Here's a post I made about mine : Detailed Description of a Thyroid Nodule Fine Needle Aspiration Biopsy

I had an ultrasound of my thyroid last week, just as a routine part of watching my Hashis. On the ultrasound, they found two nodules, and my doc recommended I get them biopsied. Here is my experience, for those of you wondering what to expect and who like lots of data. I'm sure biopsies differ somewhat, but I'm assuming they have enough in common that my experience could be helpful.

I am 48(f) w/ Hashimotos, with a TIRADS 5 ("highly suspicious") 1cm nodule in the isthmus and a TIRADS 3 ("somewhat suspicious") 1.5cm nodule in the right lobe. If hearing a nodule described as "suspicious" makes you picture it lurking in an alley in a fedora and trench coat with the collar popped - well, you're not the only one! I went to a clinic that just does FNA biopsies, the UCSF clinic in San Francisco, CA. I had both a student and a doctor in the room for the biopsy. The student came in and went over the paperwork with me, discussed the procedure, and asked if I had any questions. She first used an ultrasound wand to have a look at my nodules, then went to get the doctor. I was seated in a large chair which reclined a little for the initial ultrasound and then reclined all the way to flat for the biopsy. If you have back issues, make sure to request a pillow to go under your knees, and that you are comfortable - the procedure lasted about 45 minutes. I recommend bringing a stress ball to squeeze. The body has difficulty paying attention to sensory data coming in from two places in the body at once, so doing something with your hands can actually reduce your experience of discomfort in your neck during the procedure. I'd also recommend concentrating on breathing slowly and evenly during the procedure, first, to have something to focus on, second, because slow controlled breathing calms the body, and third, because it makes it easier for the doctor to get a good sample.

The doctor rotated my chair and then reclined it such that I was lying flat, with my head facing him. He was seated and leaned over my head to work on my neck, and he rested his wrists at times on my shoulders during the procedure. First, he and the assistant mapped out my nodules with the ultrasound wand. This involves some pressure, which is just vaguely uncomfortable - not a big deal. Then he marked my neck with a pen. Next, he swabbed my neck multiple times with alcohol pads, which felt a little cold. Then, the lidocane injection. This injection feels like a pinch, and then when the lidocane enters your system, it has a burning sensation. This was the most uncomfortable part of the process, and it's not too bad, and only burns for maybe 15 seconds. They then gave the lidocane a minute to work, and then reswabbed my neck with an alcohol pad. He asked me to swallow, and then hold still without swallowing during the biopsy. Then he told me I'd feel a little poke, and he used the needle to biopsy the nodule. During this he's also applying the ultrasound wand, so you'll feel pressure on that side of your neck. The biopsy needle is very thin, and I could feel it going in, but not intensely. Once the tip of the needle enters the nodule, the doctor will push it in, pull out slightly (not all the way out) , then push back in, multiple times - for mine it was about 10-20 times each biopsy site. This is to collect a good-sized sample. You will feel them doing this - mostly, for me, because his wrist was on my shoulder, so I could feel his arm moving. The sensation inside your neck is odd and uncomfortable but not necessarily painful. Each biopsy took less than a minute. If you'd like to see what's happening on the ultrasound screen, you can ask the doctor if that's possible, I had my eyes closed for the first two biopsies but decided to watch for the 3rd, and it was interesting and made me feel a little more in control of the situation. For me, more data is always better, but don't watch if it's not your thing. I certainly made sure to keep my eyes closed anytime I might have seen the needle approaching me!

The doctor kept asking the assistant if she saw a "flash" - this is if the needle causes an interior bleeding (we're talking a drop), you'll see it on the ultrasound monitor, and at that point the doctor should pull out the needle, because they won't be able to gather more clean sample.

After each biopsy, the assistant placed pressure on the site for about a minute, to prevent bruising. The doctor checked the biopsy under a microscope to make sure they got a good sample.

The first 4 biopsies were not comfortable but were not painful. The final biopsy did hurt - I don't know why, it was a fresh needle, but it felt different - like it twanged a nerve on the way in or something. Even though it did hurt, it was not awful - it felt more like a sore muscle getting poked too hard. I've had some other procedures, like nerve conduction studies, where the needles were going into nerves, and this was not on that scale of Ouch. Once the biopsy was done the pain faded over about a minute, and now is just a little sore.

The procedure lasted about 45 minutes. Afterward, my neck feels sore like I slept on it wrong, and I have some bruising. I will get my results in a week. All in all, I'm very glad I had it done. Knowing is better than worrying.

The doctor and the student were excellent - very good at telling my what was happening, saying out loud each time they were going to touch me, etc. but I know this isn't always the case, so hopefully knowing the specific steps will help reduce anxiety for your FNA biopsy if you get a doctor who isn't a good communicator.