Thursday, September 29, 2005
Laser Thermocoagulation of Benign Solid Thyroid Nodules: A New Therapy
We now put alcohol into recurrent cysts, as an alternative to surgery. Now there are studies published in Clinical Thyroidology 2003;15:11 on the effective use of another form of destruction of thyroid tissue. The use of a laser to "cook" the inside of solid FNA proven benign nodules that cause local symptoms in the neck, or appearance issues. Randomly assigned 30 females to Laser or no therapy for six months. The method involves Ultrasound Guided 18 G needle into the nodule.Then a o.4 mm wire is inserted into the center of the nodule.The needle is withdrawn.Then 2.5-3.0 W output power is given to the nodule. Vapor is seen in the area of the wire on ultrasound, and the area becomes hypoechoic. Two more 2.5-3.0 W outputs complete the therapy, for a total median energy of 2007 J.
The results:
The median volume decreased from 8.2 to 4.8 ml, while the volume increased from 7.5 to 9.0 ml in the untreated patients. A 44% reduction. The controls increased 9 %. There was a 53% difference between the two groups at 6 months. 7/15 in the laser group had neck pain, or tenderness for up to seven days. However, all would have the therapy again if needed. No serious complications occurred, such as vocal cord paralysis. 13/15 laser group patients had pressure symptoms before, and 10/13 had marked relief after the therapy. Cosmetic symptoms also decreased. There was no change in symptoms in the control group, even though the size increased an average of 9%.
Hegedus et al Eur J Endocrol 2005; 152:341-5
Dr Robert Utiger, editor of Clinical thyroidology, states that this seems to be a reasonable way to reduce nodules.
Even though the nodules did not disappear, they decreased enough to reduce symptoms and appearance problems. Usually symptomatic nodules were referred to surgery, but now this is a reasonable alternative.
Clinical thyroidologists will be offering this in the near future. Check www.thyroidologists.com to see if any are offering this now.
Dr.G.
The results:
The median volume decreased from 8.2 to 4.8 ml, while the volume increased from 7.5 to 9.0 ml in the untreated patients. A 44% reduction. The controls increased 9 %. There was a 53% difference between the two groups at 6 months. 7/15 in the laser group had neck pain, or tenderness for up to seven days. However, all would have the therapy again if needed. No serious complications occurred, such as vocal cord paralysis. 13/15 laser group patients had pressure symptoms before, and 10/13 had marked relief after the therapy. Cosmetic symptoms also decreased. There was no change in symptoms in the control group, even though the size increased an average of 9%.
Hegedus et al Eur J Endocrol 2005; 152:341-5
Dr Robert Utiger, editor of Clinical thyroidology, states that this seems to be a reasonable way to reduce nodules.
Even though the nodules did not disappear, they decreased enough to reduce symptoms and appearance problems. Usually symptomatic nodules were referred to surgery, but now this is a reasonable alternative.
Clinical thyroidologists will be offering this in the near future. Check www.thyroidologists.com to see if any are offering this now.
Dr.G.
Recurrent Thyroid Cysts Surgery or PEI
The standard therapy for a benign recurrent thyroid cyst is to remove it at surgery.
However, there are now alternative therapies for recurrent symptomatic thyroid cysts.
The use of alcohol injection, called Percutaneous Ethanol Injection PEI, have been very effective alternative to thyroidectomy. A 5 year study from Italy of 58 patients with cysts found about 90% had volume reduction. Baseline Volume was 13.7 cc, Ethanol injected 7.3 cc.Volume after 5 years was 2.3 cc. There were only 2 recurrences.
PEI is offered at centers around the country. Check www.thyroidologists.com for one near you. Go in for an evaluatuion to see if you are a candidate for this alternative to surgery.
Dr.G.
However, there are now alternative therapies for recurrent symptomatic thyroid cysts.
The use of alcohol injection, called Percutaneous Ethanol Injection PEI, have been very effective alternative to thyroidectomy. A 5 year study from Italy of 58 patients with cysts found about 90% had volume reduction. Baseline Volume was 13.7 cc, Ethanol injected 7.3 cc.Volume after 5 years was 2.3 cc. There were only 2 recurrences.
PEI is offered at centers around the country. Check www.thyroidologists.com for one near you. Go in for an evaluatuion to see if you are a candidate for this alternative to surgery.
Dr.G.
Friday, September 23, 2005
Thursday, September 22, 2005
30 Year Follow Up of Toxic Psychosis Secondary to Hyperthyroid Graves' disease
63 Y/O Female returns for her yearly examination, S/P subtotal thyroidectomy 30 years ago, for Graves' hyperthyroidism, on T4 replacement therapy. Her story is amazing.
