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Dr.Guttler’s Thyroid Patient Blog Post: Postpartum T4 dose Adjustment in Pregnant Hypothyroid patients Dr.Guttler’s comments: 1. Women need higher doses during the pregnancy to prevent adverse outcomes. Monitoring during pregnancy to keep TSH <2.5. TSH of <2.0 for cancer patients. 2. Postpartum dose adjustments were studied by Gao X. at al. Endo practice 28(2022) 578. 3. Subclinical hypothyroid patients stopped the thyroid, and 60% restarted thyroid at one year.Careful monitoring is needed to see if they will need thyroid in the future especially if the are TPO Ab positive. 4. Overt hypo ..read more

Dr.Guttler’s Thyroid Patient Blog Post; Pain from Fine Needle Biopsies. Dr.Guttler’s comments: 1. FNA is done with or without local anesthetic. 1-5 passes into the nodule is done. 2. Liu T. et al reviewed factors leading to pain. Endo.Practice 28 (2022) 628. 3. Pain level scores were evaluated. 4. Pain factors included number of passes,use of aspiration, perpendicular needle placement, and failue to use safety devices. 5. Larger needle, operator experience or patient education were not pain causing factors. 6. SubQ lidocaine was better than topical. 7. In my practice the key factor is the use ..read more

Modify your search Dr.Guttler’s Thyroid Patient Blog Post: Concurrent Use of Thyroid Hormone Therapy and Interfering Medications in Older US Veterans. 1. Thyroid hormone management in older adults is complicated by comorbidities and polypharmacy. 2.The prevalence of concurrent use of thyroid hormone and medications that can interfere with thyroid hormone metabolism (amiodarone, prednisone, prednisolone, carbamazepine, phenytoin, phenobarbital, tamoxifen), and patient characteristics associated with this practice. 3. Rachel Livecchi, et al The Journal of Clinical Endocrinology & Metab ..read more

Dr.Guttler’s Thyroid Patient Blog Post: Long-Term Efficacy of a Single Session of RFA for Benign Thyroid Nodules. DR.Guttler’s comments: 1.Two hundred and fifteen patients were included. 2. An early significant reduction of nodule volume was found at 1 year, lasting up to 5 years. 3. A 67% nodule shrinkage was observed at the end of the observation period. 4. The best response was recorded in nodules below 10 mL (79% reduction early and 81% at 5 years) 5. Patients’ symptoms were significantly reduced. 6. This study, by demonstrating a durable shrinkage of benign thyroid nodules treated by RFA ..read more

Dr.Guttler’s Thyroid Patient Blog Post: New treatment FDA approved for Thyroid Eye disease TED. Dr.Guttler’s comments: 1. The FDA approved treatment for eye disease. 2. Thyroid Eye Disease TED is a lesser-known condition that affects five times more American women than men. 3. The FDA approved an infusion called Teprotumumab  Tepezza in 2020. 4. Its the first drug created to take on this disease. 5. TED creates antibodies that can get stuck behind the eye. 6. The antibodies thicken the muscle and make your eyes bulge. 7. Fifty percent of people who have Graves Disease experience this as w ..read more

Dr.Guttler’s Thyroid Patient Blog Post: PET/CT to Prevent unnecessary Surgery in Follicular Neoplasm with Low PET/CT SUV. Dr.Guttler’s Comments: 1.28/86 had PET/CT. 2. 6/28 had high SUV> 5 were sent to surgey. 3.22/28 had low SUV <5 were treated with RFA. 4. 74% volume reduction by 12 months. 5. 1/22 had temporary vocal cord paralysis recovered by 3 months. 6. By using PET/CT,  select patients with low SUV follicular neoplasm could have RFA  which offers a safe and feasible alternative treatment option for patients unsuitable or unwilling to undergo surgery. 7. I use PET/CT fo ..read more

Dr.Guttler’s Patient Thyroid Blog Post: The Gold Standard Thyroid Nodule Evaluation: How to have the best chance to avoid surgery. 1. Endocrine evaluation, TSH,FT4,TPO, TIRADS Ultrasound, FNA. 2. Low risk ultrasound and Class II cytology. With symptoms or cosmetic issues RFA is the treatment of choice not surgery. Large benign cysts are treated with ethanol. 3. Class III or IV nodules need further evaluation. molecular markers are needed. A benign classifier also means no surgery and symptomatic nodules can be treated with Ethanol or RFA. 4. A negative PET/CT with no uptake in the nodule is an ..read more

Dr.Guttler’s Patient Thyroid Blog Post: Why are so many patients with small thyroid cancers looking for alternatives to surgery? DR.Guttler’s comments: 1. Two major breakthroughs in 2018 have FDA approval of radiofrequency ablation RFA and the use of Active surveillance AS instead of surgery. AS is long term follow up with no surgery unless the small nodule grows.RFA is a minimally invasive method to ablate the small nodule. Both are used and the patient can choose what is the best for them. 3. AS has the potential for rescue surgery later if the nodule grows. RFA has a high success rate in ab ..read more

Dr.Guttler’s Patient Thyroid Blog Post: Does BRAF V600E mutation effect the outcomes of 1-1.5 cm papillary cancers? S.Silver et al Nov. 2021 J.of Otolaryngology. Dr.Guttler’s Comments: BRAF mutations are found in 40% of small cancer. 50%-80 %  had aggressive features at surgery. 20-29% without BRAF mutation had aggrssive features at surgery. Prior to use of active surveillance or radiofrequency ablation the determination of BRAF could help guide management. We can use microdissection on the biopsy slides to determine BRAF before deciding on RFA treatment. Call me at 310-393-8860 or email ..read more