Complexity of the Evaluation of Thyroid Disease
Over the last ten years there has been considerable new advancements in managing specific conditions of the thyroid gland. The patient who has a thyroid condition now has a multitude of tests which may be obtained for their specific condition.
The use of ultrasound studies in the neck has identified patients with thyroid issues long before the physician's fingers are able to palpate a problem. The ultrasound study has been utilized for more than ten years and has been extremely effective in identifying significant disease processes including cancer and autoimmune thyroiditis. Dr. Harding has been performing thyroid and parathyroid ultrasound for over fifteen years. This acquired skill in interpreting the ultrasound studies from a surgical perspective has led to considerably improved surgical outcomes for his patients.
The use of Fine Needle Aspiration (Biopsy) of the thyroid has allowed for tissue to be analyzed to determine if a specific thyroid lesion is potentially harmful to the patient. There are numerous categories describing the cytologic findings in a thyroid biopsy. One category which causes considerable consternation amongst the surgeon and endocrinologist is the result described as "indeterminate" or "suspicious". The patient with this lesion is frequently referred for surgical consultation to help clarify the limitations in cytologic evaluations.
Additionally, now we have the availability to send FNA obtained tissue for genetics (DNA and RNA) testing of specific genes associated with thyroid conditions. These are performed in order to determine if a malignancy is likely, versus a simply benign condition.
Also included are complex patient's who have hyperthyroidism related to Graves' disease. Many of these patients have been treated for years with medications before the condition seems to worsen. Risk factors of medical failure include an enlarged gland, as well as prolonged poor medical control of hyperthyroidism.
The confusing repertoire of testing is not commonly performed by most physicians, and especially many surgeons. The expertise of this area has made Dr. Harding a regional expert in the management of diseases of the thyroid gland which require surgery. It is his goal to help patients understand their test results and how they may guide future recommendations. He commonly performs thyroid evaluations and surgery for both benign conditions and cancer.