A physician Naturopath, was following E.Denis Wilson's
methods to treat functional hypothyroidism in over 200 patients in a western state.
In 1994, he began treating a patient by online contact, with just a history form , and no physical examination from another western state. He sent instructions to take tempatures, and send them to him. After looking at the hx and temp. charts he diagnosed Wilson's syndrome. He did not do any lab testing. He odered T3, cytomel which was sent via mail from his local pharmacy. By 1995, he was treating 100 long distance patients, via online,telephone, and mail.
T3, cytomel is normally used at doses of 25-75 mcgs. He gave up to 300 mcgs. 25% were on > 200 mcgs. Overmedication with T3, can be very dangerous and cause death. Even his claim that he saw tests from the patient's primary care group was not factual, as the records release came after he started treating the patient. In 1992, Wilson was suspended and fined and has not returned to practice in Florida. He was ordered to receive metal health assistance as part of the order. His website is still up, and caught this naturapath, in it's bogus web.
1998, the naturapath was fined $3,000, and given a 30 month suspension. He was ordered not to treat out of state patients, without a physical examination, and only with the help of tandem physician in the state of the residence of the patient. He had to submit to audits of his patient records for an additional 2 years after suspension.
The American Thyroid Association stated:
1.Wilsons is inconsistent with known facts about the thyroid gland.
2. Diagnosis is imprecise, using non-specific symptoms and body temperature.
3. T3 is no better than placebo in treating non-specific symptoms, of patients with normal thyroid hormone concentrations.
4.T3 results in wide swings in blood levels, and can produce symptoms, and cardiovascular complications in some patients, that can be potentially dangerous.
Wilson's Syndrome as described by Denis Wilson is a bogus diagnosis, but there is a real Wilson's disease , but it is a rare disease of copper metabolism.
Ref:
Disciplinary actions: E.Denis Wilson MD #0048922
Longwood FL. 2/12/92 Board of Medicine 8(2):10,1992
FL.Depart. of Professional Regulations Tallahassee FL.
TSH, and usually T4, will be abnormal BEFORE you have symptoms of hypothyroidism. Throw away the thermometer, unless you need it for your child's fever, mom!
Even with the new TSH upper normal of 2.5-3.0, you need to have the TSH > 5-10 before symptoms occur.
Dr.G
Saturday, July 30, 2005
Thursday, July 28, 2005
Women Smokers have higher incidence of Graves' Disease
115,000 women's lifestyles were studied to see the effect on the incidence of Graves' Disease. 543 women developed Graves' Disease. Heavy smokers > 25/day, were 3 times more likely to develop Graves' Disease. The rate decreased if they quit 10-15 years ago. However, even past smokers were still more likely to develop Graves'. Archives of internal Medicine, July 25 2005 vol.165, pp.1606-1611.
Now, besides worsening thyroid eye disease, we now know we have more Graves' Disease in smoking women!
Dr.G.
Now, besides worsening thyroid eye disease, we now know we have more Graves' Disease in smoking women!
Dr.G.
Tuesday, July 26, 2005
Monday, July 25, 2005
Overcoming Thyroid Problems: A Great New Book from Harvard Medical School Guide Series. A Book Review.
Dr.Jeffery R.Garber,assistant clinical professor, Harvard Medical School, and a fellow member of the Academy of Clinical Thyroidologists ACT, www.thyroidologists.com, American Thyroid Association ATA thyroid.org, and American Association of Clinical Endocrinologists AACE,www.aace.com, has written a thyroid patient book for the Harvard Medical School Guide series.
The introduction compares thyroid disease to the auto part you never heard of until your car breaks down. This is a good start. He has contact to the laymen, by this simple, but apt analogy.He states the thyroid is undervalued, and it is normal for patients, to not know it's basic functions. He tells the reader thyroid works behind the scenes, and can effect every organ if it is malfunctioning. The only thing most people know is that thyroid failure causes obesity, and that is wrong.
The chapters are well written, and have great side bars.
An example is the one on Kelp, Myth or Fact:
The myth is that kelp is good for you if you have thyroid problems, while the fact is just the opposite, it can harm you. He includes excessive kelp or iodine under risk factors for hypothyroidism, nodular goiter, Hashimoto's thyroiditis, and hyperthyroidism.
