Ultrasound is the most important test for looking at the thyroid and the neck. At Diabetes & Endocrine Specialists, the endocrinologist who manages your thyroid performs the ultrasound himself, in our office, and interprets it during your visit. When a nodule needs a biopsy, the same physician performs it under ultrasound guidance.
Thyroid ultrasound and biopsy are performed by Darius A. Schneider, MD, PhD, who holds the Endocrine Certification in Neck Ultrasound (ECNU) from the American Association of Clinical Endocrinology. Procedures are done at our La Jolla office.
Why it matters who performs the ultrasound
In many settings, a technologist acquires the images, a radiologist reads them later, and a third physician decides what to do. When the endocrinologist does the scan, the images are interpreted together with your history, examination and blood tests, in real time. Questions such as “has this nodule really grown?” or “does this lymph node look normal?” are answered while you are in the room, and the next step, whether that is reassurance, a biopsy or a treatment plan, can usually be discussed in the same visit.
What thyroid ultrasound is used for
- Evaluating a thyroid nodule found on examination or on another scan (CT, MRI, carotid ultrasound)
- Deciding whether a nodule needs a biopsy, using its size and its ultrasound features (TI-RADS)
- Following known nodules or a goiter over time
- Assessing the thyroid in Hashimoto’s thyroiditis or Graves’ disease
- Checking neck lymph nodes before and after thyroid cancer surgery
- Locating abnormal parathyroid glands in hyperparathyroidism
- Guiding procedures, including biopsy and radiofrequency ablation
What to expect at the ultrasound
No preparation is needed. You lie on your back with a small pillow under your shoulders, and gel is applied to the front of the neck. The scan is painless and usually takes 10 to 20 minutes. We measure each nodule, describe its composition, borders, shape and any calcifications, and look at the lymph nodes on both sides of the neck. We then go through the images with you.
Ultrasound-guided thyroid biopsy (FNA)
A fine-needle aspiration (FNA) biopsy collects cells from a nodule using a needle thinner than the one used for routine blood draws. Ultrasound guidance lets us place the needle precisely in the part of the nodule that matters most, which improves the chance of a clear result.
How the biopsy is done
- The skin is cleaned, and a local anesthetic can be used.
- Several small samples are taken from the nodule, each in a few seconds.
- The whole visit typically takes about 30 minutes.
- Most people return to normal activities the same day. Mild soreness or a small bruise is common; serious complications are rare.
Blood thinners: tell us before the biopsy if you take warfarin, apixaban, rivaroxaban, clopidogrel or similar medicines. Many people can continue them, but the decision is made with you and your prescribing physician, never by stopping on your own.
Understanding the results
The cells are examined by a cytopathologist and reported using the Bethesda System. Most thyroid nodules turn out to be benign. A smaller number are reported as indeterminate; in that case, molecular testing of the sample can help estimate the cancer risk and may avoid unnecessary surgery. We review the result with you and explain what it means for monitoring, treatment or referral to a thyroid surgeon.
If the nodule is benign but causing problems
Benign nodules that grow, cause pressure or a visible lump, or keep refilling with fluid can often be treated without surgery. Our physicians perform thyroid radiofrequency ablation (RFA) and ethanol ablation for cystic nodules. We have reported six-month outcomes in 118 consecutive RFA patients, presented at ENDO 2026. See also thyroid nodule treatment options.
Common questions
Do I need a referral?
Many insurance plans require one. Your primary care physician can refer you, or your office can contact us directly through our referral page.
Should I bring my previous scans?
Yes. Prior ultrasound reports, and the images if possible, let us compare nodule size accurately over time.
Is thyroid ultrasound safe in pregnancy?
Yes. Ultrasound uses sound waves, not radiation.
Schedule a thyroid ultrasound or biopsy
Call our La Jolla office at (858) 622-7200 or send a request online.
Sources: Haugen BR, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26:1–133. Tessler FN, et al. ACR Thyroid Imaging, Reporting and Data System (TI-RADS). J Am Coll Radiol. 2017;14:587–595. Ali SZ, et al. The 2023 Bethesda System for Reporting Thyroid Cytopathology. Thyroid. 2023;33:1039–1044. Written by Darius A. Schneider, MD, PhD. Reviewed October 2026.
