I had an interesting patient come into my office last week. Young, bright, successful in both family and career- definitely someone who "had it together". She was referred to me for assessment of a nodule in her thyroid. She actually hadn't even noticed it herself, but rather, her daughter had pointed it out to her one evening at dinner. Since then, she sought out numerous professional opinions regarding what she should do about this nodule. It was during this quest for information that she wound up in my office.
The nodule was not causing her discomfort, or making her voice hoarse, or interfering with her swallowing. In fact, aside from being a small cosmetic nuisance, it was posing no problems at all. She really didn't know how long it had been there, and only noticed it when her daughter pointed it out about 6 weeks ago. We carefully reviewed the symptoms of hyper and hypo- thyroidism, of which she had none. "Well", she said with a sigh, " I REALLY hope you don't want me to have a biopsy. I can't deal with the thought of a huge needle in my neck."
The thought of a biopsy often scares patients, even those who seem to " have it all together", like this young woman. I suppose the thought of a needle in the neck (of all places!) doesn't help matters much. Many patients who present with thyroid nodules are physically well, and have no signs or symptoms of thyroid disease. This makes the need for a biopsy seems even more obscure. I looked at my patient and realized this was the perfect opportunity to put aside some of her fears, and explains the rationale for a biopsy in her case.
We discussed the high incidence of nodules - as much as 7% of the general population. We talked about the chances of these nodules being suspicious or malignant, and how factors such as age, sex, and other historical factors (such as radiation exposure, and family history) make us more suspicious and concerned over the malignant potential of a nodule. We discussed the role of a biopsy (actually it's a fine needle aspiration- or FNAB). I brought out the needles (which she found pleasantly smaller then what she had envisioned). We went over the procedure, and she was enormously relieved to find out the biopsies are performed in the office, and take only 20-30 minutes in total. I explained to her that obtaining actual cells to look at under the microscope was without a doubt the best way to make a diagnosis. However, I cautioned her that even in the most skilled hands, up to 10% of samples may be non diagnostic. We talked about the possible results of a FNAB, and what the next steps would be. I could sense that this patient was starting to feel more comfortable about the procedure, and by the end of our conversation, she let out an audible sigh, thankful for the information she received. She decided to go home and think it over. She called the office this morning, ready to schedule the procedure.
I am grateful to this patient, because she provided me the opportunity to set aside some misgivings about FNAB. As physicians, we get so very used to ordering tests and procedures without even thinking about how the patient perceives them. Something that we find simple and routine may be frightening and confusing to someone unfamiliar with the world of medicine.
As patients, it is up to you to seek out the information you require to make an informed decision about your health care. It is so important that you let your doctors know if you are confused are concerned- so that your health care providers can address these issues with you. Ten minutes of information can result in an informed decision that will impact the rest of your life. Never be afraid to ask questions or seek out opinions- both you and your doctor will benefit from it!
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