The use of the myth or fact approach is seen next in the thyroid medication section.No, it does not cause osteoporosis if the the dose of thyroid hormone is normal. No, hypothyroidism does not cause obesity. And, no, it is not a good therapy to cause significant long term weight loss. No, animal thyroid products, or T4/T3 combinations are not better than T4 alone.
The section on ultrasound for nodules is very up to date.
He describes changes seen on ultrasound that point to cancer, and the need for FNA. However, I think he needed to tell the patients, that ultrasound results depend on the person doing the examination. Clinical thyroidologists, doing their own ultrasound can yield better information to help manage patients with a the thyroid nodule.
The section on pregnancy is excellent, and a must read for pregnant thyroid patients.The need for iodine in prenatal vitamins, and the need to take thyroid hormone at a different time than the prenatals with iron. The present day feelings that ATD's for treating hyperthyroidisms, can be given to breast feeding mothers is discussed.
Finally, he brings up the most important issues.
Who do you see about your thyroid problem? He talks about the thyroid surgeon with a high number of thyroid surgeries/ year, and the endocrinologist with extra training, and experience with thyroid problems. He calls them clinical thyroidologists. He talks about finding out if the physician sees a high percentage thyroid patients, and are less active in diabetic care. Because, the new clinical thyroidolgists society ACT, was just formed , he failed to put the thyroidologists website as a source of referrals to endocrinologists that practice 50-100% thyroidology. The site,www.thyroidologists.com, I hope will be listed in his revised edition in the future.
In conclusion, I will recommend this book to my patients,
and hope to see it become a classic in thyroid patient
literature.It is an excellent book, to give to all my new thyroid patients at the initial consultation. The book is available at the bookstore section on thyroid.com, or at Amazon.com. It is worth the $14.95 retail price in the USA, $19.95 Canadian, or 8.99
English Pounds in the UK.
Dr.G.
The introduction compares thyroid disease to the auto part you never heard of until your car breaks down. This is a good start. He has contact to the laymen, by this simple, but apt analogy.He states the thyroid is undervalued, and it is normal for patients, to not know it's basic functions. He tells the reader thyroid works behind the scenes, and can effect every organ if it is malfunctioning. The only thing most people know is that thyroid failure causes obesity, and that is wrong.
The chapters are well written, and have great side bars.
An example is the one on Kelp, Myth or Fact:
The myth is that kelp is good for you if you have thyroid problems, while the fact is just the opposite, it can harm you. He includes excessive kelp or iodine under risk factors for hypothyroidism, nodular goiter, Hashimoto's thyroiditis, and hyperthyroidism.
The use of the myth or fact approach is seen next in the thyroid medication section.No, it does not cause osteoporosis if the the dose of thyroid hormone is normal. No, hypothyroidism does not cause obesity. And, no, it is not a good therapy to cause significant long term weight loss. No, animal thyroid products, or T4/T3 combinations are not better than T4 alone.
The section on ultrasound for nodules is very up to date.
He describes changes seen on ultrasound that point to cancer, and the need for FNA. However, I think he needed to tell the patients, that ultrasound results depend on the person doing the examination. Clinical thyroidologists, doing their own ultrasound can yield better information to help manage patients with a the thyroid nodule.
The section on pregnancy is excellent, and a must read for pregnant thyroid patients.The need for iodine in prenatal vitamins, and the need to take thyroid hormone at a different time than the prenatals with iron. The present day feelings that ATD's for treating hyperthyroidisms, can be given to breast feeding mothers is discussed.
Finally, he brings up the most important issues.
Who do you see about your thyroid problem? He talks about the thyroid surgeon with a high number of thyroid surgeries/ year, and the endocrinologist with extra training, and experience with thyroid problems. He calls them clinical thyroidologists. He talks about finding out if the physician sees a high percentage thyroid patients, and are less active in diabetic care. Because, the new clinical thyroidolgists society ACT, was just formed , he failed to put the thyroidologists website as a source of referrals to endocrinologists that practice 50-100% thyroidology. The site,www.thyroidologists.com, I hope will be listed in his revised edition in the future.
In conclusion, I will recommend this book to my patients,
and hope to see it become a classic in thyroid patient
literature.It is an excellent book, to give to all my new thyroid patients at the initial consultation. The book is available at the bookstore section on thyroid.com, or at Amazon.com. It is worth the $14.95 retail price in the USA, $19.95 Canadian, or 8.99
English Pounds in the UK.
Dr.G.
The Thyroid Home Page is First!
