Category: thyroid

My Thyroid Biopsy (A Guide)

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In this post I am going to share my biopsy story and walk you through the process. I’m including tips and answering some questions you might have.

  • What: Thyroid nodule biopsy. This is called a FNA or Fine Needle Aspiration biopsy.
  • Why: To see if nodule(s) are malignant (cancer).
  • Where: Baylor Clinic, Baylor College of Medicine in Houston, Texas.
  • Who: Performed by Interventional Radiology.
  • When: March 20th 2017.
  • My variables that should be considered when reading this: My nodules were in the back of the thyroid, not in the front which makes for a more complicated biopsy. I also had 2 biopsies on each side of the thyroid which created more swelling instead of a single biopsy.

warning! IF YOU ARE READING THIS BEFORE A THYROID BIOPSY ASK IF LIDOCAINE WILL BE USED BEFORE SCHEDULING or going. IF THEY SAY NO, RUN!!! refuse any biopsy without lidocaine injection.

They should have discussed blood thinners prior to your biopsy. I am not a doctor, but I wanted to let you know to double check if they forget or you aren’t sure. I was asked to have a light breakfast, so I chose to have a bowl of oatmeal at the hotel. I feel like this was the right decision. I wouldn’t recommend anything spicy or even all that solid. You might want to pass on meat too. Yogurt or a protein shake might be a good option. Be sure to get some water in before!

I arrived at imaging, did the usual check in. An ultrasound tech came to get me. They do not allow anyone else to go with you because of sterilization. She took me to a different room from where I had my previous ultrasound done. This was more like a doctor’s office room with a counter, sink, and supply cabinets. The bed was different too, once again like you’d see in a doctor’s office with tools to raise or lower it. There was an ultrasound machine and tools on a steel table. It looked like what dentists have for their tools.

We had a discussion about the potential risks and what to expect for recovery. I don’t remember everything that was discussed, but you don’t have to worry about this part too much. Just answer the questions they ask and ask your own if you have any! They want to make sure you are safe and understand what will happen. Finally, I had to sign a consent form. These things are always scary since they list the worst of the worst outcomes. But the tech assured me again that this is very safe.

We also discussed my previous biopsy and she assured me this one would go better. Just like the endocrinologist did. They should also double check your allergies. Since I’m allergic to latex, they triple checked to make sure everything in the room was latex free. She told me this was the best doctor at Baylor and she would let him biopsy any of her daughters. That made me feel better.

I was asked to change into a medical gown. My memory fails me if I had to put on a cap, but you may or may not depending on your clinic. The ultrasound tech came in to prep. They will explain how they want you to be positioned. You will likely have a pillow placed under your neck to expose the area more. It’s possible you already had the pillow technique done on an ultrasound before, it’s not different.

The IR doctor came in and introduced himself. A lab tech person joined him and he introduced her. She would be processing the cells and putting them on slides for the pathologist. This would be a total of 3 people in the room, excluding me. She spent all her time at the counter/sink in the other part of the room so I didn’t see her much though. He looked at the ultrasound machine first to see where nodules were, so he could inject my neck with lidocaine in the right places. He informed me that he was just going to biopsy the 2 larger ones. My neck was sterilized (similar to a surgery) at some point and the surgical stuff came out. Gloves, masks, and drapes round my neck.

So to recap the steps at this point: 1. Q&A from tech plus signing consent forms. 2. Changed into a gown (with or without cap) with basic prep from ultrasound tech. 3. Doctor and lab tech come in. 4. Doctor does his own ultrasound of my neck to plan the biopsy out. 5. Final prep is done for show time.

The doctor prepared the lidocaine injections. I was told that while this will numb most of the pain, I might feel some pain in the thyroid area since they can’t numb that. When the final location was determined he injected them into my neck in different (but strategic) places. While this part is absolutely sucky and painful, this is the better alternative. If you’ve had a local injection before, its the typical lidocaine burn and sting. We waited a few minutes for them to “kick in” and he got the biopsy needles ready.

I really recommend that you don’t look at the tools too much. They look scarier than what they should. There is an attachment they add to the needle/syringe which I assume makes it easier for the doctor performing it? It almost looks like a large gun trigger or what a basic 3D printed glue gun might look like. It makes the whole thing look huge when in reality the actual equipment is about the size of what you get for lab work. Yes, I shared this because you will see them one way or another. But know the contraptions are added to what you are actually getting and it isn’t that large.

It was time for the needle to be inserted. You are requested to be VERY still with no sudden movements. Depending on where they biopsy, you could be asked to tilt your head. That usually consists of look right, left, up, etc. It wasn’t too bad once the needle was inserted. I felt pressure around the skin area and some discomfort in the thyroid. A way to describe the thyroid discomfort is like taking your nail and scratching, but not breaking the skin.

