Complications and Contraindications

The most common complication following a thyroid FNA is a hematoma. Most cases of significant hematoma after thyroid FNA are caused by a tear in the capsule of the thyroid gland. This can occur if the patient swallows, speaks, or moves while the needle is in the gland. We also recommend that the needle track remain tightly confined to a narrow region for each pass, rather than utilizing a "fanning" motion, which can lead to increased tissue damage with associated bleeding.

A second potential complication is a vasovagal episode. In case of a vasovagal experience during an FNA, the procedure should be terminated, the patient placed in a supine position with the legs slightly elevated, and a cold compress placed on the patient's forehead. Vital signs should be immediately obtained and documented, and resuscitation protocols should be initiated if indicated. The referring physician should be notified of the adverse event.

Figure 2.3. Ciliated respiratory epithelial cells. These may be obtained from inadvertent sampling of the trachea during a thyroid FNA. (ThinPrep, Papanicolaou.)

Rarely during a thyroid FNA, the needle will pass into the trachea, but this should not be a cause for alarm. Signs that this occurred include cough and a loss of vacuum in the syringe. The patient will occasionally produce a small amount of blood-tinged sputum, but significant bleeding should not occur. Microscopically, the presence of ciliated respiratory-type mucosa confirms the sampling of the trachea (Figure 2.3).

One important contraindication for a thyroid FNA is a known severe bleeding disorder, particularly because the thyroid gland is such a richly vascular organ. In urgent cases, we will perform an FNA on a patient whose thrombocytopenia has been recently corrected by platelet transfusions, but it is preferable to perform these in a hospital setting rather than an outpatient location. A thyroid FNA is rarely an urgent procedure in a critically ill patient and should probably be postponed until the patient is stable.We have not experienced complications in patients receiving daily low-dose aspirin, although it is probably prudent to discontinue the aspirin 1 week before the FNA.

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