Thyroidologist

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A thyroidologist is a medical practitioner specializing in the thyroid and related areas.

In the United States it refers to a board certified endocrinologist physician, who is either a full time academician with multiple responsibilities beside thyroid patient care, or a clinical thyroidologist. A clinical thyroidologist is a board certified endocrinologist, who cares for a majority of thyroid patients, with few patients experiencing other endocrine conditions. The American Association of Clinical Endocrinologists (AACE) developed the ENDOCRINE CERTIFICATION IN NECK ULTRASOUND (ECNU) program.[1] ECNU is a professional certification in the field of neck ultrasonography for Endocrinologists, Thyroidologists, and Thyroidology practices who perform consultations and diagnostic evaluations for thyroid and parathyroid disorders through both diagnostic ultrasound and ultrasound-guided fine needle aspiration (UGFNA). ECNU is seen as a distinguished certification, which increases public and patient confidence in thyroid ultrasound practice. These clinical thyroidologists are also interventional thyroid radiologists doing ablation therapy without surgery for thyroid and parathyroid cysts and recurrent neck thyroid cancer lymph nodes after prior surgeries failed. It is called Ethanol ablation EA, or PEI. They also do radio frequency, and echo ablation by HIFU for large solid symptomatic benign thyroid nodules.

Physicians and medical practices whom hold the distinction of Endocrine Certification in Neck Ultrasound (ECNU) professional certification are highly specialized thyroidologist. in the field of neck ultrasonography for physicians who perform consultations and diagnostic evaluations for thyroid and parathyroid disorders through both diagnostic ultrasound and ultrasound-guided fine needle aspiration (UGFNA).

The thyroidologist is the one needed to do long term active surveillance for micro-nodules too small to deserve a FNa biopsy. If and when the nodule grows it can be biopsied later. Also a large number ( 11,000 ) i 2014-15 were called thyroid cancer that now have been downgraded to a "look a like" benign adenoma. The clinical thyroidologist will review the case and with the help of cytopathologist experts decide if it was a cancer or this "look Like" adenoma. The change to benign will be a relief to the patient. Also new cases should be treated as a benign adenoma and only have minimal treatment and no cancer follow up.

Also, the patient with 1 cm true micro-papillary that is ideally located by an endocrine neck ultrasound study, away from the isthmus, recurrent nerve and trachea can be offered an alternative to surgery. These are unlikely to grow or to cause death, and a new program called Active Surveillance can monitor the cancer for minimal growth > 3MM or nodal involvement. The deferred thyroid surgery can be done later without any change in prognosis. A thyroid cancer registry TCCC will have the patients records to assure them that the ultrasound images will be available for future endocrinologists to access.

The major goal is to deliver the best thyroid patient care with the use of modern tools. This includes office based thyroid ultrasound ("US"), Medical ultrasonography, US guided FNA, Percutaneous Ethanol Injections ("PEI"), for thyroid cysts, and thyroid cancer lymph nodes.

Also, office thyroid nuclear studies and treatments, such as I/123 uptakes, scans, I/131 therapy for cancer, Graves', toxic nodular goiter, and large nontoxic goiters with obstruction. Finally, office based thyroid blood hormone studies, such as T4, T3, TSH, TPO thyroid antibodies, and cancer markers thyroglobulin, TG and Calcitonin, CT.

The 2016 use of molecular markers BRAF, RET/PTC, RAS etc, and classifiers obtained by needle washout during the needle biopsy or after on the biopsy smears of thin prep, have added another way to decrease unnecessary surgeries for those with indeterminate biopsy results. Several companies have approved methods for marker and classifier testing in the USA and Canada.

The clinical thyroidologist is usually also a member of academic endocrine societies, such as the Endocrine Society, and the American Thyroid Association, and the American College of Endocrinology. He may be a member of the Academy of Clinical Thyroidologists, recently founded in 2005.

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