Here is what you need to know: They don’t just put the needle in the nodule, pull the syringe, take out the needle, and you’re done. The doctor “bobs” the needle. They move it up and down while still inserted. While it does look like it, it’s not quite a repeated stabbing. This sensation feels odd for sure. Picture your nodule being a trampoline and the needle has to bounce on (more like inside) it to get your cells. This is probably the best way I can describe it. You will not have one trampoline session either. Trampolines are fun after all, you can’t go just once! Every time the needle goes in it’s called a pass. You will have multiple passes per nodule on different locations. This is to get an accurate picture of the cells within the nodule.

I got breaks between each pass due to placing the collected cells on a slide. I could ask for additional time if I needed it. MAJOR TIP: Try to keep your breathing stable and slow. If it helps, close your eyes. Try some guided visualization techniques prior to your biopsy and use them. I won’t claim like other people that it will completely take away all the anxiety, but it will help. Prayer is another option. Think about past memories, no funny ones though. Keep busy mentally. Plan a party, craft project, or even mentally redesign part of your house! Your biopsy will go much better if you have something to do in your mind away from the procedure. I’m a fidgety type person so it makes me nervous to be completely still. That gets amplified to 1000 when a needle is in your neck and you Absolutely. Shouldn’t. Move. Thinking about anything else helped.

We reached the part where both nodules were biopsied and it was time for a pathologist to review the slides. If the pathologist thought they were sufficient, I was free to go. If not, I would need additional passes. Everybody left the room at that point, so I was by myself. They lowered the lights so I could rest. The ultrasound tech went to the waiting room to update my mom on what happened until that point and what would be happening next. It felt like a long time, but it was probably 20-30 minutes.

The doctor came back in and said I would need a few more passes. I was able to get a little more lidocaine, but there is a limit to how much you can get in a period of time so I wasn’t as numbed up like I was earlier. While these passes were significantly more uncomfortable, they were tolerable. At no time did I feel like I couldn’t handle the pain/discomfort. After the additional passes, the doctor informed me we hit our limit for each nodule and I was done. I received an ice pack to immediately place over my neck and several others since I had a long car ride home. They told me I did a great job. I walked out to the waiting room feeling amazing. I conquered something that had haunted me for years. No longer did a biopsy have any power over me.

Let me stop here and answer a few questions:

  • Can I drive myself? If you are 1. About 30 minutes or under from home and 2. A low traffic area, you probably can. An hour is iffy. Any more than that is an absolute NO. If you want to be on the safe side have somebody else drive you home.
  • Can I go back to work the same day? I’ll be honest, no. I don’t recommend this. And if you want to attempt at that, don’t bank on staying the whole day. Your swelling will likely increase as the day goes on. Your neck will start to get sore. You could have issues with your voice, I did! Ideally you need to rest and ice your neck.
  • Okay, so when do you think I can return to work? I think a good litmus test is when you can speak without pain or if you can hold your neck up comfortably. If you have one nodule that was biopsied, would say depending on your job, perhaps the next day. If your situation was like mine, you probably need at least 2 days off. I really can’t say for sure, it is dependent on so many factors. My biggest advice is listen to your body. If you feel like you aren’t ready yet, don’t push yourself.
  • Can I be alone or should I have a family member with me? Sure to either one. Whatever makes you most comfortable. While this isn’t a surgery, if having somebody around helps your recovery or that would make you feel better, go for it! If you do better alone with just you and Netflix, that’s cool too. My advice with that in mind is to already have soft snacks like applesauce, gelatin (the usual or vegetable based), smoothies/veggie juices, or pudding ready when you get home. Your neck might be too swollen to eat regular foods yet and I don’t recommenced going out shopping afterwards. Here is my exception to whatever floats your goat (that’s intentional): If you have small kids, YES get help or have grandparents kick in. I think that would be too much.
  • What do you recommend for ice packs? Something that has give. You are going to want something that gently lays over your neck. Hard ones will not work. Honestly, frozen peas might be perfect for this. I already had an ice pack in my freezer that was soft and pliable and it worked great. You will want more than one to rotate with.
  • Are there some other foods you recommend? Yes, besides what I mention above Sonic slushes are PERFECT. The ice consistency goes down easy and helps soothe the soreness. Icees work too, but Sonic CRUSHES this.