The Thyroid Home Page, the official website for Santa Monica Thyroid Center, was recently re-evaluated by a company that ranks websites by visitor traffic. They only rank the first 900,000 websites. Any lower ranking, is listed as "not ranked".
Thyroid.com was ranked first for pure thyroid websites at 156,000.
Only endocrineweb.com was ranked higher at 47,000, but it had wider draw as it included all of endocrinology. American Thyroid Association, thyroid.org, was ranked 195,000, or second. Thyroid Foundation of America was not ranked, nor was thyca.org. Stats were not available for thyroid.about.com , because it was part of a large corporation website, about.com. AACE website was ranked 164,000, but it was a general endocrine website. Canadian Thyroid Website, thyroid.ca was ranked 322,000.
Even though thyroid.com may be googled at 2nd through the 5th position, it still is the most visited pure thyroid website.
Thanks for all your support,
Dr.G.
Thyroid.com was ranked first for pure thyroid websites at 156,000.
Only endocrineweb.com was ranked higher at 47,000, but it had wider draw as it included all of endocrinology. American Thyroid Association, thyroid.org, was ranked 195,000, or second. Thyroid Foundation of America was not ranked, nor was thyca.org. Stats were not available for thyroid.about.com , because it was part of a large corporation website, about.com. AACE website was ranked 164,000, but it was a general endocrine website. Canadian Thyroid Website, thyroid.ca was ranked 322,000.
Even though thyroid.com may be googled at 2nd through the 5th position, it still is the most visited pure thyroid website.
Thanks for all your support,
Dr.G.
Wednesday, July 13, 2005
Visit to Ireland: Birthplace of The Physician who was one of the first to describe Hyperthyroid Graves' Disease
We just returned from Ireland, home of Sir Robert Graves. He was born in Dublin in 1796. He graduated from Trinity College in medicine when he was 22. He was a dynamic fellow. In a severe storm when the ship he was traveling on, was about to sink, due to damaged pump values, he took an axe to the lifeboat, because he knew they would all perish in it.He then took over command of the ship, and using his own boot leather, repaired the pumps.He published "Newly observed afflection of the thyroid gland in females" in the London Medical Journal in 1853. He detailed the clinical features of what is now recognized as Graves' disease, even though it was described earlier by Caleb Perry in 1825. It is remarkable that it is the one contribution that is most remembered today. Few call it Perry's Disease today!
In 9 days traveling throughout Ireland, I did not see a single goiter.
My daughter rode horses in western Galway, and at Castle Leslie in the northern Irish Republic, she rode cross-country on the castle's 1000 acre eventing course.
My Irish wife searched out her clans, the Delaneys, and McMonagles.
We found her family McMonagle homestead in Meenagoland,Donegal and the graveyard with 26 McMonagles in nearby Finn Town. There were 600 Delaney's in the Kilkenny phonebook!
It is good to be back.
Dr.G.
In 9 days traveling throughout Ireland, I did not see a single goiter.
My daughter rode horses in western Galway, and at Castle Leslie in the northern Irish Republic, she rode cross-country on the castle's 1000 acre eventing course.
My Irish wife searched out her clans, the Delaneys, and McMonagles.
We found her family McMonagle homestead in Meenagoland,Donegal and the graveyard with 26 McMonagles in nearby Finn Town. There were 600 Delaney's in the Kilkenny phonebook!
It is good to be back.
Dr.G.
Friday, July 01, 2005
Ireland on Horseback: Sir Robert Graves, Here We Come
Well, it is the time of the year to get away from the
usual daily exposure to the many problems associated
with caring for thyroid patuents, and lay back and relax.
However, my 14 Y/O daughter A.J. is an eventer. That means she rides horses over fixed objects, such as stone fences, logs, and water holes. We are going to the land of Sir Robert Graves, one of the first physicians to describe the disease of hyperthyroidism. A.J. will be riding Irish Horses all across western Ireland, and will
then travel to Castle Leslie to jump 150 fixed sites in 5 days. Thyroid clinic is less stressful, than watching her, in a titanium helmut, and flack jacket, jump irsh stonewalls. However, because my wife is second generation 100% Irish, we will search for her roots in Donnigal,in Northwest Ireland, for the McMonigle homestead. We will also look in Killkenny for signs of the Delaney clan. I will research the exact location of the famous man who
has his name on one of my most common disorders, Graves' Disease, I see in my center. It should be fun, if all goes well with my little horse mad daughter. Delaney, my wife, and a private chef, www.delaneyfoods.net, will get a few cooking tips from Darina Allen. She is the most famous chef in Ireland, and has a cooking school just outside of Cork. We will stay in the Red Room at Castle Leslie on the last night in Ireland.