At age 33 she had a 50 pound weight loss, and severe anxiety to the point of admission for psychosis. While being treated on the Psych ward, a total T4 was drawn and was 20. n 4.2-12.
She was paranoid, and stated 3 men broke into her house. One of them was a well known
actor. People were talking about her outside her window all night. She was mad all the time, and lost her temper, and could not work. Her employer stated she was a very normal employee for 10 years with no sick days. She had other Sx of hyperthyroidism, such as tremo.. Smooth soft skin, muscle weakness, sweats, and palpitations. There was no FH of thyroid disease, but her dad killed himself after returning from army combat.
I saw her 10 days after admission, and she had a dull stare, drooling from the mouth, and a coarse tremor. She had smooth soft skin, pulse of 136, and a diffuse smooth goiter 2-3 times normal size.
She was on large doses of Thorazine. She was under the care of a conservator due to her acute
mental illness. She was considered an endocrine emergency, and under Inderal blockade, she had an uneventful total thyroidectomy. She was kept on Thorazine for 6 week post surgery, became euthyroid and was never treated again for mental illness.Not even a tranquilizer, for 30 years! She had a recurrence of hyperthyroidism 3 years later, that was treated with radioiodine, but there was no flare up of mental illness. She return to her job, and has spent the last 30 years mentally "normal".
She had examinations by experts in mental illness after her recovery, and they found no abnormal thought processes. I have seen her twice a year since 1976, and she is a very normal lady.
Dr.G.
At age 33 she had a 50 pound weight loss, and severe anxiety to the point of admission for psychosis. While being treated on the Psych ward, a total T4 was drawn and was 20. n 4.2-12.
She was paranoid, and stated 3 men broke into her house. One of them was a well known
actor. People were talking about her outside her window all night. She was mad all the time, and lost her temper, and could not work. Her employer stated she was a very normal employee for 10 years with no sick days. She had other Sx of hyperthyroidism, such as tremo.. Smooth soft skin, muscle weakness, sweats, and palpitations. There was no FH of thyroid disease, but her dad killed himself after returning from army combat.
I saw her 10 days after admission, and she had a dull stare, drooling from the mouth, and a coarse tremor. She had smooth soft skin, pulse of 136, and a diffuse smooth goiter 2-3 times normal size.
She was on large doses of Thorazine. She was under the care of a conservator due to her acute
mental illness. She was considered an endocrine emergency, and under Inderal blockade, she had an uneventful total thyroidectomy. She was kept on Thorazine for 6 week post surgery, became euthyroid and was never treated again for mental illness.Not even a tranquilizer, for 30 years! She had a recurrence of hyperthyroidism 3 years later, that was treated with radioiodine, but there was no flare up of mental illness. She return to her job, and has spent the last 30 years mentally "normal".
She had examinations by experts in mental illness after her recovery, and they found no abnormal thought processes. I have seen her twice a year since 1976, and she is a very normal lady.
Dr.G.
Thursday, September 08, 2005
Tango and Thyroid
Well, I am off to Argentina in October to learn the tango, and have one of my thyroid cancer studies presented as an oral presentation at the International Thyroid Congress.
The LAC/Keck/USC Thyroid Cancer Group has a paper on the cancer marker thyroglobulin, TG. The study will look at the value of improved TG sensitivity in the long term followup of well differentiated papillary thyroid cancer.Some of our members are Carole Spencer, John Lopresti,and Peter Singer. On the way back, I stop in Dallas to attend the AACE's New advances in the use of Ultrasound for thyroid. This will include interventional ultrasound techniques.
Dr.G.
The LAC/Keck/USC Thyroid Cancer Group has a paper on the cancer marker thyroglobulin, TG. The study will look at the value of improved TG sensitivity in the long term followup of well differentiated papillary thyroid cancer.Some of our members are Carole Spencer, John Lopresti,and Peter Singer. On the way back, I stop in Dallas to attend the AACE's New advances in the use of Ultrasound for thyroid. This will include interventional ultrasound techniques.
Dr.G.
Wednesday, September 07, 2005
Thyroid Cancer Occuring with Graves' Disease. Is it More Aggressive?
At LAC/USC Thyroid Conference, a patient was presented and discussed, who had papillary thyroid Cancer and newly diagnosed Graves' Disease with hyperthyroidism. A paper from Italy was presented, and it claimed that the cancers were more aggressive in Graves' patients. I discussed my experience with this rare combination. My 5 cases were not more aggressive than the typical papillary cancer. No one of the experts present had more than one or two cases to talk about.Prior studies have not always agreed with the more aggressive concept.
What can you do to make sure your Graves' patient does not harbor a rare cancer as well?
