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Clinical Thyroidology
What does it take to have a thyroid only private practice?
Masters Class with One of the Original Clinical Thyroidologists
Young Endocrinolgists, older endocrinologists who want to concentrate on thyroidology, or fellows out of training should consider a career in clinical thyroidology. The field is wide open for those who will take the time and training to become expert in all areas of clinical thyroidology. It requires a decision to make a practice that does not include diabetes, or internal medicine. Parathyroid, and or general endocrinology can be included.
The building blocks of a clinical thyroidolgoist practice are:
- Thyroid Lab (CLIA Certified)
- Thyroid Nuclear Medicine Certification
- Endocrine Neck Ultrasound Certification "ENCU" with USGFNA
- Interventional Ultrasound Certification, PEI
- Thyroid Cytology for Endocrinologists "First Look Concept"
Microscope and Digital Camera essential
Spend 3 to 30 days at the Santa Monica Thyroid Center. A 3 day course is the minimum time allowed. One, two or three weeks are also available.
The cost for this course is $500/day for 3 days, or $2,000 for 5 days. ACT members get a discount of $100/day.
Dr. Richar Guttler has a private thyroid center that was founded in 1974. He is the sole physician, and does all his own thyroid studies. After the initial consultation he draws blood for thyroid studies. The blood is processed and reported by his CLIA certified lab. If a nuclear thyroid study is indicated he will prepare the pill, do the update and imaging personally. If Graves' Disease, toxic nodular goiter, or large non-toxic goiter is the diagnosis, he can treat with radioiodine in his office. He does not have a nuclear medical technician. If a diagnostice ultrasound is indicated, he will use a state of the art high frequency ultrasound (ML-70 Esaote) to do the study. If a biopsy is needed, he will do an Ultrasound guided FNA with a large flat screen display to view the needle tip. A second ultrsound ML-25 with X view upgrade is available with a second flat screen for his students to practice diagnostic, and interventional US, and a blue Phantom model is available to practice FNA and PEI techniques. Dr. Richard Guttler has originated the "First Look Concept" in thyroid cytology, which he teaches to endocrinologists in the Thyroid Cytology for Endocrinologists workshops, recently approved for CME by the AACE board of directors, and given at the last AACE national meeting and at two cancer ultrasound workshops in Las Vegas and Chicago. He personally makes the smears, and then sends the smears to be stained at an ouside private path service. The path service does not interpret the slides. Slides return to him. He looks at the slides, determines adequacy, and makes the diagnosis. All questionable slides are sent for outside opinion to an expert thyroid cytopathologiest. He has two BX-41 Olympus microscopes outfitted with a digital camera, and makes photomicrographs to attach to his reports. He also obtains all previous FNA slides when seeing a second opinion. If the patient has had previous thyroid surgery, he obtains the original slides from the surgery, not just the report. He does his own prognostic scoring from the surgery slides on the cancer patients. If there is a suspicious lymph node seen in a cancer patient during US lymph node mapping, he will do cancer marker washout tests from the suspicious node as well as a biopsy. If a new thyroid cancer is diagnosed on USGFNA, he will do a detailed neck lymph node mapping, and if a susipcious node is found he will do a biopsy and washout. If positive, this can alter the extent of the original surgery 20-30% of the time. The side of the positive node would then be included in the original surgery. If a thyroid or parathyroid cyst recurs, he will treat the cyst by Ethanol injection, PEI and save the patent from a major surgery. If the patient has hyperparathyroidism, when indicated, he can locate the adenoma, do a delicate FNA, and PTH washout and make the location known to the surgeon. If a cancer patient is in need of ablation of the remnant normal thyroid after surgery, or radiation therapy for cancer, he is licensed to treat you as an outpatient in his clinic.
He does not go to the hospital except for conferences, and has 9-5 office hours 5 days a week. If you are interested in this life style, and are willing to not accept diabetes patients, you will become an expert in thyroid disease diagnosis and treatment in your local community. There are examples of successful recent thyroid clinics opening in different parts of the country. If you want to spend time with Dr. Richard Guttler, to see if you are interested in clinical thyroidology, cyou can contact him by email, fax or phone.
Program Overview
The program offers 3 days of study with one of the early experts in the use of ultrasound and cytology to evaluate and treat thyroid and parathyroid disorders.
Description
This is a combined lecture and hands on program to familiarize the physician with all aspects of thyroid ultrasound. Diagnostic and interventional thyroid ultrasound will be covered. That includes parathyroid identification, and USG Parathyroid FNA, Cancer Lymph node mapping, and USG Lymph node FNA, washout testing for cancer markers,
PEI ( percutaneous ethanol injections ) therapy for cancer nodes, thyroid and parathyroid cysts, and thyroid nodules. The microscope review of all biopsy materials adds the last component to a well rounded program. Proper smearing technique will be taught to all students to improve their ability to make good smears.
