Thursday, March 20, 2008

Endocrine Neck Labratory Open for Busness

Modern thyroid care for patients is vastly more complicated now than 20 years ago.
Most internists and endocrinologists would and could care for thyroid patients. However, the new skills needed to care for thyroid cancer patients and patients with nodules and goiters, are not universally available at your local endocrinologists office. They still use nuclear medicine types at the local hospitals to advise them on the need for radiation therapy for their thyroid cancer patients.They send the patients to radiologists to do ultrasound guided FNA. A new concept in thyroid care is the Endocrine Neck Lab. It will offer thyroid studies performed by a clinical thyroidologist, and thyroid ultrasonographer, Dr.Richard Guttler. Any physician caring for thyroid patients can have Dr.Guttler perform studies for them.These include:1.Diagnostic thyroid/parathyroid/lymph node studies 2. Ultrasound Guided Fine Needle Aspiration biopsy 3. Pre-op and follow-up lymph node mapping in thyroid cancer patients 4.Percutaneous Ethanol injections to cure thyroid cysts 5.PEI for cancer nodes. 6. Node Localizations by US guided blue dye injection pre-operatively to aid the surgeon.

Tuesday, March 11, 2008

Why Surgery Not Needed for most Goiter Patients

Why take the risk of a hospital visit to remove a non-cancerous goiter. Hospital induced secondary diseases, and the real risk of complications from the surgery makes many turned off by surgery. The alternative use of low dose radio-iodine, 30 Millicuries is a great way to reduce goiter size, and stop complications from the knife and all it's ramifications. With a small booster shot of TSH, to increase thyroid iodine uptake, you can deliver enough radiation to decrease the gland by about 50%.Doses below 80 Millicuies are not associated with secondary cancers of other organs, such breast cancer. Call your local thyroidologist for details before you listen to the physician how recommends surgery as the only option.

Hashimotos Thyroiditis, HT: A Thyroid Cancer Risk?

The TSH may be elevated for years before the patient is diagnosed with chronic thyroiditis.Thyroid cancer cells have receptors for TSH. There is a 3 fold increase in cancer if Thyroiditis is present. How many family physicians,internists, and even endocrinologists know that,and do a High frequency ultrasound on their patients with Hashimoto's Thyroidits? Even small nodules not palpable by your physician, but seen on ultrasound can be as dangerous as a larger one that was felt by your physician.If you have thyroiditis, insist on a thyroid ultrasound.

Use of Radioiodine for Thyroid cancer is not needed in Low Risk Patients

Why are nuclear medicine departments in major community hospitals still recommending
ablation therapy for most if not all their patients, regardless of the level of prognostic risk. Two major medical centers with top ten ratings, still have high rates of hospital treated high dose >75 Millicurie therapy for even low risk patients. One uses 150 MCI as standard therapy! 80 MCi or more have increased incidence of solid tumors of the stomach,bladder,prostate,penis, breast,and many more. Why is this happening even though the literature has no evidence it is helpful? The answer is found in the referral patterns of a given center. Busy diabetes and internal medicine endocrinologists and surgeons, commonly defer radiation decisions to the nuclear physician. It is like Little Red Riding Hood asking the wolf for his opinion on the best thing for dinner that night. The need for a new leader to decide the need for adjunct therapy should be a clinical thyroidologist, not the nuclear medicine physician. A clinical thyroidologist with the ability to do lymph node mapping, thyroglobulin, USGFNA of suspect cancer nodes, and can develop an endocrine neck lab to help the many endocrinologists who are too busy to master the skills to be expert at lymph node FNA, percutaneous ethanol injections of cancer nodes, would be the ideal new player in this field. The days of routine use of total body scan and radiation therapy by nuclear medicine is in decline, and that of thyroid ultrasonographers are in ascendancy.