# Biopsy of multinodular goiters



## Tharmas01 (May 12, 2011)

Hi everyone,

Does anyone know the standard practice of biopsy when it comes to multinodular goiters? I've read several articles that talk about the "dominant nodule," and obviously not every nodule can by biopsied (due to cost), so how do most doctors proceed? I ask b/c I have a MND, and my doc biopsied the two nodules that were >1cm but did not biopsy the two that were <1cm.

Thanks!


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## Andros (Aug 26, 2009)

Tharmas01 said:


> Hi everyone,
> 
> Does anyone know the standard practice of biopsy when it comes to multinodular goiters? I've read several articles that talk about the "dominant nodule," and obviously not every nodule can by biopsied (due to cost), so how do most doctors proceed? I ask b/c I have a MND, and my doc biopsied the two nodules that were >1cm but did not biopsy the two that were <1cm.
> 
> Thanks!


Checking to see if you can "see" this. Let me know, please!


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## Andros (Aug 26, 2009)

Tharmas01 said:


> Hi everyone,
> 
> Does anyone know the standard practice of biopsy when it comes to multinodular goiters? I've read several articles that talk about the "dominant nodule," and obviously not every nodule can by biopsied (due to cost), so how do most doctors proceed? I ask b/c I have a MND, and my doc biopsied the two nodules that were >1cm but did not biopsy the two that were <1cm.
> 
> Thanks!


Just bumping up so others can reply; got you "validated" now!


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## Tharmas01 (May 12, 2011)

Yep, got it. Thanks!


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## Tharmas01 (May 12, 2011)

The two >1cm nodules that were biopsied were found to be be benign.

I still have two other nodules (one that is complex-6mm another that is solid-9mm) that were not biopsied.

I've read quite extensively about how doctors decide which nodules to biopsy and which to not biopsy. I'm a little confused as to how they do this with a multi-nodular goiter (especially if there are 5 or more nodules; do doctors biopsy all of them?) I read that some find "dominant nodules" and I think that's what my endo did.

The closest answer about suspicious nodules <1cm I got was from the American Thyroid Association - they said that generally speaking nodules that are <1cm (the clinical definition is 5mm-1cm) are not biopsied unless the patient has a high-risk history or the nodules have suspicious sonographic features.

High risk history includes: 
history of thyroid cancer in one or more first degree relatives, history of external beam radiation, exposure to ionizing radiation in childhood, prior hemithyroidectomy with discovery of thyroid cancer, FDG avidity on PET scanning; MEN2/FMTC-associated RET protooncogene mutation, calcitonin > 100 pg/mL. MEN, multiple endocrine neoplasia; FMTC, familial medullary thyroid cancer.

Suspicious features include:
microcalcifications; hypoechoic; increased nodular vascularity; inflitrative margins; taller than wide on transverse view.

As far as I know I have none of these high risk or suspicious features. Technically speaking, my doc is following the guidelines set out by the ATA. I know it's better to be safe than sorry. Does anyone on the list have nodules that they follow-up with their physician? Do they biopsy all of them, or does their physician simply biopsy some and not others? What criteria do they use?


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## Andros (Aug 26, 2009)

Tharmas01 said:


> Yep, got it. Thanks!


You are most welcome and in the process I learned a thing or two.


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## lainey (Aug 26, 2010)

Nodules are very common--up to 40% of the general population has thyroid nodules. They are much more common in people with thyroid disease, and can exist independently of it--ie, just because you have nodules (found for what ever reason) does not necessarily mean that you have a thyroid problem, and vice versa.

The key to the FNA is getting the proper cell sample. Size and location of the nodule play into this. If you can't get a proper sample, ie: the nodule is not large enough, it really is of little use to do the study, especially if the patient is very low risk.

It has been my own experience, both personally and anecdotally on boards such as these, that nodules in a multinodular goiter can come and go, grow and shrink, especially when they are smaller in size.

If they sampled the larger nodules and found them to be benign, then likely they figured the chances the others would be problematic was very unlikely given your history. The usual course would be a follow-up ultrasound to monitor changes in all of the noted nodules, and proceed from there.


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