Thyroid Center

• We ask for any adult attending a visit at Boston Children’s please have a photo ID on them. Adults may be asked to show photo ID prior to entering the hospital.
• When you arrive, you will be asked to complete a questionnaire about your child’s symptoms and medical history. A clinical assistant will measure your child’s height, weight, heart rate, and blood pressure.
• Next, you and your child will meet with a Thyroid Center nurse, who will review medical information and answer any questions you may have about the clinic.
• In most cases, the nurse will place a topical anesthetic cream on the front of your child’s neck. This cream helps to numb the area in case a fine-needle aspiration biopsy is recommended when you see the physician. This numbing cream takes about 30 minutes to work.
• While the numbing cream starts working, the nurse will give you directions to your thyroid ultrasound appointment. A Thyroid Center endocrinologist will meet you in the Thyroid Ultrasound Clinic, which is located across the street at neighboring Brigham and Women’s Hospital.

• In the Thyroid Ultrasound Clinic, you and your child will meet a Thyroid Center endocrinologist who will review your child’s medical history and perform a physical examination.
• One of our expert radiologists will perform a complete ultrasound evaluation of the thyroid gland and neck. Ultrasound is a safe and painless method of imaging, and it's the best way to evaluate the size and characteristics of a thyroid nodule.
• After reviewing the imaging results with the radiologist, your endocrinologist will discuss the results with you and make recommendations about next steps, including whether a fine-needle aspiration (biopsy) is recommended. Some common scenarios include:
  • No significant thyroid nodules are found, and no further imaging or testing is needed
  • One or more thyroid nodules is found, but no fine-needle aspiration is necessary now; another ultrasound or blood tests may be needed in the future to make sure nothing changes
  • One or more thyroid nodules is found, and a fine-needle aspiration is recommended
  • There are other findings on ultrasound that may require some blood tests and/or another type of thyroid imaging

If a biopsy of the thyroid nodule is recommended, it will usually be performed on the same day, immediately after the ultrasound. Fine-needle aspiration biopsy is a very safe, minor procedure. The endocrinologist will explain the procedure in detail, answer all your questions, and obtain your consent before the procedure.

With our experience of more than 1,000 fine-needle aspiration procedures in children, unlike many centers we can perform thyroid fine-needle aspiration without sedation or general anesthesia for almost all children over 8 to 9 years of age. This allows us to avoid the risks and side effects of sedation, making the procedure faster and safer.

Here is how the fine-aspiration is performed:

• The topical anesthetic cream placed in advance by the nurse numbs the surface of the skin. We then use a small amount of local anesthetic to numb the area even further.
• Once the area is numb, we use a very thin needle to take three to six samples of thyroid cells from the nodule. The radiologist provides real-time ultrasound guidance to the endocrinologist taking the samples, which helps obtain the best possible samples while avoiding damage to nearby structures. The entire procedure generally takes less than 10 minutes.
• The samples of thyroid cells are sent for analysis by an expert thyroid cytopathologist, who examines the cells under a microscope. Your endocrinologist will arrange a follow-up clinic visit to discuss the results of the biopsy and any further recommendations for care.

After the biopsy, a patient may experience some soreness of the neck (like a small bruise) within the first 24 hours, which is easily treated with acetaminophen. There is no scar, or activity or dietary restrictions after the biopsy.

In some cases, the endocrinologist may recommend that blood tests be performed before, during, or after your visit to help determine how the thyroid gland is working.