Thyroid Scan

A thyroid scan is a picture of the thyroid gland taken after a small dose of radioactive iodine has been swallowed. The scan not only visualizes the thyroid and the nodule but also shows whether the nodule is functioning (a "hot" nodule) or not functioning (a "cold" nodule). Because cancer is rarely found in hot nodules, a scan showing a hot nodule usually eliminates the need for surgical treatment. If a hot nodule causes hyperthyroidism, it can be treated with radioiodine. Unfortunately, thyroid scans show that most thyroid nodules are cold or nonfunctioning. Although this finding does not indicate cancer, such nodules must be studied further.

Thyroid Ultrasonography

Thyroid ultrasonography is a procedure for obtaining pictures of the thyroid gland by using high-frequency sound waves that pass through the skin, bounce off the inner structures of the neck, and are converted into a "live" image by a computer. It can visualize nodules as small as 2 to 3 mm. Ultrasound studies were first used to distinguish thyroid cysts (fluid-filled nodules)from solid nodules. Cysts were usually benign, and solid nodules were potentially cancerous. Most nodules, however, have both solid and cystic components.

Certain other characteristics, such as a "halo" around the nodule, increased tissue density of the nodule, and calcifications around the rim of the nodule, are more common in benign nodules than in cancerous ones. Nevertheless, many exceptions occur, and ultrasonography alone is rarely able to distinguish between a benign (non-cancerous) nodule and a malignant (cancerous) one.

A more important use of thyroid ultrasonography is in guiding the placement of a biopsy needle to decrease the frequency of inadequate specimens for the biopsy sample. Such guidance allows the biopsy sample to be obtained from the solid portion of those nodules that are both solid and cystic, and it avoids getting a specimen from the surrounding normal thyroid tissue if the nodule is small.

Even when a thyroid biopsy sample is reported as benign, the size of the nodule should be monitored. A thyroid ultrasound examination provides an objective and precise method for detection of a change in the size of the nodule pending manual examination. A nodule that is stable or decreasing in size is unlikely to require surgical treatment.

Dr. Scoma has had a dedicated ultrasound machine since 1985 to perform ONLY Thyroid Sonograms, unlike hospital and outpatient radiology clinics who do sonograms on many different organs and are not as experienced in thyroid sonography.

Also, the same technician has been doing sonography since 1985, so that the year to year films are consistent and comparable, again unlike other sites where sonograms are done by different technicians with slightly different techniques, so films are not comparable.

Thyroid Fine Needle Biopsy

A thyroid needle biopsy is a simple procedure performed in the physician's office. No anesthesia is necessary, and patients usually return to work or home with no ill effects afterward. It provides information that no other test can offer. Although the test is not perfect, a thyroid needle biopsy will provide a diagnosis in more than 95% of the biopsy specimens. Thus, it has drastically reduced the number of patients who have undergone operations for benign nodules. About 5% of biopsy specimens are interpreted as inconclusive, that is, the pathologist cannot be certain whether the nodule is cancerous or a benign lesion. In such cases, a physician who is experienced with thyroid disease can use other criteria to make a decision about whether or not to operate. About 5% of biopsy samples do not yield enough material to make a diagnosis. Such biopsies are usually repeated, preferably with the use of thyroid ultrasonography.

Currently, the office also follows thyroid cancer patients who have been treated. We use Ultrasound yearly, to check for recurrent thyroid cancer, lymph-nodes which develop with cancer, and post operative and post radiation follow up.