> 1. Local anesthesia or no? May I request one way or the other?
I don't use anesthesia; the needle used is very thin. Anesthesia obscures the ability to feel the nodule and can result in a missed biopsy. A needle is used for the anesthesia and the anesthesia stings when instilled so IMO it is MORE painful to use the anesthesia and less safe. > > 2. ...there are to my knowledge, no reasons to > remove a nodule." > > My Primary Care doctor had a non-cancerous thyroid nodule removed at > this same hospital. It was believed the nodule was contributing to > her chronic hoarseness.
It would have to be a very large nodule to contribute to hoarseness. I would estimate that a nodule would need to be 3-4 cm in size, maybe more AND located in a way so as to press on the larynx. I have never seen this happen, but an ENT might have seen more so I would not say it is impossible.
To interfere with swallowing, again, it would be huge or associated with a large goiter or posterior (over the esophagus).
Before an open biopsy on an indeterminate specimen, I'd suggest a second needle biopsy unless technical considerations were why the first one was indeterminate. Unless the nodule was "cold" on a thyroid scan, after an indeterminate needle biopsy with no cellular atypia, I'd try thyroid suppression rather than an open biopsy.
But, as Dennis Miller would say, "That's just my opinion, I could be wrong."
John
John J. Messmer, M.D. Assistant Professor, Family & Community Medicine Penn State College of Medicine
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