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Endocrine radiology · London

Thyroid nodule FNA, read by a specialist.

Ultrasound-guided fine-needle aspiration for thyroid nodules, done by a head-and-neck radiologist and reported by a Bethesda-trained cytopathologist, with molecular testing available for indeterminate results.

A stethoscope on a clinical desk

Indicative pricing

What a private thyroid FNA costs in London.

Indicative ranges across UK centres.

Procedure Indicative range
Diagnostic thyroid ultrasound + TI-RADS report £350-£650
US-guided FNA (single nodule, radiology only) £550-£950
US-FNA + endocrine consult + TFTs (bundled) £850-£1,600
Molecular testing add-on (Afirma GEC / ThyroSeq v3) £1,600-£2,800
Technetium / iodine uptake scan (if TSH suppressed) £450-£850
Second-opinion review of prior ultrasound + cytology £250-£450

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.

The journey

From scan to Bethesda result - what happens, in order.

One team from first message to endocrine review, including molecular testing for indeterminate results.

  1. 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.

  2. 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.

  3. 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.

  4. 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.

When it helps

When FNA is the right step - and when it is not.

Thyroid nodules are common - up to half of adults on high-resolution ultrasound - but only 5 to 15% harbour cancer. TI-RADS and size rules decide whether a needle helps.

  • 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 the hyperthyroidism is treated, 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.

Procedure options

FNA is a family of techniques - and molecular testing sits beside it.

What each option means and which fits your nodule. Core biopsy is selective (lymphoma, anaplastic), molecular testing reclassifies indeterminate results.

  • US-guided fine-needle aspiration (standard)

    A 25-27G needle under real-time ultrasound, 2 to 4 capillary passes. Local anaesthetic to the skin, no sedation, home within the hour.

  • On-site cytology (ROSE) where available

    A cytotechnologist stains a slide in the room and confirms cellular adequacy before the needle comes out. Cuts the non-diagnostic rate.

  • Cell block for molecular testing

    Extra material is fixed in formalin so Afirma, ThyroSeq v3 or MicroRNA panels can be run later if the Bethesda category is indeterminate.

  • Lymph node FNA + thyroglobulin washout

    For a suspicious neck node, the needle rinse is sent for thyroglobulin - a very sensitive marker of thyroid cancer spread.

  • Core needle biopsy (selective)

    A larger 18-20G core is used when lymphoma or anaplastic cancer is suspected, or after a second non-diagnostic FNA. Higher yield, slightly more discomfort.

  • Repeat FNA at 3 months

    For a Bethesda I non-diagnostic result, it is repeated under ultrasound at 3 months - most become diagnostic on a second attempt.

  • Molecular reclassification (Afirma / ThyroSeq)

    For Bethesda III and IV, molecular testing reclassifies 50-70% of nodules as benign and avoids a diagnostic hemithyroidectomy.

  • Second-opinion review

    A specialist re-read of your ultrasound images and cytology - sometimes the answer is watchful ultrasound, not another needle.

Safety and recovery

What to expect afterwards - honestly.

US-FNA is one of the safest interventional procedures. The things worth planning are the bruising window, the 5-10% non-diagnostic rate, and the plan for an indeterminate Bethesda result.

  • 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. Lying flat with legs raised and sipping water settles it 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. The FNA is repeated at 3 months under ultrasound, or core biopsy is used 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.

Reading your thyroid FNA report

Your FNA report in four parts. Read the last one first.

Whichever centre reports it, the letter keeps to the same shape: ultrasound findings, procedure, Bethesda cytology and impression.

  1. 01 Ultrasound

    Nodule sonographic features + TI-RADS score

    Composition, echogenicity, shape, margin, echogenic foci - each scored, summed, and given an ACR-TIRADS or BTA U-score.

  2. 02 Procedure

    Needle gauge, passes and adequacy

    How many passes, whether ROSE confirmed adequacy on the day, and whether extra material was banked for molecular testing.

  3. 03 Cytology

    Bethesda category I to VI

    The single most important line. Bethesda II benign, III atypia, IV follicular neoplasm, V suspicious, VI malignant, or I non-diagnostic.

  4. 04 Impression

    Molecular result + management recommendation

    Read this first: Afirma or ThyroSeq call if run, surgical referral if needed, or the interval for repeat ultrasound follow-up.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for US-FNA varies by insurer and by indication - usually funded when a nodule meets TI-RADS + size thresholds.

Frequently asked

Common questions about thyroid FNA.

Quick answers on TI-RADS, Bethesda, molecular testing and cost.

  • What is a thyroid nodule FNA?

    A fine-needle aspiration (FNA) is a quick outpatient biopsy where a very thin 25-27G needle is passed into a thyroid nodule under ultrasound guidance to collect cells for cytology. It takes 15 to 25 minutes, uses only local anaesthetic to the skin, and you go home within the hour. Cytology is reported using the Bethesda system in 3 to 7 days.

  • Which nodules actually need an FNA?

    Broadly: solid nodules over 1 cm with TI-RADS 4-5 features, mildly suspicious TR3 nodules over 1.5 cm, and low-risk TR2 nodules over 2.5 cm. A suspicious cervical lymph node, a growing nodule, a family history of thyroid cancer or prior neck radiation all lower the threshold. Purely cystic nodules and hot nodules on uptake scan are almost never sampled.

  • What does the Bethesda result mean?

    Bethesda I is non-diagnostic (repeat in 3 months). II is benign, with a 0-3% cancer risk and no surgery. III (atypia) sits at 5-15% risk and IV (follicular neoplasm) at 15-30%, both good candidates for molecular testing. V is suspicious at 60-75% and VI is malignant at 97-99%, both go to a thyroid surgeon.

  • What is molecular testing (Afirma, ThyroSeq)?

    For indeterminate Bethesda III and IV results, molecular panels (Afirma GEC by Veracyte, ThyroSeq v3, MicroRNA rosetta) analyse gene expression or mutations from your FNA cell block. A benign call typically reclassifies more than half of these nodules to a low risk profile and avoids a diagnostic hemithyroidectomy.

  • How much does a private thyroid FNA cost in London?

    US-guided FNA in a private radiology unit is roughly £550-£950. Bundled with an endocrine consult and thyroid function tests it is £850-£1,600. Molecular testing (Afirma or ThyroSeq) adds £1,600-£2,800. A second-opinion review of an outside ultrasound and cytology is £250-£450.

  • Does my TSH matter before the FNA?

    Yes - always check TSH and fT4 first. If TSH is suppressed (low), the nodule is likely toxic (hot) and an uptake scan with technetium or iodine is done before any needle. Hot nodules are almost never malignant, so treatment is for hyperthyroidism, not FNA. If TSH is normal, the next step is ultrasound-guided FNA.

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