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Diagnostic Tests – Fine-Needle Aspiration (FNA) of the Thyroid
1. What is this test?
Fine-needle aspiration (FNA) of the thyroid is a minimally invasive procedure in which a thin needle is used to obtain a sample of thyroid cells for cytologic examination. It is the initial diagnostic test of choice for most solitary thyroid nodules, as it helps determine whether a nodule is benign or malignant.
2. When is this the most accurate test?
FNA is the most appropriate and accurate next step when a patient has:
In exam questions, if a euthyroid patient with a thyroid nodule is described and the question asks for the next step in diagnosis, the correct answer is typically fine-needle aspiration.
3. When is this the wrong answer?
FNA is not the correct initial test in patients with a solitary thyroid nodule who are thyrotoxic (suppressed TSH, elevated T3/T4). In this scenario, a thyroid scintigraphy (radioiodine uptake scan) should be performed first to determine whether the nodule is:
1. What is this test?
Fine-needle aspiration (FNA) of the thyroid is a minimally invasive procedure in which a thin needle is used to obtain a sample of thyroid cells for cytologic examination. It is the initial diagnostic test of choice for most solitary thyroid nodules, as it helps determine whether a nodule is benign or malignant.
2. When is this the most accurate test?
FNA is the most appropriate and accurate next step when a patient has:
- A palpable solitary thyroid nodule
- Normal thyroid function tests (euthyroid state)
In exam questions, if a euthyroid patient with a thyroid nodule is described and the question asks for the next step in diagnosis, the correct answer is typically fine-needle aspiration.
3. When is this the wrong answer?
FNA is not the correct initial test in patients with a solitary thyroid nodule who are thyrotoxic (suppressed TSH, elevated T3/T4). In this scenario, a thyroid scintigraphy (radioiodine uptake scan) should be performed first to determine whether the nodule is:
- Hyperfunctioning (“hot”) — almost never malignant
- Hypofunctioning (“cold”) — higher risk of malignancy and may then require FNA
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