Let’s talk about recovery! I feel like this is an “expect the worst but hope for the best” situation. My recovery was longer than I anticipated. We’re family here so I will be completely honest. My biopsy was harder to recover from than my thyroidectomy in the throat area. The swelling was a real issue and I couldn’t eat solid foods for a while. To give you an idea from March 20th to my first appointment at MD Anderson on April 6th, I struggled. I was still bruised and sore to the touch, but thankfully not consistently sore. I’ll admit that my ultrasound at MD Anderson was definitely uncomfortable. Although I’m telling you about the difficulties, I’m confident you will make it through the hard parts! I would recommend expecting one full week of not being 100%. Don’t try to be Superwoman or Superman. Take it easy!

Here are two pictures of my bruising:

This was RIGHT after my biopsy when I got in the car. I drew a circle about a part of my neck that still had betadine solution on it.

Here is three days post biopsy. Note the yellow bruising.

I think recovery is so unique to the individual so I want to stress that you just have to take it day by day. I also want you to know that you need to take all the time you need and don’t be afraid to ask for help. Yes, this is “minor” but you still need to recover. If anybody gives you trouble about this just send them to me!

Do you want to hear a funny story? Of course you do! So anybody that knows me knows I am a HUGE My 600 lb fan. I love seeing people turn their lives around and I root for them. I actually coped with my trips to Houston by pretending I was going to see Dr. Nowzaradan. Remember this, it will tie into my thyroidectomy later. My poor mother due to the stress of what just happened AND Houston’s never ending construction made a wrong turn. That wrong turn was AMAZING!

While I was laying in the passenger seat tilted back I started noticing familiar buildings. I said no way. NO WAY. I told my mom to keep going.

GUYS. WE ENDED UP AT DR. NOW’S OFFICE BY ACCIDENT. IT WAS INCREDIBLE.

Yes, I should have rolled down the window but I didn’t want to seem like a Dr. Now stalker.

This was such a blessing to me and I took it as a sign of encouragement.

  • Final thoughts: You’ll get through this. It can be uncomfortable, but tolerable and I have faith that you will do great. Don’t be afraid to speak up if you need a break during the biopsy. Please go easy on yourself during recovery and go at your own pace. Don’t think you are “being a baby” or something like that. It is a sign of strength, not weakness, to ask for help. I believe in you and I’m sending you a virtual hug!

A Wild Cancer Appears

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Here is a picture I took on the day I found out I might have cancer. I find it so funny that MD Anderson was in the picture. It was almost a sign!

It was February 8th, 2017. This was the day of my first ultrasound outside my local hospital. I had just arrived at Baylor College of Medicine in Houston, Texas. The clinic was smack dab in the Texas Medical Center. The parking garage feels like a twisted American Ninja Warrior course. Objective: Reach your appointment ALIVE. I was dodging cars and people. Pro tip: If you are in a parking garage at any TMC facility, never close your eyes. Don’t even blink! Hold your eyes open as if you were waiting for expensive mascara dry, but you have to sneeze. Look at yourself in the mirror EYES WIDE OPEN with a half sneeze praying your eye shadow stays unscathed. This is what your battle plan needs to be. Running isn’t the best solution either, you’ll need to play the visibility game. If you must, flail your arms around or wear a safety vest. No judgment here. To those parking, would you PLEASE go slower? All of us have the same goal, we want to live. That is why we are going to specialty care after all. Thank you for your consideration. This concludes my public service announcement.

When I successfully arrived at the correct floor, I did the usual check in and sit down routine. I started chatting with other patients because 1. I assumed there would be a long wait and 2. I needed my adrenaline to go down from my live action Frogger experience. I was called back no more than 5 minutes later. I did what people do when they are picked out at a concert or TV show. Pointed to myself and stated “Me? Me?? ME???” several times to be sure. Surely this was a mistake, since I didn’t have to wait until I was on the fellow patient’s Christmas card list. She assured me that I was indeed the one she wanted. All without breaking into the musical number from Grease. I was incredibly disappointed.

She led me back to the ultrasound room. My tech seemed tired and not feeling social at first. Following the typical instructions, I laid on a surprisingly comfortable hospital bed. I had nice real sheets (not paper) and pillows! What was this? The Hilton ultrasound suite?? That wasn’t the only impressive thing. I stared at the ultrasound machine like I had never seen this technology before. Ooooohhhs and Ahhhhhs occurred several times during the actual ultrasound. I was captivated by how vivid and sharp the images were. I’m sure my tech was wondering “does she use a horse and buggy to get around?” but was polite enough not to ask. At some point her demeanor suddenly changed. She asked me questions like what I was told about my nodules, had they been biopsied before? Finally it was over and she handed me plenty of towels to clean up with. Ultrasound techs can’t tell you anything. We know they know, but are sworn to secrecy. After all the ultrasound goo was gone, she started to discuss thyroid cancer in general and that the survival rate was good. We parted ways with jokes and cheerful conversation.

