SANTA MONICA THYROID CENTER THYROID COM 1996 2017

SANTA MONICA THYROID CENTER THYROID. COM 1996 -2017 Richard B. Guttler MD, FACE, ECNU

US Army Public Health Officer to NIH Thyroid Fellowship at USC

1996 First thyroid. com Website

Ultrasound was considered useless Endocrinologists US was essential

No Ultrasound without an indication: Leads to unnessary biospies and surgery

Thyroid cytopathologist by default

LIFETIME GOAL FOR MY PRACTICE • In 1974 I presented a grand rounds at a major hospital in Los Angeles. • The subject was the use of ultrasound to decrease surgeries on thyroid cysts. • During the talk I presented data on the thyroid surgeries for the last year at this hospital and the outcomes. 5 cancers per every 100 operations. More complications than deaths from thyroid cancer. • The surgeons talked about thyroid surgeries on benign nodules was a way to put their children through medical school.

What I did so far toward my goals • 1. As a fellow I did nuclear studies to separate goiter nodules from cancer. This was a failure. • 2. I studied and began using FNA in my practice 1978 when few pathologists even recognized thyroid cytology as a valid test. I had the best teachers in Sudha Kini, John Abele and others. • 3. I became a thyroid cytologist by default as few pathologists would look at my slides. • I saw how FNA and proper expert cytology could decrease surgeries. • 4. I took part in the studies to prove molecular markers could decrease the surgeries on thyroid nodules. (Thy. Gen. X-Thyra. MIR) • 5. I have been active in ablation therapy since the 90's with ethanol ablation of thyroid and parathyroid cysts and local recurrent thyroid cancer neck lymph nodes. • 6. I refused to allow my patients and others that found me from the web to have surgery if they were willing to travel to Europe or Asia for alternative therapy with RFA or HIFU. • 7. After 3 years of effort to get thyroid ablation off the ground in the USA it is getting closer.

11, 000 cases of follicular variant PTC now benign Non-Invasive Follicular Tumor NIFT-P No Total TX only a less risky lobe for diagnosis only

No Surgery for Micro-Papillary: Active Surveillance

I was one of the original authors on this Molecular Marker Breakthrough

Background in RFA prior to 2017 • 1. Spent time in Reggio Emilia with Roberto Valcavi training in RFA with Korean Thyroid RF Mini Probe from Star Med. • 2. Spent 2 months using the Medtronic larger probe in my office doing work on technique for RFA for thyroid nodules learned in Italy. • 3. Medtronic decided not to fund any further work on thyroid and stopped their smaller probe from completing FDA approval. • 4. Star Med was presented with our plan 3 years ago for initial study but has not obtained FDA approval to this day. • 5. Our thyroidology interventional group Dan Duick, Mark Lupo and myself kept hopes alive and we hope the time has come to get RFA off the ground in the USA.

Results of Recent Study on Thyroid Surgery • 1. 50% of total thyroidectomies were done by surgeons doing one case a year. • 2. Another 34% by surgeons doing 2 -5 cases a year. • 3. Increased complication rate compared to high volume surgeons doing >25 cases a year was a 51% for one case a year to 34% for 1 -5 cases a year. • 4. Vast majority of thyroid surgery 85% were by low volume surgeons with higher complication rates. • 5. Even 21 -24 cases a year had higher complication rates than > 25 cases done by high volume surgeons

Much better than this but still too many needless complications

Another ancient method of goiter surgery

Conclusion I will not be happy until all possible methods are available to reduce the pain and suffering caused by surgery on thyroid disease that can be safely treated by alternative means.

Thank You

After the Demo let's go sailing

My first sail on a Dhow on the Indian Ocean off of Mombasa Kenya in 70's