This is for me. I am half Italian from Umbria Italy.The Red Room is decked out in rare items from Umbria.
Paul McCartney was married there to his second wife.
I will return on July 13, 2005. I will post a blog, if I find anything about Sir Robert Graves.
Dr.G.
usual daily exposure to the many problems associated
with caring for thyroid patuents, and lay back and relax.
However, my 14 Y/O daughter A.J. is an eventer. That means she rides horses over fixed objects, such as stone fences, logs, and water holes. We are going to the land of Sir Robert Graves, one of the first physicians to describe the disease of hyperthyroidism. A.J. will be riding Irish Horses all across western Ireland, and will
then travel to Castle Leslie to jump 150 fixed sites in 5 days. Thyroid clinic is less stressful, than watching her, in a titanium helmut, and flack jacket, jump irsh stonewalls. However, because my wife is second generation 100% Irish, we will search for her roots in Donnigal,in Northwest Ireland, for the McMonigle homestead. We will also look in Killkenny for signs of the Delaney clan. I will research the exact location of the famous man who
has his name on one of my most common disorders, Graves' Disease, I see in my center. It should be fun, if all goes well with my little horse mad daughter. Delaney, my wife, and a private chef, www.delaneyfoods.net, will get a few cooking tips from Darina Allen. She is the most famous chef in Ireland, and has a cooking school just outside of Cork. We will stay in the Red Room at Castle Leslie on the last night in Ireland.
This is for me. I am half Italian from Umbria Italy.The Red Room is decked out in rare items from Umbria.
Paul McCartney was married there to his second wife.
I will return on July 13, 2005. I will post a blog, if I find anything about Sir Robert Graves.
Dr.G.
English Physician Diagnoses and Treats Hypothyroid Patients by Symptoms Alone. He Does Not Believe in TSH.
A private clinic in a large city in England treating 4000 patients
referred by GP's for hypothyroidism, by symptoms alone. The physician
felt blood tests failed to diagnose hypothyroidism. He had testimonials
of dramatic cures, including shedding wheelchairs, curing depression, and severe lethargy. He defended his methods saying you could not rely on T4, TSH testing.
The British Thyroid Association and the General Medical council, considered removing his certificate to practice medicine, but due to no fatal outcomes recorded, they allowed him to continue to practice, but with restrictions. He was not to accept
referrals from GP's that were not endocrine in nature. He was to inform the GP of the exact thyroid diagnosis, and thyroid therapy given. He also had to keep detailed records of all patients treated with thyroid hormone, who did not have modern thyroid testing proof, ie T4,TSH of hypothyroidism.
Beware of physicians who claim you are hypothyroid, when you present with symptoms, but
when your prior endocrinologist's testing results were normal. Check to see if his new tests are normal also. Treating by symptoms for hypothyroidism is wrong.
The thyroid tests are always abnormal before symptoms occur.
This physician, although they allowed him to continue practice, with careful supervision, is at risk to do harm in the furtue. This will not be the last we hear about this clinic.
Be Safe,
It is a jungle out there!
Dr.G.
referred by GP's for hypothyroidism, by symptoms alone. The physician
felt blood tests failed to diagnose hypothyroidism. He had testimonials
of dramatic cures, including shedding wheelchairs, curing depression, and severe lethargy. He defended his methods saying you could not rely on T4, TSH testing.
The British Thyroid Association and the General Medical council, considered removing his certificate to practice medicine, but due to no fatal outcomes recorded, they allowed him to continue to practice, but with restrictions. He was not to accept
referrals from GP's that were not endocrine in nature. He was to inform the GP of the exact thyroid diagnosis, and thyroid therapy given. He also had to keep detailed records of all patients treated with thyroid hormone, who did not have modern thyroid testing proof, ie T4,TSH of hypothyroidism.
Beware of physicians who claim you are hypothyroid, when you present with symptoms, but
when your prior endocrinologist's testing results were normal. Check to see if his new tests are normal also. Treating by symptoms for hypothyroidism is wrong.
The thyroid tests are always abnormal before symptoms occur.
