The further procedure depends on the precise characterization of the thyroid change (size? number of nodules? sonographic characteristics). In most cases, the initial diagnosis is made using ultrasound and these cardinal questions can be answered immediately. If a lump is of a certain size or has certain features on the ultrasound, surgery should be discussed. For smaller and sonographically inconspicuous nodules, a timely follow-up can be useful as a conservative short-term procedure. If the nodules are unclear, scintigraphy and, in the next step, fine-needle biopsy can help. A blood test is essential for every thyroid investigation.
Thyroid nodules:
Suspected malignancy on fine-needle biopsy
During a fine needle biopsy, a very thin cylinder of tissue is removed from an abnormal thyroid nodule. The tissue obtained is then processed by a pathologist and examined under a microscope. In many cases, special immunohistochemical staining examinations are also carried out to differentiate benign thyroid nodules from thyroid carcinoma even more precisely. The limitation of the study lies in the technique of tissue collection itself. A vivid comparison that seems very appropriate to me is that of the thyroid nodule with a Mozartkugel, with the marzipan in the center representing the malignant (part of the) nodule. If you pierce the Mozartkugel with a thin cylinder and aim right in the middle, there is a good chance that you will hit the marzipan and make the correct diagnosis.Unfortunately, the thyroid nodule differs from the Mozartkugel in that the marzipan can be anywhere and therefore, even with a malignant nodule, in some cases no malignant cells are found in the biopsy. Therefore, even if the fine-needle biopsy is “inconspicuous,” further observation of the nodule size is necessary. A rapid increase in size must be taken seriously; if malignant cells are detected in the fine needle biopsy, surgical treatment is urgently necessary.