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.


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