Tuesday, October 17, 2006

Why you need to see a Clinical Thyroidologist before parathyroid surgery

42 Y/O female sees me for a second opinion for the need for parathyroid surgery. She has documented hyperparathyroidism by calcium and PTH testing.Prior Parathyroid scan
was negative. Ultrasound before seeing me was consistent with a parathyroid adenoma on the left, but a thyroid nodule was seen on the right. There was no change of plans when the thyroid nodule was found pre-op. That was what prompted her to get a second opinion.

I believe that real time high frequency Ultrasound done by the physician thyroidologist, is manditory in this case. Therefore, I repeated the US personally.
The 11 mm mass in the left extra-capsular area of the thyroid had a polar parathyroid like artery coming into the mass. The right lobe of the thyroid had a 6-8 mm mass with irregular border, cystic posterior enhanced views consistent with cystic fluid, and microcalcifications worrisome for papillary thyroid cancer. Also an abnormal shaped lymph node was seen on real time in level 4 lateral to the thyroid nodule in the right lobe.

You wonder if she is having surgery anyway, who cares if there is cancer, she will have her thyroid removed while doing the parathyroid.

Well, the reason is if the node is positive it can change the surgery. There will be a need to remove the lateral neck nodes as well as the total thyroid , and the parathyroid adenoma. This is called a three for one surgery. It would surely save her a relapse and surgery, and Radioiodine years later.

What happened?

The parathyroid was a single adenoma.
The right thyroid nodule was papillary thyroid cancer.
The node washing was positive for TG on FNA, and the surgeon did a right lateral neck node removal at the original surgery.

Now do you know why you need to see a clinical thyroidologist BEFORE you submit to surgery, even if it is recommended by a good endocrinologist, and surgeon. This evaluation may have saved her future surgery for cancer nodes. Pre-op physician
thyroidologist real time ultrasound and US guided FNA of nodes can change the
surgery planned for you 30-44% of the time.

Check www.thyroidologists.com or thyroid.com for details.

I will visit with you with the next great thyroid case soon,


Thursday, October 05, 2006

Alternative Therapy for Graves' Hyperthyroidism for 10 years: A Serious Failure

46 Y/O male sees me for the first time 10 years after he was first diagnosed with hyperthyroidism. He was trying alternative therapy and refused the main stream medical therapy for his disease. Each new therapy was giving him some relief for a short time. The goiter even shrunk for a while. Herbs, therapy in Mexico, accupuncture, and other treatments only gave partial relief. He continued to try other methods without much success. He developed a dangerous irregular heart beat called atrial fibrillation,AF, 7 years ago but still refused to follow the cardiologists advice to get the thyroid treated. He was doing poorly, and finally consented to be treated, when he learned that a stroke, and even death could occur if he continued to be untreated with western medications.

He had a visible goiter from across the room. The pulse was 130, and irregular,irregular. Slight exercise caused a rapid rise to 170-180.
He had muscle wasting, elevated nail beds called Plummer's nails, Pre-tibial Graves' Dermopathy, and mild Graves' exopthalomas. I sent him to a sports store to but a sports heart rate monitor. I started him on beta blockers and ask him to monitor the dose until he was controled with mild exercise to 110-120.

The left atrium of the heart enlarges due to AF, and clots can be sent from the heart to the brain causing a stroke. I added 10 gr ASA to help stop clotting, and sent him for detailed cardiology`evaluation. I started anti-thyroid drugs to control hyperthyroidism for 6 weeks, before I give him radioiodine.

This is a rare example of the false hope given by alternative care givers to patients with clearly treatable disease. This false hope could have made him a drooling stroke victim for the rest of his life, or killed him by means of thyrocardiac disease, or liver failure.

In 32 years of private thyroid only practice, This is the worse example of the wrong headed approach to thyroid treatment, I have ever seen.

Your alternative approach works for some symptoms, but stay away from thyroid patients that have curable disease, which you put in danger when you offer half baked treatments that delay the onset of life saving western care.

Shame on all the fools that tried to treat him, with their treatment plans that have no validity, and their disrespect for the highly successful mainstream medical treatment, that has saved lives for 60 years!