Wednesday, February 23, 2005

Breast Feeding Infants at Risk from Rocket Fuel Chemical

Perclorate is a drug that can be useful in treating some forms of hyperthyroidism, and was used in the past as a test of thyroid function, in the perchlorate discharge test.
It is hard to find in the USA for treatment, but can be found all over the country in mother's breast milk. It is found in foodstuff raised with water contaminated with perchlorate. This level in breast milk is higher than in cow's milk. This is even more troubling, because the infant is the most susceptable to iodine deficiency.Perchlorate causes blockade of nutritional iodine, and thyroid hormone formation. Thyroid hormone is needed for brain, and IQ development in the infant.Because of this finding the researchers are recommending women block the bad effects of perchlorate by iodine suppliments while they breast feed.The amount of perchlorate in breast milk would give a one month old enough perchlorate to exceed a safe level, called a reference dose that was established by a panel of NAS experts last month. This should result in lowering the safe dose level to protect breast fed infants. Perchlorate levels are high in the lower Colorado river which covers 2 million acres of cropland. What should you do?
Use iodine containing vitamins to counteract the perchlorate effect in breast milk.


Tuesday, February 08, 2005

A.C.T. A new thyroid society

I attended a thyroid meeting in Snowbird in January. The two directors of the meeting, Jack Baskin, Dan Duick, and I were talking about who in addition to ourselves are doing 100% thyroid in their private centers. We came up with a list of about 8-10 names. 2 in Detroit, one each in Texas,Florida,Arizona, California,and New York. We thought it was about time we started a clinical thyroid society as a counterpoint to the American Thyroid Association.This would be similar to the AACE, clinical endocrinologist, and the Endocrine Society.We need at least 100 clinical thyroidologists in the next 5-10 years. The criteria would be to do only thyroid, and just a small amout of adrenal, pituitary, but no Diabetes. The future thyroidologist would need to train in ultrasound, USG needle biopsy of thyroid nodules, suspect cancer neck lymph nodes, parathyroid, as well as interventional therapy, such as alcohol therapy for thyroid cysts. The future thyroidologist must train in thyroid nuclear medicine, so he or she can treat their patients with I/131 for cancer, hyperthyroidism, and simple goiter. They need to learn how to scan their patients for diagnosis of recurrent cancer, and hyperthyroid goiters. They need to train in cytopathology by taking courses offered Cytopathology, even if they do not read their own thyroid biopsy slides.They need to be able to read the slides, and if they do not report out the results,they need to know enough to review the slides and ask key questions of the pathologist. The training in Ultrasound is the cornerstone of the future thyroidologist's practice. It supplies the eyes into the thyroid gland, beyond the reach of expert thyroidologist's fingers. Anyone using small parts U.S. with 10-12.5 Mhz probe, will tell you it brings us way beyond our limited palpation
skills. We find 5-10 mm cancer nodes, in Total Body Scan negative patients with elevated Thyroglobulin cancer markers. We also can biopsy them easily with the 10-12.5 probe, and do TG washings to confirm cancer recurrence. These nodes are almost always not palpated by the thyroiologist.A recent 29 y/o female came to see me with an MR showing one nodule.She had an ultrasound done by a radiologist also showing the one nodule. She balked at my suggestion of my repeating the U.S. myself. When she heard why, she consented. My thyroidologist ultrasound result was starkly different.There were 9 nodules, ranging from 20 mmm to 3 mm in size. There were two highly suspect nodules with 4+ blood vessel penetration into the nodules by power doppler, and microcalcifications. We need to be doing our own ultrasounds for the good of the patients. We are meeting in May at the AACE meeting to jump start this society. We are looking for members, future members, and interested sponsors for out new venture.


Wednesday, February 02, 2005

The Italian Thyroid Ultrasound Machine

It is 2 months since I became the 7 th thyroidologist in the USA to own the Technos Partner Biosound Esaote Small Parts ultrasound, made in Italy. The machine is awesome. I can see and biospy 5 mm suspect cancer nodes, inject saline, and alcohol in thyroid cysts,and analyze nodules for cancer characteristics. Irregular borders, vascular invasion in the nodule, as well as size and echogenicity. The picture quality is as good as the $200,000 all purpose machine they make. I am finding more suspicious neck nodes with this machine, and can biopsy them as well. The guided needle into the node can be sent for cytology, but also washed into saline for Cancer markers,thyroglobulin, and calcitonin.Small suspect parathyroid masses, and cysts can be biopsied, and needle washed for parathyroid hormone. The nodule evaluation is more refined with this machine. For example, if one faces a patient with a goiter with 6 nodules, the cancer may not be the biggest or dominant one by size.This is the one we all would have biopsied in the past. By evaluating the factors most suggestive of tumor, by ultrasound, we can pick out the nodule most likely to harbor cancer, or the "real" dominant nodule. The lower risk nodules can be followed and only biopsied if they grow. The new age of thyroid evaluation for thyroid cancer by high resolution ultrasound is here. Moved to the back bench, is the old mainstay of thyriod cancer follow up, the Total Body I/131 Scan.