Tests and procedures

What it is for

It allows the thyroid to be measured, shows whether there are any nodules and describes their features (size, shape, content, blood supply with colour Doppler). It is also used to check the lymph nodes of the neck, the parathyroid glands and, after surgery, the operated area.

Based on the appearance of the nodules, the doctor decides whether they need monitoring over time or a fine-needle aspiration.

How it is done

1. You lie on the couch on your back, with a pillow under your shoulders and your neck tilted slightly back.
2. The doctor puts a little gel on your neck and places the probe on it.
3. The doctor moves the probe over the skin and looks at the images on the monitor. You may be asked to swallow.
4. At the end the gel is wiped off: you can go straight back to your normal activities.

How to prepare

• You do not need to fast and you can take your usual medicines.
• Bring previous ultrasound scans and tests: they are needed for comparison.
• It is best to avoid necklaces and high-necked tops.
• It can also be done during pregnancy.

What it is for

It is the most reliable test for finding out whether a thyroid nodule is benign or needs further investigation. With a thin needle, similar to the one used for blood samples, a few cells are taken and the pathologist examines them under the microscope (cytology).

Not all nodules need to be sampled: the doctor decides this based on the size and ultrasound appearance.

How it is done

1. You lie with your neck tilted slightly back, as for the ultrasound scan.
2. The doctor disinfects the skin and locates the nodule with the ultrasound probe.
3. The doctor inserts the needle, following it on the monitor, and draws out the cells for a few seconds. Usually 2 or 3 samples are needed.
4. Pressure is applied to the spot for a few minutes and a plaster is put on.

Before the test

• You do not need to fast.
• If you take anticoagulants or antiplatelet medicines (for example warfarin, new oral anticoagulants, aspirin, clopidogrel), tell the doctor before the test: the doctor will tell you whether and how to stop them. Do not stop them on your own.
• Bring your most recent ultrasound scan and your thyroid tests.

After the test

• You can go straight back to your normal activities and eat normally.
• For a day you may feel slight discomfort or see a small bruise: this is normal and goes away by itself.
• If your neck swells noticeably or you have difficulty breathing or swallowing, go to the Emergency Department immediately: this happens very rarely.
• You will be told how long the result will take on the day of the test.

How to read the result

In Italy the result of the cytology test is expressed in TIR classes. The doctor will always explain the meaning and the next steps to you.

What they are for

TSH and the thyroid hormones (FT4, FT3) show whether the thyroid is overactive, underactive or working normally. Antibodies (anti-TPO, anti-thyroglobulin, anti-TSH receptor) help to identify autoimmune diseases, such as Hashimoto's thyroiditis or Graves' disease.

In patients who have had surgery for thyroid cancer, tumour markers are measured: thyroglobulin for differentiated cancers and calcitonin for medullary carcinoma.

How to prepare

• The blood sample is usually taken in the morning.
• If you take levothyroxine, it is generally advised to take it after the blood draw, on the day of the test. In any case, follow the instructions you have been given.
• Tell us if you take biotin supplements (vitamin B7 or H): they can affect some results.
• Some tests require fasting: we will tell you when you book.

What it is for

After surgery and any radioiodine therapy, thyroglobulin is the marker that shows whether any disease remains. It becomes more reliable when it is measured after stimulation with TSH. Recombinant TSH provides this stimulation without stopping levothyroxine therapy, and so without the symptoms of hypothyroidism.

Good to know

• The injections are given into the gluteal (buttock) muscle.
• During the days of the test, some people feel mild nausea, headache or tiredness: these usually pass quickly.
• Keep taking your therapy as usual, unless told otherwise.

How it works

1. Day 1First intramuscular injection of recombinant TSH
2. Day 2Second injection
3. Days 3–4No activity needed, normal life
4. Day 5Blood sample for thyroglobulin, often together with an ultrasound scan of the neck

What it is for

Medullary thyroid carcinoma is hereditary in some cases and depends on mutations of the RET gene. All patients with this cancer have the genetic analysis. If a mutation is found, the test is offered to family members too: those who are carriers can be monitored and treated before the disease appears.