This physician, although they allowed him to continue practice, with careful supervision, is at risk to do harm in the furtue. This will not be the last we hear about this clinic.
Be Safe,
It is a jungle out there!
Dr.G.
Wednesday, June 22, 2005
Monday, June 20, 2005
A Rare Thyroid Disease in A Teenager
I recently saw a 17 year old high school student, and it reminded me of a patient I saw a few years ago with a similar problem. He had thyroid nodule 3 years before I first saw him. His Pediatrician sent him to see a pediatric endocrinologist. All thyroid tests were normal,except the TSH was slightly low. The Thyroid scan showed a "hot" Nodule, with suppressed thyroid uptake on the other side.The 6/24 HR uptakes were normal.He was followed 3 times a year. The nodule increased in size, the TSH decreased, and the T3 increased, but still in the normal range. Because the T3 was still normal, inspite of significant decrease in TSH, there was no therapy given. Finally, one year later the T3 was abnormally elevated.
The TSH was very low. He had increased resting heart rate in the 90's. Again, there was no therapy for hyperthyroidism offered. He was seen again 5 months later, and the again the tests clearly confirm T3 Toxicosis. They considered surgery vs. radioiodine, but deferred to an adult endocrinologist. The reason they gave was they were not used to treating a teenager with Toxic Nodule, just Graves' Disease.
There was no anti-thyroid drug, or beta blocker given. The tests again showed T3 toxicosis at the second opinion 4 months later. The recommendation was for surgery, but no therapy was offered. 3 months later he was still untreated, and referred to me.
He was 17. School grades were poor. He had poor concentration, and memory problems.He had sweats, felt jittery, and had palpitations, and lost 12 pounds from his normal weight.Also had symptoms of hypoglycemia, without diabetes. Mentally, He had nightmares, a short temper,and felt very tense.
PE: WT loss 12 LBS, BP 110/60 P 130 regular
With mild exercise up stairs the pulse increased to 180. Proximal muscle weakness, and a large visible mass on the right side of his neck. The U.S. showed a 5 cm mixed mass. It was 2.5 cm larger that 3 years ago. in benign thyroid nodules.The scan confirmed a hot nodule. The I/123 uptake was elevated at 60 % N 8-32%. My testing confirmed hyperthyroidism secondary to a toxic nodule. This is rare in teenagers. The T3 was elevated, TSH was non-detectable, and the T4 was upper normal.
He finally had surgery after 6 weeks, when he was euthyroid. He is doing well in college now.
The time between childhood and adulthood, can be a wasteland for teenage thyroid patients. His health, and schooling suffered because he had a rare disease, Toxic Nodule in childhood, which is common in older adults.There was never any therapy given to combat his hyperthyroidism, and only a plan for definitive surgery, or radioiodine was offered. He needed to be rendered euthyroid before surgery anyway, and even probably before radioiodine. Surgery is the therapy of choice for a teenager. A more rapid referral to adult endocrinologist, who is used to treating toxic nodules in the adult population, may have saved 2 years of reduced health and poor school grades.
DR.G.
The TSH was very low. He had increased resting heart rate in the 90's. Again, there was no therapy for hyperthyroidism offered. He was seen again 5 months later, and the again the tests clearly confirm T3 Toxicosis. They considered surgery vs. radioiodine, but deferred to an adult endocrinologist. The reason they gave was they were not used to treating a teenager with Toxic Nodule, just Graves' Disease.
There was no anti-thyroid drug, or beta blocker given. The tests again showed T3 toxicosis at the second opinion 4 months later. The recommendation was for surgery, but no therapy was offered. 3 months later he was still untreated, and referred to me.
He was 17. School grades were poor. He had poor concentration, and memory problems.He had sweats, felt jittery, and had palpitations, and lost 12 pounds from his normal weight.Also had symptoms of hypoglycemia, without diabetes. Mentally, He had nightmares, a short temper,and felt very tense.
PE: WT loss 12 LBS, BP 110/60 P 130 regular
With mild exercise up stairs the pulse increased to 180. Proximal muscle weakness, and a large visible mass on the right side of his neck. The U.S. showed a 5 cm mixed mass. It was 2.5 cm larger that 3 years ago. in benign thyroid nodules.The scan confirmed a hot nodule. The I/123 uptake was elevated at 60 % N 8-32%. My testing confirmed hyperthyroidism secondary to a toxic nodule. This is rare in teenagers. The T3 was elevated, TSH was non-detectable, and the T4 was upper normal.
