Thyroid nodule FNA, read by a specialist.

Prices vary by centre, by whether a bundled endocrine consult is included, and by whether molecular testing is added. London centres include King's College Hospital Private Thyroid Clinic, HCA The Wellington Endocrine and Head and Neck, Chelsea and Westminster Private, Imperial Private at Charing Cross, London Endocrine, and Guy's and St Thomas' Private Endocrine, along with BAETS-registered independent surgeons and radiologists.

1. 01

   Before

   You send us the scan and TFTs

   A short, confidential form. Any prior thyroid ultrasound, TSH and fT4, and a description of the nodule (size, TI-RADS score if known).

2. 02

   Before

   We come back with a recommendation

   Within one working day: whether US-FNA is indicated, whether TSH needs repeating, and whether an uptake scan comes first. Indicative price, an honest read.

3. 03

   Before

   We book the ultrasound and FNA

   Usually within one week. Antiplatelets and anticoagulants are reviewed. You can eat and drink normally beforehand.

4. 04

   On the day

   Arrival at the radiology suite

   Arrival, consent, a fresh diagnostic ultrasound to confirm the target nodule, and local anaesthetic to the skin over the neck.

5. 05

   On the day

   The US-guided FNA itself

   15 to 25 minutes. A 25-27G needle, 2 to 4 passes with capillary aspiration, on-site cytology (ROSE) where available, cell block for molecular testing.

6. 06

   On the day

   Home within the hour

   A short pressure and ice period, written aftercare, and home the same visit. No sedation, so you can drive and return to work.

7. 07

   After

   Bethesda result and next steps

   Cytology in 3 to 7 days, reported by Bethesda category, with molecular testing added on for indeterminate results. Endocrine review to plan management.

• Solid hypoechoic nodule > 1 cm (TI-RADS 4-5)

  The classic FNA target. Marked hypoechogenicity, taller than wide, irregular margins or microcalcifications push a nodule up the score.

• TR3 mildly suspicious > 1.5 cm

  Solid isoechoic without high-risk features. FNA at the 1.5 cm threshold under ACR-TIRADS and British Thyroid Association U3.

• TR2 not suspicious > 2.5 cm

  Predominantly cystic or spongiform. FNA only at the 2.5 cm threshold, and often just serial ultrasound is enough.

• Growing nodule on follow-up

  A 20% increase in two of three dimensions, or > 2 mm growth in a solid component, triggers reassessment and often FNA.

• Suspicious cervical lymph node

  A rounded, hilum-lost or calcified node with a thyroid nodule needs FNA of the node with thyroglobulin washout, not just the primary.

• Family history or prior neck radiation

  Familial medullary or papillary thyroid cancer, MEN2, or childhood neck radiation lower the threshold for FNA.

• Suppressed TSH - do the uptake scan first

  A low TSH suggests a toxic (hot) nodule. Hot nodules are almost never malignant, so we treat the hyperthyroidism, not the cytology.

• Red flag: rapid growth, hoarseness, hard fixation

  Hoarse voice, a hard fixed mass or rapid enlargement over weeks needs an urgent two-week-wait head-and-neck pathway, not a private booking.

• Local anaesthetic, no sedation

  A small volume of lidocaine to the skin over the neck. You are awake, talking to the radiologist, and can drive home afterwards.

• Bruising and minor bleeding

  The commonest issue. A firm pressure pad and ice for 12 to 24 hours settles most bruising. Bleeding into a nodule can transiently enlarge it.

• Neck discomfort for 24-48 hours

  Ache on swallowing is normal for a day or two. Paracetamol is usually enough. Avoid heavy lifting for 24 hours.

• Vasovagal reaction on the couch

  A brief feeling faint during the needle is common. We lie you flat with legs raised, sip water, and it settles in minutes.

• Rare tracheal or vessel puncture

  The needle is thin and ultrasound guided, so serious complications are very rare. Brief cough may occur if the trachea is grazed.

• Bethesda I non-diagnostic (5-10%)

  Not a failure. We repeat the FNA at 3 months under ultrasound, or move to core biopsy for repeatedly non-diagnostic nodules.

• Molecular testing for indeterminate

  For Bethesda III (AUS/FLUS) and IV (follicular neoplasm), Afirma or ThyroSeq refines the risk and avoids unnecessary hemithyroidectomy.

• When surgery is the answer

  Bethesda V (75% cancer risk) and VI (99%) go directly to a BAETS-registered surgeon for hemithyroidectomy or total thyroidectomy.

• Red flags after discharge

  Rapidly expanding neck swelling, difficulty breathing, difficulty swallowing or a large haematoma - call the unit or go to A&E the same day.