The fine needle aspiration biopsy should only be done under ultrasound guidance. Sometimes the thyroid nodule is evident enough that it can easily be felt. Some people will elect to do a biopsy without ultrasound guidance. This is not recommended and not good practice! Many nodules contain more suspicious or less suspicious areas. A needle biopsy should be testing the most suspicious areas within a nodule which can only be determined while looking by ultrasound. Ultrasound guidance also ensures that the normal thyroid that surrounds a nodule is not removed and sampled. This would lead to a misleading (benign) diagnosis or a false-positive biopsy result. Since the fine needle aspiration involves multiple needles, we highly recommend that the patient be numbed by a short local injection. This involves a pinch and a burn for less than 10 seconds. After appropriate time is allowed for the numbing medicine to fully work, a fine needle aspiration involves a deep pressure sensation but not an intolerable amount of pain. It is curious that many of our patients report that they have had prior FNA biopsies which were extraordinarily painful. In our hands, we have seen that they report remarkably better experiences in the way that we perform these biopsies. While an FNA is not the most comfortable procedure to undergo, certainly it should not be an extraordinarily painful experience. One of the most common mistakes that we see is that patients are numbed and not given adequate time for the numbing medicine to take effect. This leads to a very uncomfortable biopsy and patients often tell us that they would rather have surgery than to have the needle test repeated. This is a reflection of a poorly done FNA!