Any palpable nodule needs ultrasound, I/123 imaging for cold nodules, and possible FNA biopsy. Ultrasound will find any non-palpable significant nodules, and it can help guide the needle into the mass.Significant nodules would be hypoechoic, irregular borders, vascular, and micro-calcifications. If the biopsy is suspicious or positive for cancer, than surgery will be the ideal therapy for both diseases. A rare medical "two for one". After a 4-6 week course of anti-thyroid drug therapy total thyroidectomy needs to be done.
Dr.G.
What can you do to make sure your Graves' patient does not harbor a rare cancer as well?
Any palpable nodule needs ultrasound, I/123 imaging for cold nodules, and possible FNA biopsy. Ultrasound will find any non-palpable significant nodules, and it can help guide the needle into the mass.Significant nodules would be hypoechoic, irregular borders, vascular, and micro-calcifications. If the biopsy is suspicious or positive for cancer, than surgery will be the ideal therapy for both diseases. A rare medical "two for one". After a 4-6 week course of anti-thyroid drug therapy total thyroidectomy needs to be done.
Dr.G.
Tuesday, September 06, 2005
Thyroid Nodular Goiter in a Horse:Is it Cancer, or Just Too Much or Too Little Iodine?
I have treated two horses in my life with thyroid disease. In 1972, a physician friend ask me to look at her horse. It had recently been purchased, and was noted on arrival to have an enlarged thyroid gland. I felt a 3-4 times enlarged nodular goiter.The blood testing of T4 was very low. I first thought the horse was hypothyroid, but after consultation with vet endocrine experts, I was told the horse's total T4 thyroid blood test will seem low by human standards, but the free T4 will be normal. The most likely cause was either a benign tumor, or enlargement secondary to either excess iodine in supplements, or iodine deficiency. There was no use of iodine supplements, so I diagnosed iodine deficiency.
Iodine salt lick was added to the horses diet, and the goiter markedly reduced in size.
The second horse had a large nodule, and after ultrasound studies , it was not consistent with a follicular tumor which is common in horses, but was more likely to be part of a diffuse goiter with a nodule. This time the owner did use kelp supplements,
which contained large amounts of iodine. Fortunately, with removal of the kelp, the nodular goiter reduced in size. Cancer of the thyroid is rare in horses.
Even horses can develop a goiter from excess or deficient iodine in their diet.
Humans in the USA, have a higher chance to develop excess iodine goiter from supplements, as iodine deficiency is rare in the USA.
My daughter's horse, Casey, does not have a goiter, thank God, or I would have had to treat my third horse in 31 years!
I will stick to human thyroid disease, as horses can not tell me what bothers them.
Dr.G.
Iodine salt lick was added to the horses diet, and the goiter markedly reduced in size.
The second horse had a large nodule, and after ultrasound studies , it was not consistent with a follicular tumor which is common in horses, but was more likely to be part of a diffuse goiter with a nodule. This time the owner did use kelp supplements,
which contained large amounts of iodine. Fortunately, with removal of the kelp, the nodular goiter reduced in size. Cancer of the thyroid is rare in horses.
Even horses can develop a goiter from excess or deficient iodine in their diet.
Humans in the USA, have a higher chance to develop excess iodine goiter from supplements, as iodine deficiency is rare in the USA.
My daughter's horse, Casey, does not have a goiter, thank God, or I would have had to treat my third horse in 31 years!
I will stick to human thyroid disease, as horses can not tell me what bothers them.
Dr.G.
Saturday, September 03, 2005
Free Questions Answered By "Ask the Thyroid Doctor", for Katrina, and Flood Victims
Any thyroid patients in the New Orleans, Mississippi, or Alabama areas, who are displaced and wondering about the status of their thyroid condition, or about thyroid medications they are taking, you can get answers from The Thyroid Home Page. Just bypass the usual pay site that includes Paypal credit card section, and go to my thyroid.com email address: dr.guttler@thyroid.com. Be sure to state you are a Katrina victim, as there is usual fee of $35 for all others, at the official "Ask The Thyroid Doctor" site on www.thyroid.com.
Here is a two thyroid patient points to remember:
1. The thyroid hormone used to treat hypothyroidism is not an emergency hormone. You have several weeks to get a new supply, without serious effects.
2. However, the drugs used to treat hyperthyroidism such as Graves' Disease have a short life in your body.Tapazole has an 8 hour half life, and PTU is even shorter. This means your condition will worsen after 1-2 weeks. If you are taking one of these drugs, please notify the nearest medical facilities you come to, that you need this drug refilled, if you lost them in the storm surge, or flood.
The Ask The Thyroid Doctor service has helped many thyroid patients get help all over the world. We want to help you. Please email me if you need thyroid help.