How it is done

• A normal blood sample is enough: fasting is not required.
• Before the test, the doctor explains what the test means and asks you to sign the informed consent form.
• The result is always given and explained during a consultation.

What it is for

It shows which parts of the thyroid are more or less active. It is used mainly to understand the cause of hyperthyroidism and to assess "hot" nodules (which produce too many hormones) or "cold" ones.

How it is done

1. You receive a small amount of radioactive tracer: by mouth (iodine) or by an injection into a vein (technetium).
2. After a waiting period, from a few minutes to several hours, you lie under a gamma camera that records the images.

How to prepare

• You may need to stop some thyroid medicines for a few days and avoid foods or medicines very rich in iodine: we will give you the exact instructions when you book.
• Tell us if in recent months you have had tests with iodinated contrast medium (for example a CT scan with contrast).
• Always tell us if you are pregnant or breastfeeding.
• The radiation dose is low. For the rest of the day it is advisable to drink plenty of fluids and limit close contact with small children and pregnant women, if the doctor recommends it.

What it is for

In primary hyperparathyroidism, one or more parathyroid glands produce too much parathyroid hormone (PTH) and the calcium in the blood rises. Scintigraphy, together with an ultrasound scan of the neck, helps to find the affected gland before any surgery.

How it is done

• You receive an injection of tracer into a vein.
• Images of the neck and chest are taken at two points in time, about two hours apart.
• Between the two scans you can wait in the waiting room.

What they are for

A single blood sample is sometimes not enough. In dynamic tests, a substance is given that stimulates or slows the production of a hormone, and the response of the gland is measured with blood samples at set times. Examples are the ACTH stimulation test, the dexamethasone suppression test and the glucose tolerance curve.

How it is done

1. You arrive in the morning, usually fasting.
2. A small cannula (needle) is placed in a vein in your arm, so that later blood samples do not need further needle pricks.
3. A first blood sample is taken, then the test substance is given.
4. Further blood samples follow at precise intervals. In the meantime you stay seated or lying down.

Good to know

• Each test has its own specific preparation, which we explain when you book: follow the instructions on medicines and fasting carefully.
• Bring something to read: there are breaks between one blood sample and the next.
• For some tests it is better to have someone accompany you home.

What it is for

It measures bone mineral density in the lumbar spine, the femur and, if needed, the forearm. It is used to diagnose osteoporosis, estimate the risk of fractures and monitor the effect of treatment over time. The result is expressed as the T-score, which compares your value with that of a young adult.

Vertebral morphometry, which looks for any fractures of the vertebrae, can also be carried out at the same centre.

How it is done

1. You lie on your back on the table of the instrument.
2. A moving arm passes over your body without touching you.
3. You only have to stay still for a few minutes.

How to prepare

• On the day of the test, do not take calcium supplements before the measurement.
• Remove metal objects (belts, buttons, jewellery) in the areas being measured.
• Tell us if in the previous days you have had tests with contrast medium or nuclear medicine tests.
• Not performed during pregnancy.
• Bring your previous densitometry results: it is useful to measure with the same instrument.

What they are for

Graves' disease can affect the tissues around the eyes (bulging or red eyes, double vision). The eye examination assesses the activity and severity of the disease. The visual field test checks the function of the optic nerve. The orthoptic assessment measures eye movements and any double vision.

How they are carried out

• Visual field test: you look at a fixed point inside the instrument and press a button each time you see a light appear. One eye is tested at a time, for about 10 minutes each.
• Orthoptic assessment: the orthoptist asks you to follow a light or an object with your eyes and checks whether the eyes move together.
• If drops are put in during the visit to dilate the pupil, your vision may be blurred for a few hours: it is better not to drive.