10-15 years ago, a referral for thyroid second opinion from an internist, and from a general endocrinologist would show that the endocrinologist knew more about the thyroid condition than the internist. Sadly, it is not the case today.
With diabetes and general medicine taking up the majority of the waking hours for the endocrinologist, there is now a loss of thyroid specific expertise by the endocrinologist. He is little better than a general internal medicine physician. He is still the king of diabetes, but not thyroid.
51-year-old female seeks my opinion on the thyroid condition she is not sure she has, or the therapy that is needed. Two years ago the endocrinologist, while treating her type one diabetes, noted an upper normal TSH, 5.61, and commented on her enlarged thyroid on his physical. He did nothing to evaluate the goiter, and told her to return in a year.
He did not offer therapy. She had a family with autoimmune disease of the thyroid, aunts with Graves' disease, and papillary thyroid cancer. No antibodies were drawn or was an ultrasound done to evaluate the goiter.
Next year the TSH was 6.32 and he offered her a thyroid hormone, but no work up. This resulted in her getting a second opinion with me. The thyroid was visible from across the room. There was a large 2 cm nodule on the right. The ultrasound found 6 nodules of which two were > 1.5 cm. One was 3 cm. It had an irregular border, and 3 deep penetrating blood vessels on power Doppler. There was a papillary thyroid cancer in the larger nodule by USGFNA, and she was studied for abnormal nodes,which was negative.
She had surgery, and is disease free with an undetectable cancer marker 6 weeks post surgery. She is lucky to have sought another opinion on her very excellent endocrinologist taking care of her type one diabetes, but learned that his knowledge not sufficient enough to care for her thyroid disease.
Dr. Guttler has been a Thyroid Expert for 31 years, board certified in endocrinology, Clinical Professor of Medicine, Keck School Medicine USC.