Thyroid No Surgery 101: Thyroid Ultrasound US and Fine Needle Biopsy FNA.The Two Most Dangerous Procedures Without Expert Consultation.
Dr.Guttler comments on thyroid ultrasounds and thyroid biopsies in 2 part article.
Part One: Ultrasound
Any physician can buy an ultrasound machine and do your thyroid ultrasound. However, it takes experience and training to decide if an ultrasound of the thyroid is indicated and be able to do a high quality examination.
Not all ultrasound machines are equal. GE top of the line can do everything needed including small lymph nodes and assisting in needle biopsy.
Totally inadequate old used machine for $5000.
Thyroid Ultrasound as a screen for thyroid disease and cancer
- Thyroid ultrasound done in a patient that has no risk factors for thyroid disease is a loaded gun aimed at the patient leading to finding small innocent micro nodules in 50% of the patients.
- If you have an enlarged thyroid goiter or palpable nodules, family history of goiters, Hashimoto’s thyroiditis with hypothyroidism, nodules, cancer, or radiation to head and neck for other cancers, you have an indication for an ultrasound.
- If not refuse to have an ultrasound as a screening procedure, and don’t volunteer for a free one at a health fair.
- This can lead to referral for a FNA
- The FNA can lead to unnecessary surgery.
Epidemic of Poor Quality Thyroid and neck ultrasound before thyroid cancer Surgery.
Going to surgery in a 2018 for thyroid cancer without complete proper mapping of the neck lymph nodes is epidemic in the US. Recent study of over 200 referral to major thyroid cancer surgeon presented at recent a meeting of thyroid experts found 2% had proper pre-op thyroid ultrasound including bilateral neck lymph node evaluation.
This means the 50 % of thyroid cancer patients with neck lymph node cancer are not getting neck dissections with their surgery. This sets them up for multiple surgeries in the next few years even though they might have had radio iodine RAI after the original surgery.
RAI is bad at killing thyroid cancer in lymph nodes big enough to be seen with a proper US of the neck.
Surgery is needed when nodal metastatic disease is found even after negative Radio-iodine studies. After prior surgery then ethanol or radiofrequency ablation can be used.
My advice is never have your local surgeon do the thyroid surgery. Get a referral to expert thyroid cancer surgeons. There is no emergency to do the surgery. You have time to get opinions.
Call me for an evaluation before you have a screening ultrasound or need a proper neck/lymph node/thyroid cancer pre-op US.
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