I walked out to my mother waiting for me. Each step seemed longer than it was due to processing what just occurred. She started talking about getting lunch and where we could go shopping. After all, she knew that no news comes from the ultrasound. We would have to wait for the doctor appointment the next day. I stopped her and said “Mom, the ultrasound is abnormal”. We have a policy in our family that we try not to worry about something until it is certain, but I shared what happened. While cancer was looking like a real possibility at this point, we agreed to wait until confirmation. After arriving at the hotel later I tried not to think about it too much. I was sure an answer was coming the next day either way. Having the comfort of a definite was enough to get me through the night.

The next morning I ate a Texas shaped waffle. It was my feeble attempt to harvest the Lone Star State’s power to face the parking garage situation once again. It obviously worked because I arrived at the Internal Medicine/Endocrinology clinic for my results. After the typical vital signs I sat and waited even less than I did for my ultrasound. The doctor comes in and says:

“Hi, are you Alexa? You need a biopsy as soon as possible”

Getting told I needed a biopsy stat was quite the introduction. This was the chosen ice breaker? That would be equivalent to proposing on your new date’s doorstep. “Yeah, I saw your picture on the app and got the ring right away!” Dude, can’t we go out for dinner first? Or in this case some basic small talk.

“What do you mean as soon as possible?” I asked the doctor. She explained how my ultrasound showed signs of thyroid cancer. My nodules were solid, hypo-echoic, calcified, and with ill-defined borders. Now, these particular signs don’t always mean cancer separately. But together this was a Crocs and socks combo of the imaging world. I apologize for the disturbing metaphor, but we all know that is not a good look. I was so confused because none of my radiology reports at home had these terms. I consulted Dr. Google later to learn exactly what they meant.

I told her that I couldn’t have a biopsy. I “failed” my other one. I wasn’t a good patient after all. I would probably fail again and what would be the point. Now fully confused, she asks if a local anesthetic was used. Uh no. I had some sort of alcohol solution put on my neck that suspiciously looked like it came out of an alcohol container. Did I mention it also smelled just like alcohol? Does that count? I got the same look as the ultrasound tech gave me the previous day. Let me set the record straight: I do live in this century. I also have an iPhone and data plan if that helps my case.

I think she felt relieved that we were talking about two different types of biopsies. Mine: Unrealistic expectations, no local anesthetic, lack of skill, and not to mention lack of compassion. Theirs: As many breaks as needed, local anesthetic used, significantly quicker, and consideration of my comfort. Once we established this she returned to the urgency issue. Ideally, it needed to be done within a month, but her schedule was backed up. I was given the option of having the Interventional Radiology team do it. They only do procedures while she still has to see patients, which might help with scheduling. Not to mention they do complicated biopsies all the time. I was sold. She put the order in and assured me I could do this.

Unfortunately, for whatever reason, 2017 was a bad year for nodules requiring a biopsy. Shout out if you were part of this crew. The best I could get was in 6 weeks, and that was expedited. It was bad for my sanity. Being that far out my appointment the pep talk hype went stale. I also didn’t appreciate all the time my brain had to create bizarre scenarios. Would Steve Martin come in the room to reprise the role of Orin Scrivello in Little Shop of Horrors while mischievously looking at the biopsy instruments? This is where my mind goes people. Moral of the story: Try to get any procedure like this done as soon as possible to reduce your marathon thinking sessions. I found one upside to the wait. It gave me plenty of time to decide where I wanted be treated if it was cancer.

In our next adventure together I will walk you through the biopsy process and share some (hopefully) helpful tips.

Diagnosis: Impossible

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Here is an actual picture of my arm after the lab incident!

Every cancer patient has a moment in their story where they knew something was off. Mine is a bit more complicated. As stated in my “About” section: My butterfly (thyroid) was already broken before cancer. I started thyroid hormone replacement therapy when I was 16 due to Hashimoto’s thyroiditis including a goiter (enlarged thyroid gland).

I was losing my hair. My skin looked like the Sahara Desert. My nails were brittle like glass. My face was droopy like the sad cat memes. And oh, the fatigue! No vitamin, supplement or caffeine amount would save me. Something was wrong. In an effort to find out what was causing my symptoms I visited several doctors. They said I had some sort of “anxiety issues” or puberty is rough for everybody so stop complaining about it. Or the big one: I was too young to have health problems. Just “relax” and all my issues would ~*magically*~ disappear. Did they learn these lines from med school? And if magic IS essential to my recovery, does that mean they attended Hogwarts School of Medicine? Your guess is as good as mine. I kept trying and found a doctor who ordered lab work for me.