 Interventional Ultrasound Lab Esiote Biosound Italian MyLab 70 with X Vision. The machine is used by trend setting thyroid ultrasound expert Dr.Roberto Valcavi in Italy. A second ultrasound room with a MyLab25 with X view upgrade, and plasma TV monitor is available for diagnostic practice, and USG FNA and cyst drainage can be done on our blue phantom.
Prerequisite
The desire to do all aspects of diagnostic and interventional ultrasound on their own patients with thyroid or parathyroid masses. The basic AACE Ultrasound course is recommended but not essential. Only endocrinologists are accepted for this 3 day course.
Thyroid Ultrasound by Jack Baskin, and Thyroid Cytopathology by Douglas Clark, are two paperback books to get from Amazon.com
Registration
Only one or two physicians will be accepted for any given 3 day course. To apply email Dr.Guttler at dr.guttler@thyroid.com.
Arrangements
Travel and hotel are the responsibility of the student. Email me for close hotels, and things to do in Santa Monica California at the beach.
Application Fee
$1500 is the course tuition. There is a 50% cancellation fee paid if it occurs within 2 weeks of the course. Payment can be made by check, or credit card to
Richard Guttler MD, FACE.
1328 16 th St Santa Monica Ca 90404
310-393-8860
fax 310-395-8147
The thyroid Home page has a paypal account if you wish to pay that way.
Disclaimer: This is a totally private venture of Dr.Guttler. There are no other sponsors.
Curriculum
Wednesday
9 AM to Noon
See and ultrasound old and new cases and select ones for biopsy or therapy.
Thyroid Nodule
Abnormal node in patient with papillary cancer s/p total TX and RAI/131.
TG 0.9 N < 0.1.
Mass inferior to the thyroid lobe
12PM -1PM Lunch
1PM- 4:30 PM Continue patient evaluations
Thursday
9 AM to Noon
USGFNA nodules and parathyroid adenomas, PEI for Cancer Lymph nodes and
Cyst Therapy.
The nodule was an athrophic colloid nodule
USGFNA of the node.
TG washout 13,231 N> 1.0
The node was papillary cancer
Serum Calcium 11.6 PTH 67
The mass inferior to the thyroid was a Parathyroid Adenoma
Needle Washout PTH 4621 pg/ml
12-1 Lunch
1-4:30 More interventional and diagnostic studies.
Friday
9-12
Microscope review of the biopsies done on Thursday. Learn how to use the microscope, take digital jpeg photo’s and learn the basics of evaluating the biopsy for adequacy, and begin to understand the basics of diagnostic thyroid cytology.
12-1 Lunch
1-4
Case presentations, and finally the nuts and bolts of beginning a thyroid practice with the ultrasound machine as the primary focus. All necessary codes will be supplied as well as the suppliers of the needed equipment, and supplies to get started.
dr.guttler@thyroid.com
310-393-8860 Office
310-395-8147 Fax
thyroid
cancer, thyroid problems, hyperthyroid, hypothyroid, thyroid doctor,
thyroidologist, Benign thyroid nodules, Calcitonin, Colloid Goiter,
Ethanol therapy for cysts, FNA for cancer lymph nodes, FNA for
parathyroid, Graves disease, Graves' dermapathy, Graves' eye disease,
Hashimoto's thyroiditis, Iodine induced goiter, Lithium goiter,
Medullary thyroid cancer, Metastatic thyroid cancer, Percutaneous
ethanol injection therapy, Radiation induced cancer, Subacute Thyroditis,
TSH, Thyroglobulin, Thyroid Cancer oncologist, Thyroid adenoma,
Thyroid cancer markers, Thyroid cytology, Thyroid nodule, Toxic
Nodular goiter, Toxic Nodule, USGFNA, USGFNA for suspect parathyroid
adenomas., USGFNA for thyroid cancer, lymph nodes, USGFNA injection
of ethanol into cysts., USGFNA to obtain washings from the node
for cancer markers, Ultrasound of neck cancer lymph nodes, anaplastic
thyroid cancer, fine needle biopsy FNA for nodules, follicular
thyroid cancer, hyperparathyroidism, iodine deficient goiter, lingual
thyroid, parathyroid adenoma, parathyroid incidentaloma, pituitary
hypothyroid, radioiodine therapy for cancer, radioiodine therapy
for goiter, radioiodine therapy for hyperthyroid, thyroglossal
duct cyst, thyroid cysts, thyroid goiter, thyroid oncologist, ultrasound
guided fine needle biopsy USGFNA for thyroid nodules.
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