THE THYROID BLOG

Why a General Endocrinologist Should Not be your Thyroid Doctor

2008-06-30T17:55:00.000-07:00

10-15 years ago, a referral for thyroid second opinion from an internist, and from a general endocrinologist would show that the endocrinologist knew more about the thyroid condition than the internist. Sadly, it is not the case today. With diabetes and general medicine taking up the majority of the waking hours for the endocrinologist, there is now a loss of thyroid specific expertise by the

Calcitonin Measurement in All New Thyroid Nodules

2008-06-16T13:37:00.000-07:00

Is Calcitonin screening of all thyroid nodules cost Effective? A recent study by Cheung and associates in the JCEM 93:2173-2180,2008, suggests it is worth the expense. They found it was comparable to screening with TSH,colonoscopy,and mammography. Two groups were studied. One following the guidelines for nodule evaluation by the American thyroid Association ATA, and the other the same ATA except

Alarms Go Off in Restrooms When Radiated Thyroid Patients Urinate.

2008-06-16T11:01:00.000-07:00

A 30 Y/O female with Graves' hyperthyroidism was treated with 15 Millicuries of radioiodine. The next day she entered the restroom at her workplace, and an alarm of a flame sensor sounded. This happened everyday for 6 days, whenever she went to the restroom to urinate,the sensor went off and stopped when the toilet was flushed, and the radiation in the toilet was washed away. The sensor was 10

Beware of Compounding Pharmacy Thyroid Hormone Dispensing Errors

2008-06-13T15:00:00.001-07:00

I do not use compounding pharmacy thyroid hormone for my patients. There are pure thyroid hormones made by companies such as Abbott, that makes Synthroid. Errors have been found with other medications from these pharmacies. Recently, errors have occurred when they have compounded thyroid hormone. Case History: 46 Y/O male admitted the hospital with 22 pound weight loss,palpitations, but he did

Why I Need to Know About Alternatives to Surgery for my Large Simple Goiter

2008-05-27T11:04:00.002-07:00

There are not many therapy alternatives to surgery if you have a goiter. The large goiter may be causing obstructive symptoms, or harbor a cancer. The obstructive component can be evaluated by MR, and pulmonary function testing, including flow loop to see if there is any upper airway obstruction. Any suspicious nodules found on ultrasound need to be biopsied. If no obstruction or cancer is found,

88 Year Old with Recurrent Papillary Thyroid Cancer: Do No Harm or Treat?

2008-05-25T13:37:00.000-07:00

Case Presentation: Question: Why are they treating 85-94 year old patients so aggressively? Answer: Because they have the tools to do it. 88 Y/O male with a 4 cm mass, which was proven to be a follicular variant of papillary cancer. After total thyroidectomy, he was subjected to hormone withdrawal at his age. Well it is no surprise that he was developed cardiac complications. The TSH >100, and

What Should You do if your Primary Care, or Endocrinologist tell You that Your Blood Calcium is Elevated and you need Surgery to Remove a Parathyroid

2008-05-24T15:35:00.000-07:00

The most common cause is over-active parathyroid gland activity. Usually a single non cancerous tumor called a parathyroid adenoma. The screening testing is easy. Calcium, parathyroid hormone, and urine studies for calcium and creatine. But once the diagnosis is made the next step is not as easy. The location of the tumor can be anywhere in the neck, and may even be in the chest. Also, there may

What is Thyroid Cancer Ultrasound Lymph Node Mapping, and why do I need to have one BEFORE my Cancer Surgery?

2008-05-24T08:58:00.000-07:00

Prior to the new approach to thyroid cancer, the radio-iodine whole body scan WBS, was the mainstay of diagnostic cancer studies. Along came highly sensitive cancer markers, Thyroglobulin TG, and the TG antibody. The WBS was poor at detecting recurrence. The addition of the newer high frequency ultrasound was better at finding recurrences, than the WBS. With Cancer markers and Ultrasound we can

What is Methylene Blue Dye Localization, and why do I need to know about it if I have recurrent thyroid cancer after multiple surgeries?

2008-05-22T08:29:00.000-07:00

Case Presentation: 69 Y/O female with an aggressive form of papillary thyroid cancer called Tall Cell Variant. She has had total thyroidectomy, and central compartment node removal.. 150 MCI was given after the first surgery. The first recurrence was in the right lateral neck. Another surgery was done. 200 Millicuries of I/131 was given. Over 12 months her thyroglobulin,TG rose from 0.36 to 6.5

PEI: What is Percutaneous Ethanol Injection, and why do I need to know about it, if I have had multiple surgeries for papillary thyroid cancer?

2008-05-21T14:11:00.000-07:00

Case Presentation: 70 Y/O Japanese female with multiple surgeries in the lateral neck after total thyroidectomy for papillary thyroid cancer. Her cancer marker rose again, and she was given another thyroid cancer lymph node mapping. There was a 7 mm tall and 6 mm wide node in level 4 on the right side. The node had abnormal Doppler blood flow suggestive of another recurrence. She was given an

PEI: What is PEI and why do I need to know about it, if I have a thyroid cyst, or parathyroid cyst, and have been told to have surgery?

2008-05-21T11:06:00.000-07:00

Case Presentation: 50 Y/O Chinese male was told in Shanghai, that the only therapy for his recurrent thyroid cyst was surgery. A modern Chinese male hits the web to research this, before submitting for surgery. He found thyroid,com, and emailed me about coming to the USA for a consultation. He was euthyroid, on no medications, and had a 15 cc pure cyst. The ultrasound guided FNA biopsy confirmed

Murder by Thyroid Poisoning, or Paranoia?