He finally had surgery after 6 weeks, when he was euthyroid. He is doing well in college now.
The time between childhood and adulthood, can be a wasteland for teenage thyroid patients. His health, and schooling suffered because he had a rare disease, Toxic Nodule in childhood, which is common in older adults.There was never any therapy given to combat his hyperthyroidism, and only a plan for definitive surgery, or radioiodine was offered. He needed to be rendered euthyroid before surgery anyway, and even probably before radioiodine. Surgery is the therapy of choice for a teenager. A more rapid referral to adult endocrinologist, who is used to treating toxic nodules in the adult population, may have saved 2 years of reduced health and poor school grades.
DR.G.
Tuesday, June 14, 2005
They Changed Your T4 Brand at the Pharmacy. What happens to your health?
A Pharmetrics study of 196 patients who were switched to a different T4 brand, but at the same dose. Prior to the switch, the titration blood studies confirmed they all had normal TSH.
Results:
1. 35% had a change of TSH of less than 0.5. This may not be important, unless the patient had cancer, were even that small change could stimulate cancer cell growth. Also T4 suppression therapy for goiters may be impacted.
2. 20% had a change of TSH of 0.5-1.0. Again not bad except for suppression or cancer therapy.
3. 17% had TSH change of 1.0-1.5. Again major impact of cancer and suppression. But could also impact hypothyroid therapy.
4. 5% had TSH changes of 1.5-2.0 Major impact on cancer, goiter suppression, and some on hypothyroidism.
5. However, the big news was that 25% had TSH changes of >2.0. This has a major impact on all types of thyroid hormone therapy.
Do not let them switch you, and if they do, demand another blood test within 6 weeks from your physician.It is mandated to re-test if switched by 6 weeks.
Switching T4 products may result in harm to the patient without retesting.
Patients must be pro-active to secure safe, effective thyroid hormone therapy.
DR.G.
Results:
1. 35% had a change of TSH of less than 0.5. This may not be important, unless the patient had cancer, were even that small change could stimulate cancer cell growth. Also T4 suppression therapy for goiters may be impacted.
2. 20% had a change of TSH of 0.5-1.0. Again not bad except for suppression or cancer therapy.
3. 17% had TSH change of 1.0-1.5. Again major impact of cancer and suppression. But could also impact hypothyroid therapy.
4. 5% had TSH changes of 1.5-2.0 Major impact on cancer, goiter suppression, and some on hypothyroidism.
5. However, the big news was that 25% had TSH changes of >2.0. This has a major impact on all types of thyroid hormone therapy.
Do not let them switch you, and if they do, demand another blood test within 6 weeks from your physician.It is mandated to re-test if switched by 6 weeks.
Switching T4 products may result in harm to the patient without retesting.
Patients must be pro-active to secure safe, effective thyroid hormone therapy.
DR.G.
Monday, June 06, 2005
Recommendations for FNA of Non-Palpable Thyroid Nodules and Neck Lymph Nodes
At the first meeting of the Academy of Clinical Thyroidologists, the group produced a position paper on non-palpable thyroid nodules, and neck lymph nodes.
Here are the indications for Ultrasound guided FNA of thyroid
micronodules( 0.5-1cm):
1.History of radiation to head and neck during childhood.
2.Family history of medullary, or papillary thyroid cancer.
3.Micronodule in remaining lobe after hemithyroidectomy for thyroid cancer.
4.Hypoechoic micronodule with one of the following ultrasound findings.
A.Blurred margins
B.Intranodular vascularity
C.Taller that wide
D.Microcalcifications
E.Significant neck lymphadenopathy
Our indications for FNA of neck lymph nodes found in thyroid cancer patients
Any node >5 mm in height without a hilar line, and having one or more of the following characteristics:
A.Anterior-posterior/transverse ratio >0.5, in the transverse view.
B.Calcifications
C.Cystic Necrosis
D.Peripheral vascularity
E.Causes deviation of the internal jugular vien
We recommend all thyroid nodules >2 cm be biopsied, unless it is known to be "hot" on I/123 Iodine scanning.
Nodules 1.1-1.9 cm were felt to need biopsy, but the judgement of the endocrinoiologist was paramount in this decision. Some features such as comet tail, and hyperechogenicity were felt to be reasons to delay FNA, as long as there would be follow up obervation.
