodes;
- trachea puncture;
- hyperemia due to infection;
- pain;
- dizziness if there is a history of osteochondrosis;
- uncontrolled contraction of the larynx (laryngospasm);
- laryngeal nerve damage.
Most often this is due to a violation of the manipulation technique, the inexperience of the doctor, or the abnormal location of the vessels. Don’t be alarmed by what you read: these complications are just as rare as after a regular blood draw from a vein. If the puncture was performed by a competent specialist and all sterility conditions were met, then there will be no negative consequences.
Complications after puncture - video
Decoding the results
Unfortunately, despite the high accuracy, in approximately five percent of cases, patients are given a false negative diagnosis. Examination of the obtained material can be carried out by both a doctor and a cytologist in special laboratory. Thyroid cells are placed in a small layer on the surface of a glass slide, stained with special dyes and examined under a binocular microscope.
There are several options for the obtained result:
- benign formation, which indicates the absence of cancer cells;
- malignant formation, establishing an oncological tumor;
- intermediate result, which requires clarifying additional methods analysis;
- an uninformative result that requires repeated sampling of material.
There are many different diseases of the thyroid gland, but among them there are four most common ones, which are diagnosed by analyzing histological material obtained by puncture. After studying the drugs, the doctor can make an accurate diagnosis.
Colloid nodule of the thyroid gland
Other names for colloid node are hyperfunction of the thyroid gland, colloid goiter. This disease is the most common. Fortunately, this type of formation is benign and never develops into cancerous tumors. The node consists of normal thyroid cells, not foreign ones; they are filled with colloid, a specific liquid substance, due to which the cells increase in size. Most often it is formed due to a lack of iodine in the body.
Colloid goiter is usually detected in adolescence, during menopause and during pregnancy, when the load on endocrine system especially great. Often no special or surgical treatment colloid nodes, they resolve themselves when the iodine deficiency in the body is replenished.
Hashimoto's thyroiditis
This disease is autoimmune; its other names are autoimmune thyroiditis or chronic lymphocentric thyroiditis. It does not develop abruptly, but gradually progresses, affecting the thyroid gland and its follicles. The cells are attacked by antibodies, an inflammatory process occurs, and the functioning of the organ deteriorates and its functions are lost. The unaffected parts are forced to increase in size to cope with the increased load and this is what leads to the appearance of a kind of goiter. Decreased hormone production leads to hypothyroidism and, as a result, many other serious diseases.
Usually registered in women aged 30 to 50 years with genetic predisposition. Treatment is mainly medication and for most of life.
Thyroid adenoma
Is benign tumor, which is formed from glandular cells of the thyroid gland. There is a risk of degeneration into a malignant form. There are many reasons for the occurrence of adenoma: hyperactivity of the pituitary gland, poor ecology, toxic poisoning, hormonal disorders, heredity and much more. Visually, the tumor is very noticeable upon examination. Under no circumstances should this type of neoplasm be left; it is required urgent treatment. Depending on the severity and reasons for the formation of adenoma, the doctor will suggest either drug therapy, or surgical removal tumors.
Carcinoma
This type of tumor is malignant. Despite the terrible diagnosis, this type of oncology most often has a favorable prognosis. For getting positive result carcinoma should be detected at an early stage, the affected part of the thyroid gland should be completely removed, and therapy should be carried out radioactive iodine if combination therapy is necessary.