Lobectomy for a Large Benign Thyroid Nodule? Second Opinion Saved the Day

50 Y/O female for second opinion on a referral for a lobectomy for a very large thyroid nodule. The FNA of the nodule was benign, but because of the size her endocrinologists referred her for surgery. The ultrasound described two small insignificant nodules 7 mm each in the opposite lobe. My evaluation revealed a major historical finding not known by the first opinion physician. Her sister had thyroid cancer. My ultrasound again saw the nodules but they has 4 + Doppler blood flow in the nodules, irregular borders. My FNA of the large nodule was also benign, but because of the ultrasound findings and the family hx of thyroid cancer I biopsied the two suspicious small nodules not evaluated by the first opinion physician. Both were positive for papillary thyroid cancer. What should you learn as a thyroid patient with a nodule?
1. Get an outside second opinion from a clinical thyroidologist before going under the knife.
2. The second opinion found out during the history that she was at risk due to the fact her sister had thyroid cancer.
3. Careful evaluation of the thyroid by ultrasound revealed not 2 insignificant small nodules, but suspicious nodules for FNA.
4. The second opinion consultant had now changed the whole case from a simple lobectomy to remove a large benign nodule, to a total thyroidectomy for cancer. The lobectomy would have left her with thyroid cancer in the other side that the surgeon would not have felt as they were too small to palpate.
4. The two tests needed before surgery for thyroid cancer would not have been done. They are thyroglobulin cancer marker and an ultrasound 6 level lymph node mapping. This procedure can result in a change in the extent of surgery 30% of the time to include one or more lateral neck lymph node compartments.

It is no emergency to go to surgery for a thyroid nodule. Stop, Think, and get proactive.
Second opinion from an expert thyroidologist can save you from the wrong surgery, as in this example.

My Thyroid Ultrasound Referral Center is Certified by AIUM

Endocrine Neck Ultrasound Lab of Southern California is the only referral center on the west coast that has both the certification of the physician sonographer by the American College of Endocrinology ACE, and the ultrasound lab certified by the American Institute of Ultrasound Medicine.100 endocrinologists have been certified by ACE, but only 5 have had their ultrasound equipment certified by AIUM. My referral ultrasound center is the only one double certified on the west coast. This allows us see referrals from general endocrinologists,and thyroid surgeons for specific studies. Diagnostic Endocrine neck ultrasound, lymph node mapping before and after cancer surgery, parathyroid localization, USGFNA of nodules,lymph nodes, and parathyroid adenomas. Interventional sonography for Ethanol injection treatment of benign recurrent cysts to replace surgery, and recurrent papillary, medullary cancer lymph nodes after prior neck dissection.

Clinical Thyroidologists: What we do for our patients.

In the last month in cooperation with filmmaker John Lynch, I have produced 5 2 minute videos to explain what a real clinical thyroidologist, who only see patients with thyroid disease or thyroid cancer does. The first one is an introduction to my center, and an example of the careful history and physical examination that still is the key to discovering the cause of the thyroid disease. The second is my clinical thyroid nuclear medicine section to evaluate toxic nodules, Graves disease, and cancer.The video is designed to explain why the thyroid expert is the best person to treat you, not the general nuclear medicine types who spend little time with thyroid patients. I can treat the cancer patients with radio-iodine as an outpatient. The hall mark of my center is the core thyroid lab, with excellent confirmed results for T4,T3,TSH,TPO Antibodies, Thyroglobulin, thyroglobulin antibodies,and Calcitonin. The Ultrasound section is top heavy with state of the art testing and treatment for nodules and cancer.We are one of the few centers to treat thyroid/parathyroid cysts,and cancer lymph nodes with ethanol. The thyroid cytology section is a leader in the field of alerting endocrinologist of the need to quality control the results of thyroid FNA,and surgical pathology results by general pathologists concerning their own private patients before subjecting them to surgery or radiation therapy. The videos are uploaded to my twitter site and blog.
Enjoy,
Dr.G.