Thyroidologists

What is a Thyroidologist?

A Thyroidologist is physician who specializes in all facets of thyroid disorders. Usually a board-certified Endocrinologist, a Thyroidologist has additional expertise and credentialing in the complex, multi-faceted field of Thyroidology. This includes highly advanced skills in neck ultrasound, expertise in fine needle aspiration (FNA) biopsy techniques, advanced knowledge in thyroid cytology and pathology, nuclear medicine training, and thyroid oncology expertise. This multidisciplinary approach allows the Thyroidologist to be the leader of the treatment team which often involves the surgeon, pathologist, internist, cardiologist, obstetrician, medical and radiation oncologists, ophthalmologist and other specialists.

There may be multiple treatment options that a Thyroidologist expert is best suited to discuss with you. When you have a complex thyroid disorder or need a second opinion, a Thyroidologist is the specialist to consult.

Efficient Patient Care
A Thyroidologist offers comprehensive thyroid exams and treatment for all thyroid conditions, including extensive on-site testing. Often, the entire evaluation can be completed in one or two visits. This includes in-office thyroid blood tests, physician performed ultrasound, and ultrasound FNA biopsy with expert cytology interpretation. If I-131 treatment is needed, this can be done in many cases by the Thyroidologist in-office, avoiding the need to consult with another doctor who is not directly involved in the patient’s thyroid care. In many cases, without a Thyroidologist, patients make multiple trips to different facilities for testing. This approach is far more expensive to the patient, not to mention time consuming. Dedicated thyroid care means more efficient patient care.

ACT – The Power of Many Experts
Members of Academy of Clinical Thyroidologists (ACT) are a closely knit group of Thyroidologists and consultants in endocrinology, pathology, surgery and laboratory disciplines. When an ACT member has a case that is complex or unusual, the case is presented anonymously to the group via e-mail. The member receives feedback from top thyroid experts around the world. To the patient, this is like seeing several specialists at one time and results in excellent, cutting-edge care for their thyroid condition.

Medical Procedures and Testing
A Thyroidologist offers comprehensive thyroid procedures and testing to accurately diagnosis a broad range of thyroid diseases. Typical office-based medical services of a Thyroidolgist include:

  • Thyroid ultrasound (US)
  • Ultrasound-guided fine needle aspirations (FNA) biopsy of thyroid nodules and lymph nodes
  • Diagnosis, treatment and follow-up surveillance of thyroid cancer (thyroid oncology)
  • Pre-operative/post-operative neck ultrasound to optimize thyroid cancer surgery
  • Cytopathology and FNA specimen adequacy assessment
  • Percutaneous Ethanol Injections (PEI) for thyroid cysts and malignant lymph nodes
  • Nuclear uptake studies and scans
  • Coordination and administration of Radioactive Iodine (I-131) treatments for thyroid cancer, hyperthyroidisn and enlarged goiter
  • Parathyroid Evaluation
  • Thyroid hormone analysis
  • Medical management of hyperthyroidism and hypothyroidism

Thyroid Ultrasound (US)
Ultrasound utilizes harmless sound waves to produce images of the thyroid. The procedure is simple and painless and allows the Thyroidologist to gather information about the thyroid including the size of the thyroid, detection of any inflammation in the thyroid, and the blood-flow through the thyroid. Thyroid nodules and cysts are measured and detailed descriptions of their characteristics are recorded. To further advance the use of ultrasound in thyroid exams, the Endocrine Certification in Neck Ultrasound (ECNU), was developed in 2009. ECNU is a professional designation which is awarded to Endocrinologists who meet specified knowledge requirements measured through a standardized examination and validation process in diagnostic neck ultrasound and ultrasound-guided fine needle aspiration (FNA). ECNU is recognized by the American Institute of Ultrasound in Medicine (AIUM), one of the preeminent, national accreditation bodies for ultrasound practices.

Ultrasound-guided fine needle aspirations (FNA) biopsy of thyroid nodules and lymph nodes
Thyroid nodules are a common condition that often require biopsy (FNA) in order to determine if a nodule is benign and can be monitored without surgery or if the nodule is suspicious for cancer and needs to be removed surgically. As thyroid experts, Thyroidologists are highly skilled at ultrasound-guided FNA of nodules and offer the best chance of getting a good sample. In inexperienced hands the chance of needing to repeat a FNA because of a non-satisfactory sample is as high as 20% or more. A Thyroidologist usually has a non-satisfactory rate of less than 5%. Many Thyroidologists evaluate the FNA specimen immediately following the procedure to ensure there is a good sample, then, if needed, additional FNA’s can be done. This method decreases the non-satisfactory rate to 1-2%.

If you have a nodule that requires a FNA, start with an expert to get the best sample and the best advice on how to manage the nodule. Thyroidologists work closely with expert Cytopathologists (pathologists with additional training in reading FNA samples) to ensure the biopsy sample (FNA sample) is read and evaluated by experts. This leads to a more accurate diagnosis and less referrals for surgery.

Pre-operative/post-operative neck ultrasound to optimize thyroid cancer care
Comprehensive neck ultrasound has become the standard in evaluation of thyroid nodules in order to help guide FNA biopsy and diagnose thyroid cancer. Once a cancer is suspected, careful ultrasound of the entire neck allows the Thyroidologist to create a “map” for planning of the thyroid surgery. This map is a critical element in making the first surgery the most effective and curative as possible. Too often, patients proceed with the surgical removal of the thyroid without pre-operative ultrasound to determine if there may be lymph nodes to which the cancer has spread. If cancer has spread to the lymph nodes, it can be removed during the initial surgery but only if pre-operative ultrasound was performed. If pre-operative ultrasound was not performed, the patient may need additional surgery to remove the affected lymph nodes.

The long-term surveillance of a thyroid cancer survivor is also highly dependent on expert neck ultrasound to detect early recurrence or spread of the cancer.

Percutaneous Ethanol Injections (PEI) for thyroid cysts and malignant lymph nodes
Percutaneous Ethanol Injection (PEI) can be used to treat benign thyroid cysts that refill after initial drainage and biopsy. When utilizing PEI, the cyst is drained and then the cysts space is injected with medical grade ethanol to prevent the cyst from refilling.
In many cases, PEI works well enough to avoid thyroid surgery which, in the past, has been the standard treatment for recurring cysts. PEI can also be selectively used to treat neck lymph nodes to which thyroid cancer has spread. This highly specialized use of PEI can typically only be administered by skilled Thyroidologist.

Radioactive Iodine Treatment
Radioactive Iodine (I-131) has been used for over 60 years to treat hyperthyroidism due to Graves’ disease and toxic nodules as well as for the treatment thyroid cancer. This treatment involved swallowing a small pill of radioactive iodine. Radioactive iodine accumulates primarily in thyroid tissue, making it a very effective targeted therapy. Benign multinodular goiters can also be reduced in size using radioactive iodine therapy.

Parathyroid Evaluation
Parathyroid glands control calcium balance. These two pairs of glands, the size of a grain of rice, sit behind the thyroid. The most common cause of high blood calcium is enlargement of one of these glands, resulting in the over-production of parathyroid hormone. Often this condition requires surgical removal of the enlarged gland. Thyroidologists determine which patients require surgery and which patients can be observed. In addition, neck ultrasound is used to localize the abnormal parathyroid gland in order to help plan surgery. This is sometimes a difficult exam that requires expert skills in ultrasound. In some cases, FNA of the suspected target can be performed to confirm it is the culprit parathyroid. Neck ultrasound before parathyroid surgery can also identify otherwise undetected thyroid nodules that may need to be addressed at the time of surgery.