ENT Surgeon Scare Tactics: Tells Mother Anything But Surgery is Malpractice in Treating Her Daughter.
Surgeon uses scare tactics to keep a patient from getting outside opinions.
This is a new scare tactic claims anyone who recommends any other form of therapy is malpractice. Teenage female doing heavy gymnastic training noted a rapid onset of a mass in the mirror. She had no pain and no symptoms. She does many exercises with twisting of the neck and hand stands. People are noticing the mass in her neck recently. She is subclinical hyperthyroid with normal T4 T3 , suppressed TSH and negative TSI, TG and TPO antibodies. Thyroid biopsy result was of a benign colloid nodule. The DX of Autonomous Functioning thyroid nodule was made and a I/123 thyroid uptake and image ordered( pending)
The mass was visible, soft, and extended right to left past the midline. Prior evaluation by ENT told her lies about the consistency of the nodule.”It is solid.” The mother looked at the US and saw it was very cystic. She lost faith in the surgeon and ask for my opinion.The mother was looking for alternatives and started her on Iodine therapy 2 moths before she saw me.I told her to stop because it can add fuel to the fire as iodine become thyroid hormone.
The US below shows the large cystic component.
Many AFTN’s never progress to actual hyperthyroidism as they degenerate and form cystic masses which result in normal return of TSH. This may not last but it could be years before the TSH again goes low again. The daughter is only 13. The idea that it is malpractice to consider other forms of therapy is an outrage. The mother wants time for her to grow up and not have a surgery now, a scar, and the possibility of life time thyroid hormone therapy. What are the options? The possible trauma by her intense gymnastic exercises may have cause the cystic degeneration of the AFTN..
- The unsightly nodule is mostly fluid. Ethanol ablation is a safe way to reduce the cosmetic effect. Ethanol can also ablate some of the solid portion.
- If there is persistent or return of the low TSH or she develops hyperthyroidism she can be treated with antithyroid drugs for a short corse until RFA.
- The AFTN can be ablated by radiofrequency RFA.
- See the case below to see have it is treated by RFA.
- All the above is less risky and leaves less residual effects on a 13 year old than the surgery.
I presented a two stage approach to replace the surgery with the Antithyroid drugs as needed.The mother refused surgery for her daughter. She also was against her receiving radioiodine.
Comments: This type of scare tactics by surgeons have been used for years by as they see the number of cases really needing surgery decrease with each new diagnostic test or new non-invasive therapy such as ethanol and RFA. Shame on all those self serving surgeons who continue to impede the progress of new methods designed to save a patient from a hospital visit, surgery, about $35,000 cost and post op recovery and the risk of serious complications.
ALWAYS GET ANOTHER OPINION, BUT NOT FROM ANOTHER SURGEON BUT FROM A CLINICAL THYROIDOLOGIST/ENDOCRINOLOGIST.
The malpractice is by the surgeon who fails to see any other way to treat patients except by the use of his scalpel.
Richard Guttler MD,FACE,ECNU
Interventional Tumor Thyroidologist