The full text of the position paper can be found found on www.thyroidologists.com
.
This includes references.
The work of H.Jack Baskin M.D., expert in thyroid ultrasound, was the driving force behind these recommendations.
Thank you,
Richard Guttler
The Thyroid Blog
The Thyroid Home Page
Here are the indications for Ultrasound guided FNA of thyroid
micronodules( 0.5-1cm):
1.History of radiation to head and neck during childhood.
2.Family history of medullary, or papillary thyroid cancer.
3.Micronodule in remaining lobe after hemithyroidectomy for thyroid cancer.
4.Hypoechoic micronodule with one of the following ultrasound findings.
A.Blurred margins
B.Intranodular vascularity
C.Taller that wide
D.Microcalcifications
E.Significant neck lymphadenopathy
Our indications for FNA of neck lymph nodes found in thyroid cancer patients
Any node >5 mm in height without a hilar line, and having one or more of the following characteristics:
A.Anterior-posterior/transverse ratio >0.5, in the transverse view.
B.Calcifications
C.Cystic Necrosis
D.Peripheral vascularity
E.Causes deviation of the internal jugular vien
We recommend all thyroid nodules >2 cm be biopsied, unless it is known to be "hot" on I/123 Iodine scanning.
Nodules 1.1-1.9 cm were felt to need biopsy, but the judgement of the endocrinoiologist was paramount in this decision. Some features such as comet tail, and hyperechogenicity were felt to be reasons to delay FNA, as long as there would be follow up obervation.
The full text of the position paper can be found found on www.thyroidologists.com
.
This includes references.
The work of H.Jack Baskin M.D., expert in thyroid ultrasound, was the driving force behind these recommendations.
Thank you,
Richard Guttler
The Thyroid Blog
The Thyroid Home Page
Friday, May 20, 2005
Tuesday, May 17, 2005
Monday, May 16, 2005
Friday, May 13, 2005
Wednesday, May 11, 2005
Tuesday, May 10, 2005
Thursday, April 28, 2005
Cancer Surgery Pre-Operative Lymph Node Evaluation is Important
With the new high frequency ultrasound machines, it is now possible to evaluate the lymph nodes in patients with proven papillary, follicular, or medullary cancer on FNA, prior to the surgery. This will allow the surgeon to add a lymph node removal to the total thyroidectomy and central compartment surgery.Here is a case.
61 Y/O female with FNA proven papillary thyroid cancer on USG FNA, returns for a pre-op neck US lymph node evaluation. There are 3 nodes located lateral to the primary thyroid cancer thyroid nodule. They are suspicious as they do not have hilar lines. These are found in benign nodes, and disappear in cancer nodes.There is chaiotic blood flow in the nodes, on power doppler. They are tall compared to width with a ratio >0.5. Biopsy was positive for papillary cancer, and the Thyroglobulin washings were positive for high levels of TG in the node. The surgeon was notified about positive nodes in zone 4 on the right lateral to the thyroid mass. He was advised to consider node removal along the whole right jugular chain at the time of the standard total thyroidectomy, and central compartment node removal.
What this means to patients with biopsy proven cancer, is that they need a diagnostic Neck lymph node ultrasound with new high frequency untrasound machines, and if a suspicious node is found, then an USguided FNA, and Cancer Tg washing should be done.
This will result in a change in the surgery if positive.
Dr.G.
61 Y/O female with FNA proven papillary thyroid cancer on USG FNA, returns for a pre-op neck US lymph node evaluation. There are 3 nodes located lateral to the primary thyroid cancer thyroid nodule. They are suspicious as they do not have hilar lines. These are found in benign nodes, and disappear in cancer nodes.There is chaiotic blood flow in the nodes, on power doppler. They are tall compared to width with a ratio >0.5. Biopsy was positive for papillary cancer, and the Thyroglobulin washings were positive for high levels of TG in the node. The surgeon was notified about positive nodes in zone 4 on the right lateral to the thyroid mass. He was advised to consider node removal along the whole right jugular chain at the time of the standard total thyroidectomy, and central compartment node removal.
What this means to patients with biopsy proven cancer, is that they need a diagnostic Neck lymph node ultrasound with new high frequency untrasound machines, and if a suspicious node is found, then an USguided FNA, and Cancer Tg washing should be done.
This will result in a change in the surgery if positive.
Dr.G.
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