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From:  "John Messmer, M.D." <jjm23@p...>
"John Messmer, M.D." <jjm23@p...>
Date:  Mon Jun 11, 2001  3:10 am
Subject:  Re: [vocalist] MED: Thyroid Biopsy - further questions



> 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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