2008-04-07T13:30:00.000-07:00

A 40+ Y/O male presented to the ER with a rapid pulse and insomnia for a week. He told the ER physician that he felt he was being poisoned by a female friend. He stated that for 6 weeks he has been eating at her condo, and became progressively sicker in the last 2 weeks. He developed insomnia, anxiety and rapid heart beat which was confirmed at the ER at 160/minute.The thyroid was mildly

Why Surgery Not Needed for most Goiter Patients

2008-03-11T18:51:00.000-07:00

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

Hashimotos Thyroiditis, HT: A Thyroid Cancer Risk?

2008-03-11T18:23:00.000-07:00

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

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

2008-03-11T17:58:00.000-07:00

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

What to Do about Recurrent Cancer Neck Nodes, When You have had Multiple Surgeries, or Have Contraindications to Further Radioiodine or Surgery?

2008-02-28T12:13:00.000-08:00

The patient has papillary thyroid cancer. She had originally a total thyroidectomy, and central compartment node removal. 2/6 nodes were positive. This was followed by radio-iodine therapy. She developed recurrence in the left lateral neck, treated by modified neck removal of 26 nodes. 12/26 were positive for cancer. She had a second course of I/131, and still had detectable cancer marker, which

Gangster with Graves' Disease

2008-02-21T12:35:00.000-08:00

Jimmy Breslin's new book "The Good Rat" tells the story that Salvatore "The Bull" Gravano developed Graves'Disease. He became quite sick with hyperthyroid symptoms, after ratting out mob boss John Gotti. He had pulled out his hair, and left a head that was bald and pink.Folds of flesh hung around his eyes.Because Mr.Breslin feels politicians are as crooked as mobsters, he would not be surprised

Thyroid Cancer Radiation Therapy USA Today Front Page Story

2007-11-20T11:28:00.000-08:00

This article, "It kills thyroid cancer, but is radiation safe?, by Sternberg, and DeBarrios in the November19 USAToday, is full of facts about radiation therapy with radioactive iodine131, RAI/131 for well differentiated thyroid cancer. It is also full of errors. Paragraph 5. The claim that RAI/131 is responsible for 97% survival rate is dead wrong. The vast majority of Thyroid cancer is low risk

Bloody Bad Thyroid Smears Can Lead to The Wrong Diagnosis

2007-07-29T13:28:00.000-07:00

81 year old male comes to see me for a second opinion. He was told he had a tumor of the thyroid called follicular neoplasm. He was told it was a 20 % chance it was cancer. As part of my routine evaluation, I obtained the biopsy material from the hospital. The physician was a general endocrinologist, at one of the top hospital centers in the USA. The smears were very poor. They was air dried

Kidney Cancer Presenting as a Thyroid Nodule

2007-04-27T12:01:00.000-07:00

50 Y/O female was referred to me to evaluate a thyroid mass seen on MR to evaluate a lateral neck mass. The mass was painless. She did not have a prior history of thyroid disease. The thyroid was nodular on the right. The neck mass on the right was 2 cm and not tender. The ultrasound confirmed a mass in the thyroid on the right, and smaller masses on the left. Masses were also noted in the area

Missed Thyroid Diagnosis Due to Confusion Caused by Thyroxine Binding Protein Deficency, Hypo-TBG -emia.

2007-03-26T14:42:00.001-07:00

40 Y/O F with a diagnosis of TBG deficency since age 16. She was noted by an endocrinologist, to have a small goiter then. No therapy was directed toward the goiter. Over the next 20+ years the patient was treated with thyroxine, T3, Triac, Armour thyroid, and large amounts of iodine containing supplements. She had multiple CT scans with iodine contrast.The low Total T4 confused the physicians,

Seaweed Goiter, or How I Grew My Thyroid While Ingesting Large Amounts Kelp

2007-03-15T19:23:00.000-07:00

50 Y/O F had a small nodule 6 years ago which was biopsied and told it was benign. She refused thyroid hormone suppression, and when it continued to grow, she even refused surgery. She treated the goiter nodule with her own home plan as suggested by the internet.If you have thyroid problems,it stated, take iodine supplements.She did that for the next 5 years as the nodular goiter continued to

A Rare Cure of Medullary Thyroid Cancer ???

2007-03-15T19:08:00.000-07:00

This is a follow up of the patient with MCT, who had the best chance for cure. After a 6 hour surgery, and total removal of the thyroid, central compartment nodes, and right and left neck node removal, he had a post op calcitonin on <2, N<2. Is this a cure? Time will tell as there is 0.0-0.19 under the curve. I am hopeful his calcitonin will remain undetectable in the future. The surgeon operated

Acute Leukemia and MCT, Medullary Thyroid Cancer

2007-03-15T18:25:00.000-07:00

One year ago I saw a a 60 Y/O M with a thyroid nodule. He was in remission from Leukemia, and wanted to explore the reason for the nodule. He had only Chemotherapy. No External beam radiotherapy.The USGFNA was consistent with MCT. The pre-op calcitonin was about 1000 N <2. There was nodes in the central compartment, and down into the upper chest. USGFNA of lateral neck nodes was negative for

Medullary Thyroid Cancer: One Chance to Cure

2007-03-01T18:40:00.001-08:00

I saw a 50 Y/O male for second opinion with a Biopsy proven DX of Medullary Thyroid Carcinoma MCT. He had prior FNA of a 2 cm left lobe nodule. The cells and staining for calcitonin on the slides confirmed MCT. What do I need to do to help him. First, I did an ultrasound of 1-6 levels lymph nodes on both sides of the neck. He had many abnormal shaped nodes. Because the nodule was on the left, and