Thyroid Awareness Month – When Do Thyroid Nodules Need a Biopsy?

When Do Thyroid Nodules Need a Biopsy?

Not every thyroid nodule needs a biopsy.

The decision is based on ultrasound findings and size—not symptoms alone.

🔍 What determines the need for biopsy?

Using high-resolution ultrasound and validated systems (ATA / ACR TI-RADS), we assess:

Ultrasound risk features (solid, hypoechoic, irregular margins, microcalcifications, taller-than-wide) Nodule size Patient-specific risk factors (e.g., prior radiation exposure)

➡️ Only nodules meeting specific risk and size criteria should undergo biopsy.

🧪 What type of biopsy is used?

The standard test is an ultrasound-guided fine-needle aspiration biopsy (FNAB):

✔️ Minimally invasive

✔️ Performed in the office

✔️ No general anesthesia

✔️ Very low complication rate

✔️ High diagnostic accuracy

📊 Key facts for patients

Most nodules do NOT require biopsy FNAB helps avoid unnecessary surgery Results guide observation vs surgery vs further testing

🦋 Why this matters

Performing biopsies only when indicated:

Reduces patient anxiety Prevents overtreatment Focuses care on clinically significant disease

👨‍⚕️ Dr. Rodrigo Arrangoiz, MD

Surgical Oncologist – Thyroid, Head & Neck, Breast

Mount Sinai Medical Center

📌 Take-home message:

The goal is not to biopsy every nodule —

it’s to biopsy the right nodule at the right time.

📚 References

Haugen BR et al. ATA Guidelines for Thyroid Nodules. Thyroid Tessler FN et al. ACR TI-RADS. Radiology Gharib H et al. Fine-Needle Aspiration of Thyroid Nodules. Endocrine Practice