Preparing to do a thyroid biopsy, I was reviewing the prior biopsy the patient had few years ago, when I noticed something.
“The biopsy in 2014 was done by my colleague,” I said to the patient. “Was I on vacation or something?”
“Doctor, you may have forgotten that you had hurt your back at the time, and you could not do biopsies that day,” the patient said. “You asked your colleague to do your patients’ biopsies that day.”
“Oh, yes, now I remember,” I said.
That was the summer when we were vacationing in Mackinac Island. As I was biking with the kids, doing the 8-mile island’s perimeter, I felt the most excruciating back pain of my life. The biking perhaps instigated a compression fracture in my back, so-called Schmorl’s phenomenon (the disc of thoracic 11th vertebra into the body of the 12th vertebra). The cause, in retrospect, turned out to be a severe case of osteoporosis, worse than the most severe osteoporosis of my own patient. My T-score was -3.9 at the spine.
At the time, I was in terrible pain; I could not do thyroid biopsies that day. That back pain prompted me to go for urgent care, the first and last time I went to one. I received a tramadol injection. It did not touch the pain. Physical therapy — no use! Luckily, the pain resolved after 6 weeks, and I began intensive treatment of my own osteoporosis.
“Yes, I now remember,” I said to my patient who was lying on the biopsy table. Then we proceeded with fine needle aspiration, because his thyroid nodule had increased in size in the interim.
“Doc, you needed a doctor, then,” my patient said.
A biopsy is the term we use to describe these minor diagnostic procedures in medicine, like liver biopsy, kidney biopsy, breast biopsy and thyroid biopsy. We refer to the thyroid biopsy as FNA, though I am not sure why the “fine” description was emphasized here. I would guess that perhaps this is more friendly to patients.
In the old days, thyroid biopsies were done with the so-called core needle biopsy: large needles that have cutting stylets. While core biopsies are still used in kidney and liver biopsies, they are no longer used for thyroid biopsy. Bleeding and infection were not infrequent complications with thyroid cord biopsies. So, now the standard procedure for thyroid biopsy is FNA.