Primary Care Physician’s 2018 Thyroid Patient Care Resolutions

Primary Care Physician’s 2018 Thyroid Patient Care Resolutions

Primary Care Physician’s 2018 Thyroid Patient Care Resolutions

Primary Care Physician’s 2018 Thyroid Patient Care Resolutions.

  1. Resolve to consider thyroid disease as a complicated area that requires consultation with expert endocrinologists. Don’t try to treat the patient without a consultation first.
  2. Resolve you will never send the thyroid cancer patient to an endocrinologist AFTER the surgery.
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  4. Resolve that even “simple” cases of hypothyroidism need a consultation to determine the cause and seen if there are unknown problems of nodules and cancer.
  5. Resolve to never to tell a patient the diagnosis is hypothyroidism. Hypothyroidism is always caused by something. If there was no surgery, radiation therapy or radioactive iodine the cause is usually Hashimoto’s thyroiditis.
  6. Resolve that your failure to inform the patient of the cause of their hypothyroid can result in the entire family at risk for autoimmune thyroid disease.
  7. Resolve to inform your patient that case finding in their first degree relatives in needed at any age above 7 years old.
  8. Resolve to inform your patients that failure to have family members evaluated by an endocrinologist can result in late diagnosis of Hashimoto’s thyroiditis, with nodule formation and even cancer as early as 7 years old.
  9. Resolve to never think of this as screening but indicated evaluation because of the family history of autoimmune disease.
  10. Resolve to never order a thyroid ultrasound without an indication, or you put your patient at risk for unnecessary biopsies and surgery.
  11. Resolve to never play at being an endocrinologist and send patients for needle biopsies without first getting an endocrine consult to determine if the biopsy is necessary.
  12. Resolve to never send your patients for thyroid surgery without an endocrine consult first. thyroid-surgery-complications
  13. Resolve to stop knee jerk treatment of thyroid cancer patients. Things have changed!
  14. Resolve to determine with the help of your endocrine consultant if the cancer is small and can be followed by active surveillance without surgery, ablated in-situ by ethanol or radiofrequency if the patient does not want long term follow up or surgery.
  15. Resolve to determine if just a lobectomy is indicated for certain follicular cell tumors instead of a total with expert consultation with your endocrinologist.

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16. Resolve that if surgery is indicated for the cancer you don’t just by reflex send to your local surgeon unless they are high volume thyroid surgeons (>25 totals a year)

  1. img_042017.Resolve to never use compounding pharmacies making thyroid hormones. Dose errors can cause thyroid storm.
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  3. 18.Resolve to use only brand name T4 such as Synthroid or Levoxyl instead of generics as there is too much variation from one generic to another.
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  5. 19.Resolve to use your power as a physician to mandate no substitution by adding DSW1 to all thyroid hormone scripts.
  6. 20.Resolve to never let your patients dictate their treatment dosing or what type of thyroid they want to take. Follow the TSH and use it as your guide.
  7. 21.Resolve to never use Armour thyroid,compound products, T4/T3 combinations, or T3 alone as primary therapy for your patients. There are plenty of quacks out there that will do what ever the patient wants even if it causes some severe side effects.
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  9. 22.Resolve to refuse to continue to care for these type of patients who think they know better than you as a professional.
  10. 23.Resolve to refuse to see patients who want to increase their thyroid dose to help lose weight. Thyroid is never a cause of obesity.
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  12. 24.Finally resolve to be open minded to new but proven methods to treat your patients without surgery.
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  15. Ethanol ablation PEI for cysts.
  16. 25.Resolve to seek out experts doing ethanol ablation for your patients with large symptomatic cystic nodules instead of sending them to surgery.
  17. 26.Resolve to also seek experts doing ethanol ablation to save your patient from a second or third neck dissection for recurrent neck thyroid cancer in lymph nodes.
  18. 27.Resolve to consider expert advice if ethanol ablation of micro-papillary cancer is right for your patient who does not want Active Surveillance or surgery.
  19. 28.Resolve to inform your patient that alternative therapy with thyroid radiofrequency ablation RFA is available and safe by traveling to Korea Asan medical center
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  21. Professor JH Baek
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  23. or Italy Professor Roberto Valcavi and Palmer Institute
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  1. for treatment they have been doing for over ten years. Your patient needs to know the options not just told surgery is the only answer.
  2. If the patient can wait a year thyroid RFA will become available in the USA.
  3. Call me at 310-393-8860 or thyroid.manager@protonmail.com.
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