Spotlight on Dr.Guttler’s Career.
After fellowship I opened his thyroid center in Santa Monica.
After survey of the local hospital records for thyroid surgery he noted they took out many thyroid nodules that were benign. Only 5% were cancers and another 5% were highly suspicious but were benign at surgery. Every one hundred thyroid surgeries only found 5 cancers/100 operations.
My first grand rounds talk at the hospital was about the ultrasound diagnosis of thyroid cysts. They did not need surgery, but could be treated with drainage only and ablation therapy.
The next break through was the beginning of thyroid needle biopsy. In the 70’s I began doing FNA and this reduced the number of benign nodules needing surgery. Because most cytologists did not believe in FNA for thyroid nodules it forced me to spent time learning thyroid cytology from some of the best experts in the world. Dr.John Abele, S. Kini, and others. I became a member of the American Cytopathology Society with Dr.Kini’s recommendation.
The next breakthrough was the finding that ultrasounds down by radiologists were being ignored by endocrinologists because they were considered worthless. I was on a AACE task force that developed endocrine certification in Neck ultrasound, and developed the test questions. ECNU evaluated the whole neck with lymph nodes and parathyroid glands not just thyroid thyroid.
I was speaker at a USC/ LAC medical center grand rounds introducing Neck ultrasound done by endocrinologists.
Using ECNU methods we began to do FNA biopsies and needle washouts from cancer lymph nodes and parathyroid adenoma.
During this time I began to teach master’s classes in clinical thyroidology.
The beginning of interventional thyroidology was with the use of ethanol to ablate thyroid complex cysts, cancer neck lymph nodes. This was called PEI, or EA. I published the video describing the PEI procedure in the VideoEndocrinology journal.
I began to work with Interpace lab doing molecular markers on thyroid nodules that resulted in multiple publications. This was another breakthrough as it was able to show either low risk for cancer of definite makers for cancer.
5 years ago I traveled to Italy to learn radiofrequency ablation RFA from Dr.Roberto Valcavi.
The FDA in their wisdom did not approve of the use of thyroid RFA until late 2018.
During this time I had access to 3 different RFA systems to practice in my office.
Before FDA approval, I trained endocrinolgists in my advanced interventioal thyroid masters classes on bovine liver and turkey breasts.
Finally after 5 years I am doing thyroid RFA in my office without hospital or radiologists.
The future for thyroid RFA is expanding daily. I have now expanded into treating mico-papillary thyroid cancers instead of surgery or active surveillance.
RFA is also used today to treat select parathyroid adenoma cases.
RFA has uses in treating thyroid cysts with> 50% solid component.
I have watched the changes in clinical thyroidologist practice and will always being on the look out for additional methods to reduce thyroid surgeries.