If a nodule is felt or suspected,  an ultrasound of the thyroid is usually one of the first diagnostic studies obtained. This is an easy test to undergo and requires no specific preparation. This test can give very good information about the nature of the nodule including the size, whether it is fluid-filled or solid, if there are calcifications, and other details. In general, only nodules larger than 1 cm should be evaluated further. Occasionally, smaller nodules require additional evaluation because of suspicious ultrasound findings or risk factors for thyroid cancer. 

A serum TSH (thyroid stimulating hormone) should be checked in everyone with a suspected nodule 1 cm in size or larger. A significantly reduced level would prompt the need for a radionuclide thyroid scan to determine if the nodule is over-functioning. If so, it is unlikely that the nodule is a cancer and no biopsy would be necessary at that time. Additional work up might be indicated, however, in terms of the function of the thyroid.

Fine needle aspiration biopsy (FNA), often performed with ultrasound guidance, is the best method  for evaluating nodules 1-1.5 cm in size or larger. The possible results include a benign, non-diagnostic, indeterminate, or malignant biopsy. A benign nodule should be followed with repeat physical exam or ultrasound in 6-18 months and a repeat biopsy for significant growth. Non-diagnostic results should undergo a repeat biopsy. Repeated non-diagnostic results would often require surgery to make the diagnosis. For indeterminate results, either further imaging or surgery is recommended depending on the details of the biopsy. For malignant results, surgery is recommended.

Surgery for thyroid nodules includes thyroid lobectomy (removing essentially 1/2 of the thyroid gland), sub-total or total thyroidectomy. The extent of surgery is based on your clinical picture, size and number of nodules, and on  the results of a “frozen section” analysis of the thyroid immediately upon removal. This is done while you are in the operating room and is basically a quick look at the specimen by a pathologist to determine if it is cancer. Sometimes, cancer can be definitively diagnosed, and this would alter the surgery to be performed.

Hopefully, this has given you a little overview of the management of thyroid nodules. If you and your doctor have determined that you need further work up, please call our office and we would be happy to schedule a time for you to come in for a consultation.

The current recommendations, according to the American Cancer Society, are to get a test that finds both polyps and cancer. The options include flexible sigmoidoscopy every 5 years, colonoscopy every 10 years, double contrast barium enema every 5 years, or CT (virtual) colonography every 5 years. Testing might need to be more frequent, depending on whether polyps or other abnormalities are discovered.

Tests that primarily find cancer but do not routinely identify polyps include stool testing for blood every year, stool immunochemical testing every year, and stool DNA testing, although the frequency has not been determined. If any of these tests are positive or suspicious, colonoscopy would be required.

Screening should begin over the age of 50. Those with an increased or high risk of colon cancer may need screening earlier and more frequently.

Some polyps and almost all colon cancers will require an operation to remove part of the colon. In many cases, this operation can be done laparoscopically which is often associated with less postoperative pain, a shorter hospital stay, and an earlier return to most activities.

Now that you are briefed, be sure to discuss colon cancer screening with your primary provider and/or gastroenterologist to determine the most appropriate testing for you.  Rates of this disease have been going down in recent years, but they could be lower if all people who should be screened actually got screened!

If you are requiring colon surgery and would like to consider a laparoscopic operation, please come in for a more thorough discussion. You can call our office to schedule an appointment.

Next week is the move and we expect the transition to be seamless. During this time, you can continue to reach us through our old phone number, 224-7874 (SURG), and will be directed to the new number. Or, call our new number after September 30, 998-7874 (SURG).

Come in for a visit, once the dust settles!

Acute cholecystitis means inflammation or infection of the gallbladder and can develop when the gallbladder attack is prolonged. This is serious and often requires hospitalization and more urgent surgery. Another possible risk of symptomatic gallstones is blockage of the main bile duct which drains from the liver. This can lead to serious liver or pancreatic infection and need for hospitalization and possible urgent surgery. We know that the risk for surgery in these more inflammed states can be higher than when there is little or no inflammation.

Surgery is often recommended for symptomatic gallstones and in most cases, this can be performed laparoscopically. This approach is associated with a reduced recovery time and is often done on an outpatient basis. Most will be able to return to work in one week and can resume eating all of the things that they like without the fear of an attack.

So, if you have gallstones, talk with your doctor about whether you might be experiencing symptoms from them. On the other hand, if you have these symptoms and are not sure whether you have gallstones or not, your doctor may want to send you for an ultrasound to find out. For the most part, those of you with gallstones and no symptoms are probably okay to just continue on for now. Always discuss these decisions with your doctor during your regular check-ups. 

Feel free to call our office for an appointment if you would like to discuss laparoscopic surgery for your gallbladder.

For example, we heard from proponents of using intra-operative nerve monitoring during thyroid surgery to assist in identifying an important nerve, the recurrent laryngeal nerve. This nerve runs behind and very close to the thyroid gland which places it at risk for injury if not clearly identified and protected during surgery. An injury could affect speaking and possibly breathing in some cases. I have been utilizing this technology for several years now and feel that while strict surgical technique is the most important factor in preventing an injury, monitoring the nerve has been helpful. This is just one more way that I can assure that I am doing the best and safest thyroid operation for my patients.