I had 20 vials of blood taken. While that was a lot, it feels like even more when the much older phlebotomist is hitting on you the whole time. He got both my blood and on my nerves. Medical staff can’t claim ignorance of your age, that pesky wristband crushes any excuse. I wanted to run, but the needle in my arm kept me in that chair. I hoped Chris Hansen would pop out at any second and declare this was an episode of: To Catch a Predator. Unfortunately, Mr. Hansen never appeared. For the record, I did jump up as soon as my arm was bandaged and ran out afterwards. I also freaked out the receptionist. “What did they do to that poor girl, am I next??” were probably her thoughts. I apologize.

Since I finally got diagnosed with a thyroid problem, I was prescribed Armour thyroid for my replacement therapy. Armour is essentially dried pig thyroid in a pill. I used it for 3 or so years. For whatever reason that was making my levels worse and caused uncomfortable side effects. I had uncontrollable urges to roll around in mud and oink instead of talking. I knew the pain and embarrassment I was causing my family had to end. Just kidding, obviously. I started having issues with forgetting things and passing out randomly. I had some other problems, but I actually don’t remember them. Which proves the whole forgetfulness thing. My primary care doctor told me it was time to try Synthroid (levothyroxine), the most common and synthetic option. I didn’t want to because I saw so many horror stories and read that I would be making a terrible mistake. Not to mention it might appear that I was abandoning my holistic health philosophy. I was expecting a tar and feather treatment at my next visit to Whole Foods. Shockingly, none of those things happened. I started doing much better on “levo” and felt like I turned a corner at the time.

When I was 20, I was in an unfortunate (violent) situation. As a result of that, I had to visit my primary care doctor. He checked my neck again and told me something felt abnormal. He said he would order a neck ultrasound. Even though I was monitored with labs regularly, I never had an ultrasound before. Although it was awkward that my appointment was sandwiched between ultrasounds of babies, it was easy. Just lay there with some inconsistently warm goo on your neck. I didn’t think much of it really. I thought my neck was still swollen and that my doctor was just doing his due diligence. I received a phone call quickly after the radiology results came in. I had 3 nodules and they were large enough that they needed to be biopsied.

I was referred to a local endocrinologist and a biopsy was quickly scheduled. I was told it was going to be easy and that sometimes patients fall asleep. It wasn’t. I received no numbing medication on my neck and was expected not to swallow for an unrealistically long time. I know this now due to my second biopsy. It was nothing like my first one. Only 2 nodules were able to be biopsied. The samples were poor, and they were blamed on my skill as a patient. This statement still confuses me because I didn’t complete multiple years of schooling and residencies like the doctor did. But my skill gets blamed? Yeah, okay. This made me feel horrible, like a failure. I had been through more painful tests in the past. I pride myself on being a strong, red-haired lass. My morale was very low after the biopsy and it haunted me for years. It was something that “defeated” me. It was “stronger” than me.

If you are a patient or potential patient reading this before I write about my second biopsy, PLEASE KNOW: They aren’t all like this! Don’t worry, my second-opinion doctor looked at me like I came from the dark ages when I described this to her. If you have a good doctor, you should be in good hands. To the patient who has had this bad experience before PLEASE KNOW: Your biopsy excessively hurting, going bad, or not good samples. That is NOT YOUR FAULT! I have seen in other areas of the Internet where this story repeats. Please understand me clearly, it is not your fault. And it doesn’t mean your next biopsy will go that way, just like mine didn’t.

Answers were not coming from the biopsy. The pathologist understandably lacked enough cells to give any opinion on my nodules. The endocrinologist shrugged and said most nodules aren’t malignant (cancerous) so we could do follow-up ultrasounds. That was fine with me at the time, as long as I didn’t have to go through that again! I took my yearly ultrasounds seriously. My nodules kept growing, but I was prescribed higher doses of “levo” in hopes of shrinking them. I was concerned about the growth, but I was once again assured that most nodules were not malignant, and it could just be my Hashimoto’s. I tried to reassure myself. I was being a responsible patient after all.

After a few years of the monitoring, there became a point where deep inside myself, in my spirit, I knew something was wrong. I was having more fatigue than ever. My mind seemed like it stopped working. It felt like having the flu all the time. I wasn’t functioning well in daily life. Not only was my health failing, but I had this unshakable feeling. I blurted out months before what was my second-opinion appointment (even before it was scheduled) “I have cancer” to my confused family. No, I didn’t “speak this on myself”. It already was cancer. I just finally realized it. I knew it was time for a second opinion, including at a different hospital.

And that is when the story changed.