God Bless you all,
Dr.G.
Here is a two thyroid patient points to remember:
1. The thyroid hormone used to treat hypothyroidism is not an emergency hormone. You have several weeks to get a new supply, without serious effects.
2. However, the drugs used to treat hyperthyroidism such as Graves' Disease have a short life in your body.Tapazole has an 8 hour half life, and PTU is even shorter. This means your condition will worsen after 1-2 weeks. If you are taking one of these drugs, please notify the nearest medical facilities you come to, that you need this drug refilled, if you lost them in the storm surge, or flood.
The Ask The Thyroid Doctor service has helped many thyroid patients get help all over the world. We want to help you. Please email me if you need thyroid help.
God Bless you all,
Dr.G.
Anaplastic Thyroid Cancer Claims Chief Justice Rehnquist
September 3, 2005, After a 10 month battle with the most
aggressive form of thyroid cancer, he has passed away at home. The patients with his cancer usually live 3-6 months, but he battled the cancer for 10 months. He swore in the president for a second term. He continued on the court , when lesser men would have resigned. In October, we in the thyroid medical field predicted he had this lethal form of thyroid cancer. He did not have his thyroid removed, but only had a a hole put into his air-pipe to breath. This was the major clue he did not have much time left. He was able to continue to vote on cases before the court, and with difficulty swore in President Bush. He lived to see his clerk, Roberts nominated to the court.
He outlived every one of my own cases of anaplastic thyroid cancer, by 4 months! He was a brave man with a mission, and even a thyroid death sentence did not stop him, from achieving his last goals. No matter what your political goals for the new court, we need to salute his brave, and classy exit.
Bravo to the Chief
Dr.G.
aggressive form of thyroid cancer, he has passed away at home. The patients with his cancer usually live 3-6 months, but he battled the cancer for 10 months. He swore in the president for a second term. He continued on the court , when lesser men would have resigned. In October, we in the thyroid medical field predicted he had this lethal form of thyroid cancer. He did not have his thyroid removed, but only had a a hole put into his air-pipe to breath. This was the major clue he did not have much time left. He was able to continue to vote on cases before the court, and with difficulty swore in President Bush. He lived to see his clerk, Roberts nominated to the court.
He outlived every one of my own cases of anaplastic thyroid cancer, by 4 months! He was a brave man with a mission, and even a thyroid death sentence did not stop him, from achieving his last goals. No matter what your political goals for the new court, we need to salute his brave, and classy exit.
Bravo to the Chief
Dr.G.
Thursday, August 11, 2005
Monday, August 08, 2005
Iodine from Large Amounts of Kelp Causes Goiter Progression in a Young Lady
36 year old female is seen in consultation for goiter, referred by her family physician. Prior work up included an FNA that was read as colloid goiter. Ultrasounds have shown progressive enlargement. There is a family hx of goiter in a sibling.
She as a history of ingesting a large amount of iodine containing supplements. She eats seaweed, kelp, and powdered seaweed at each meal. Bilateral nodular goiter is noted on neck examination. TFT's were borderline with TSH of 2.8 N 0.4-2.5,FT4 0.89 N 0.8-2.0 FT3 2.6 N 1.9-5.1 TG 154, TPO <10.1 TG AB <1,0. 24 hour urine free iodine was 3002 mcgs N 100-400.
The excessive use of iodine containing products such as seaweed will cause progressive thyroid enlargement as in this case.It can cause hypothyroidism in patients with autoimmune thyroid disorders, such as Hashimoto's thyroiditis. Non-toxic goiters can become toxic goiters. Even a normal thyroid that has 1/2 left after lobectomy may fail under the pressure of high dose iodine supplements.
Dr.G.
She as a history of ingesting a large amount of iodine containing supplements. She eats seaweed, kelp, and powdered seaweed at each meal. Bilateral nodular goiter is noted on neck examination. TFT's were borderline with TSH of 2.8 N 0.4-2.5,FT4 0.89 N 0.8-2.0 FT3 2.6 N 1.9-5.1 TG 154, TPO <10.1 TG AB <1,0. 24 hour urine free iodine was 3002 mcgs N 100-400.
The excessive use of iodine containing products such as seaweed will cause progressive thyroid enlargement as in this case.It can cause hypothyroidism in patients with autoimmune thyroid disorders, such as Hashimoto's thyroiditis. Non-toxic goiters can become toxic goiters. Even a normal thyroid that has 1/2 left after lobectomy may fail under the pressure of high dose iodine supplements.
Dr.G.
Saturday, July 30, 2005
Wilson's Syndrome: A Bogus Thyroid Diagnosis Trips up another Physician
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
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
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.
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