DR.Guttler’s Rules to Avoid Unnecessary Thyroid Surgery

DR.Guttler’s Rules to Avoid Unnecessary Thyroid Surgery

DR.Guttler’s Rules to Avoid Unnecessary Thyroid Surgery

Dr.Guttler’s Rules to Avoid Unnecessary Thyroid Surgery

  1. First always question your physician as to why they want a thyroid ultrasound TUS. There should be no screening thyroid ultrasounds. There must be indications for one.
  2. If you have a TUS and there is a nodule found before going directly to have a needle biopsy you should get an opinion with an endocrinologist if the biopsy is necessary. Many nodules do not need a biopsy.
  3. If your biopsy is called suspicious or indeterminate do not go directly to surgery. Get another opinion which includes repeat FNA with DNA mutation and classifier tests on the nodule.
  4. If you have a  negative classifier and no mutations you do not need surgery.
  5. Repeat TUS at yearly intervals is all you need.
  6. If your nodule grows and a repeat biopsy and mutation studies are similar to the first you do not need surgery even though it is growing.Benign goiter nodules grow.
  7. If the nodule grows to the point of giving you symptoms or is a cosmetic problem you still do not need surgery.
  8. There are two minimally invasive treatments that can relieve symptoms and ablate the nodule without removing your thyroid gland. You will not need to take replacement thyroid for life. Benign complex cystic solid nodules with either Ethanol PEI or Radiofrequency ablation RFA.
  9. If you are told you have thyroid cancer, but it is <1.5 cm you need to see a thyroidologist to be evaluated for possible active surveillance AS instead of quick thyroidectomy.
  10. Some patients do not want surgery but have anxiety about long term follow up leaving a small cancer in the neck. Ethanol PEI or Thyroid RFA can ablate the cancer inside the thyroid.
  11. If you have a type called follicular variant papillary cancer and there is no local spread seen on ultrasound, you do not need a total thyroidectomy. A removal of the lobe can determine if it is non invasive.
  12. This non-invasive “cancer” is now considered to be a benign called non-invasive follicular tumor with papillary cells or NIFT-P. You will have a lobe left and will most likely not need thyroid hormone. As of now you will be labeled as cured with the removal of the benign tumor. It would be wise to keep in touch with your thyroidologist for check ups anyway.
  13. If you need a thyroidectomy it is wise to seek advice as to who is a true thyroid surgeon. The ability to do the surgery with low risk of complications is a key to your happiness.
  14. 25 thyroidectomies a year is needed to be able to render the best surgical care.
  • vernon mccalla March 12, 2019 10:11 pm

    Dr Guttler

    I have a 1.7cm nodule on my left lower pole. I had a US followed by a FNA which came back Bethesda 3/AUS. It was sent for genetic affirma testing which came back suspicious but negative for malignancy classifier and negative for mutations. That was in December. I am now at UCSF and scheduled for another FNA at the end of the month. This just doesn’t seems like it will stop until I have surgery and they can actually see it clearly. Meanwhile my life has been turned upside down with the worry of cancer etc. not sure what action to take at this point but just wait for the next FNA and hope for benign results.

    • Dr Guttler March 13, 2019 8:21 am

      Please stop worrying and cancel the biopsy appointment. You don’t need another biopsy.
      The studies show you have a low risk of cancer. Class III cytology is not an indication for surgery with negative Classifier.
      I suggest you visit me for a one day evaluation with your biopsy slides.
      310-393-8860 or [email protected] to talk to Alicia for details.

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