Thyroid Nodules in 2017: A Year of Big Changes in How to Treat Thyroid Nodules

Thyroid Nodules in 2017: A Year of Big Changes in How to Treat Thyroid Nodules

Thyroid Nodules in 2017: A Year of Big Changes in How to Treat Thyroid Nodules
Thyroid Nodules in 2017: A Year of Big Changes in How to Treat Thyroid Nodules
The presence of a thyroid nodule causes great concern to the patient. That is why the finding of thyroid nodules with high powered imaging like ultrasound and CT/MR causes the finding of too many small nodules that end up being biopsied.How does the patient protect themselves from this stressful situation? First demand a clinical important reason for the need for these studies especially thyroid ultrasound. Do not allow screening or routine thyroid ultrasound or CT/MRs.If you do end up with a image study showing a nodule, do not panic as 95% are not cancer, and use the same criteria for the need for biopsy as you did for the ultrasound. Small nodules without risk features DO NOT NEED biopsy.Larger spongioform nodules are not cancer and don’t need biopsy.If you have allowed a biopsy out of fear of cancer do not have surgery until the nodule diagnosis is evaluated by second opinion.THis could include a re-biopsy by an expert thyroidologist and the addition of molecular markers such as BRAF and a benign classifier. This is the big change from the past methods. Small nodules (1 cm) suspicious or cancer can be treated by Active surveillance instead of surgery and radiation without a risk to you. Finally, there are cancers there were called follicular variant of papillary cancer that have been decided by experts to be benign and are not cancers at all, and don’t need anything more routine follow up or a simple lobe removal at the most. They may not need thyroid hormone therapy either. The presence of large goiter nodules can be the cause of patient’s neck symptoms, and can be a cosmetic problem. Surgery was the only answer until 10-15 years ago.The use of ethanol ablation PEI has proven safe an effective to replace surgery as the first line treatment for thyroid and parathyroid cystic disease. Surgery is also not the first choice anymore for solid benign thyroid nodules. Radiofrequency ablation (RFA) is able to shrink nodules relieve symptoms and cosmetic concerns without hospitalization and major surgery.
Thyroid nodules that don’t not need biopsy. Spongy small cystic spaces indicate a benign nodule.
  • Thomas Mcgowan March 10, 2018 1:17 am

    I have a thyroid nodule and I am looking to shrink it down it’s been like 7 months and I have tested so many things and nothing is working 😬

    • Dr Guttler March 10, 2018 7:23 am

      You need an evaluation to see if a non-surgical option is available to you.
      Come to see me for a one day complete evaluation.
      I will tell you what options you have and either have you return for ethanol ablation
      or organize radiofrequency ablation.Call me at
      1-310-393-8860 or email to [email protected] for details.

  • VIOLETA CAIRO June 18, 2018 7:24 pm

    I have 2 Thyroid on the right which is 0.9 cm and the left side 1.03
    The Dr.oder biopsy in the left one and the pathologys said I it’s a papillary cancer. Because of the shape of the cells and the liquid viscosity. dr said I have to get my thyroid removed. should I get a second opinion?

    • Dr Guttler June 19, 2018 1:55 pm

      Yes for sure.You need further evaluation than just the biopsy.
      These are very small and even could be treated without surgery.
      Come for a one day visit to get your second opinion from me.
      310-393-8860 or [email protected]

  • Pamela S October 24, 2018 12:33 pm

    Thank God for doctors like you. I just had another ultrasound for a multi-nodular goiter, and, instead of telling me that it has shrunk considerably (which I knew because it feels totally different now–I did it with diet), they told me the right lobe was considered highly suspicious and needs to be biopsied. My husband and I compared it to last year’s ultrasound when I got home, and can see that one of their criteria that added 2 points to the TI RAD score is incorrect. I was told to have a hysterectomy when I was 37, and had UAE done by an interventional radiologist, considered experimental at the time. You, sir, are a godsend for women like me, and I thank you.

  • AG February 2, 2019 11:40 pm

    I have a 2.5 cm nodule on the isthmus. I have had an uktrasound, a fine needle biopsy and a core biopsy. All are inconclusive. My ENT wants to do an isthsmusecromy. What do you recommend?

    • Dr Guttler February 5, 2019 8:39 am

      You need DNA cancer mutation and classifier markers from the nodule before you consider surgery.
      Call for details 310-393-8860.

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