Thyroid Fine Needle Aspiration (FNA) in Singapore

Fine Needle Aspiration Cytology (FNAC), also known as Thyroid Fine Needle Aspiration (FNA), is a minimally invasive procedure used to assess thyroid nodules. During the outpatient procedure, a thin, hollow needle is inserted through the skin to extract a small sample of cells from the thyroid nodule. The collected cells are then sent to a laboratory for microscopic analysis to determine whether the nodule is benign or necessitates further investigation.

As the procedure is quick and typically causes minimal discomfort, patients can resume normal activities shortly afterward. Thyroid FNA serves as an important diagnostic tool, that help doctors decide whether a patient with thyroid nodules have to have the nodules removed by surgery.

Dr Donovan Tay

Senior Consultant Endocrinologist

Dr Ben Ng

Senior Consultant Endocrinologist

When is Thyroid FNA Recommended?

Thyroid nodules, detected through ultrasound or physical examination, are found in up to 50% of the population and are generally benign, though a small percentage may be cancerous. In such cases, a Thyroid Fine Needle Aspiration (FNA)—a diagnostic procedure with 85–90% accuracy—is often recommended to determine if the nodule requires further testing or treatment. This minimally invasive test helps distinguish between benign and malignant nodules, and its recommendation by healthcare providers depends on factors such as the nodule’s appearance, the patient’s medical history, or associated symptoms.

Characteristics and size of the Nodule

The appearance of thyroid nodules on ultrasound provides important clues about their risk of being cancerous. Features like irregular borders (uneven or jagged edges), microcalcifications (tiny calcium deposits that look like white specks), a taller-than-wide shape (nodule is taller vertically than horizontally), or a solid composition (not filled with fluid) can raise suspicion. Larger nodules (e.g., over 1 cm) with these features are often considered moderately or highly concerning. Nodules that grow over time also warrant further investigations.

History of Thyroid Cancer

Individuals with a personal or family history of thyroid cancer may need an FNA if a new nodule is found.

Symptoms Related to the Thyroid

Persistent hoarseness, difficulty swallowing, or discomfort in the neck may indicate the need for further evaluation.

Benefits of Thyroid FNA

Thyroid FNA provides valuable information about thyroid nodules, helping to determine the next steps in care. The benefits include:

Early Detection of Abnormalities

The procedure can identify whether a nodule is benign, suspicious, or cancerous, allowing appropriate follow-up.
Minimally Invasive Procedure

FNA involves a thin needle, does not require general anaesthesia, and is usually completed within minutes.
Reduces the Need for Surgery

Many thyroid nodules are benign, and an FNA helps confirm this, avoiding unnecessary thyroid surgery.
Supports Treatment Planning

If a nodule requires further management, the results help determine whether monitoring, surgery, or additional tests are needed.

Preparing for the Procedure

Most individuals do not need to make significant adjustments before an FNA. If you are taking blood-thinning medications (e.g., Aspirin, Clopidogrel, Warfarin, Rivaroxaban) or supplements (e.g., Cordyceps, Ginkgo Biloba, Lingzhi), inform your doctor. Tell your doctor if you use these so they can advise you on managing them before the procedure. Eating and drinking are allowed as usual, as fasting is not required.

What to Expect During and After the Procedure

The procedure is typically done in an outpatient setting and takes around 10–15 minutes. A doctor uses ultrasound guidance to insert a fine needle into the thyroid nodule and withdraw a small sample of cells. Several samples may be taken to improve accuracy. A topical or local anaesthetic may be used, although many people find it unnecessary. Most individuals can resume normal activities after the procedure, with only mild tenderness at the site.

The procedure can be performed in the outpatient clinic, though under certain circumstances, it may be performed in radiology depending on the size and location of the offending nodules. You will be able to resume all normal activities immediately after the procedure. You will be able to go home immediately or after 30-60 minutes of monitoring as determined by your doctor. You may experience some bruising, discolouration of the skin as well as mild pain/discomfort at the biopsy site. This should resolve on its own within 1 – 2 weeks.

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Results Review and Follow-Up

FNA results are typically available within a few days to a week and will be reviewed during a follow-up appointment. If the nodule is benign, no immediate treatment is needed, though periodic ultrasound monitoring may be advised.

If the final report is equivocal or non-diagnostic (as the thyroid FNA has a diagnostic rate of 85% to 90% approximately), a repeat FNAC, another method of tissue removal or ultrasound surveillance may be considered.

In cases where cancerous cells are detected, the doctor will discuss treatment options. The next steps will be tailored to the findings and individual circumstances.

Frequently Asked Questions

Will I need repeat FNAs in the future?

If a nodule is benign, monitoring with ultrasound may be enough. If there are changes in its size or appearance over time, a repeat FNA may be considered. If the final report is equivocal or non-diagnostic a repeat FNAC may be considered.

Are there any risks associated with an FNA?

FNA is generally well tolerated. Some people may experience minor bruising or tenderness at the site. Serious complications, such as infection or bleeding, are uncommon. Please consult your endocrinologist for personalized evaluation to assess the risks and benefits of the procedure.

If my results are inconclusive, what happens next?

If the results are unclear, a repeat FNA, additional imaging, or surgery (can also be an alternative to FNAC to obtain a definitive diagnosis of the thyroid nodule) may be recommended to provide more information.

Dr Ben Ng

Senior Consultant Endocrinologist

As a senior consultant endocrinologist with over 20 years of clinical experience, Dr Ben Ng provides comprehensive care for patients managing various endocrine conditions. His expertise includes the diagnosis and treatment of diabetes, thyroid disorders, obesity, and a range of other metabolic and endocrine conditions.

Dr Ben Ng Jen Min graduated from the Queens University of Belfast Northern Ireland, United Kingdom (UK).
He completed his postgraduate training with the certificate of completion of training (CCT) from the Royal College of Physicians (UK) with dual accreditation in diabetes and endocrinology and in general internal medicine.
In 2010, he was awarded an MD with honours by the University of Hull, UK, in recognition for his research in diabetes mellitus

Dr Donovan Tay

Senior Consultant Endocrinologist

As a senior consultant endocrinologist with over 20 years of clinical experience, Dr. Donovan Tay provides comprehensive care for patients managing various endocrine conditions. His expertise includes the diagnosis and treatment of diabetes, thyroid disorders, osteoporosis, and a range of other metabolic and endocrine conditions.

Dr. Donovan Tay graduated from the National University of Singapore (NUS) and obtained his membership in the Royal College of Physicians (UK), Master of Medicine (NUS), and Master of Clinical Investigation (NUS).
After completing training in endocrinology, he was conferred as a Fellow of the Academy of Medicine, Singapore (FAMS).
He further specialised in endocrinology with a fellowship at the prestigious Columbia University Medical Centre in New York City.

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