Our Services Services available in our office include but are not limited to: clinical consultation, follow up visits for chronic problems, the use of bone density measurement, ultrasound evaluation of thyroid nodules, the aspiration of thyroid nodules for cytology, the use of nuclear medicine to evaluate diseases of the thyroid and parathyroid glands, and the use if I-131 (radio iodine) to treat overactive thyroid conditions and thyroid cancer. Endocrine Consultation This is a personal experience where the history of illness, the supporting documents and studies, and physical findings are all synthesized by the consulting endocrinologist. Often, a specific diagnosis can be made at the bedside. At other times, it is necessary to perform ancillary testing. Most endocrine testing can be completed right within our office, but sometimes, other images, such as MRI or PET scans are indicated, and these are done in the surrounding hospitals. In 2005, our physicians performed more than 2,300 consultations. Bone Density Evaluation We utilize the Hologic Discovery QDR system to evaluate the density of bones. The procedure causes no discomfort and can be done with the patient fully clothed. The results are usually available by the next day. Osteoporosis and other causes of demineralization of the skeleton can be detected with this instrument and the progress of treatment followed, generally at intervals of 1 or 2 years. In 2005, more than 600 bone density studies were performed in our office. Thyroid Ultrasound This is a painless procedure which is performed by one of our physicians not by a technician. The ultrasound device can objectively measure the dimensions of thyroid nodules and, when necessary, serve as a guide for aspiration of the nodule for cytology. The patient receives a copy of the image on thermopaper at the completion of the examination. In 2005, our physicians performed over 900 thyroid ultrasounds in the office. Thyroid Aspiration for Cytology This procedure is done in conjunction with a pathologist of a cytotechnician from the Deaconess Hospital pathology department. The endocrinologist punctures the thyroid nodule through the skin and the small sample of fluid is prepared on microscopic slides and examined immediately for adequacy of the sample. If the sample is adequate, the procedure is terminated and the pathologist issues a full report within 24 hours. Should the initial sample be inadequate (not enough thyroid cells available for a determination) the tiny aspiration can be repeated until successful, thus saving the patient from a second trip to the office. The puncture is associated with a modest degree of discomfort, similar to the discomfort noted when blood is taken from a vein for a blood test. In 2005, our physicians performed more than 600 aspirations. Thyroid Uptake Test This procedure measures one of the important functions of the thyroid gland - its efficiency in accumulating the building block for thyroid hormone; iodine. We use radioiodine (generally I-131, sometimes I-123) which is administered in the form of a capsule. After a given period of time (generally 24 hours) a device which can detect the radioactivity is used to determine the percentage of the administered radioiodine dose which has been collected by the thyroid tissue. Radioiodine does not activate the immune system, so that patients who are allergic to iodine can safely take the radioiodine without fear of an allergic response. The measurements are made with the patient in a sitting position and there is no discomfort. Thyroid Scan The radioactivity of I-131 or I-123 can also be used to image the thyroid gland. A normal gland resembles the profile of a butterfly. Defects in the thyroid gland may be detected. Some areas may over accumulate the isotope ("hot") but some areas may not accumulate any of the test isotope ("cold"). The endocrinologists will "mark" a nodule, if one is present, using a tiny amount of isotope so that the function of the physically detected nodule can be accurately compared to the image of the thyroid gland. The image is made by using a large detector which is centered above the thyroid gland as the patient lies on a special table-like trolley and there is no discomfort. The scan is often combined with I-131 or I-123 uptake. We did more than 300 of these tests in 2005. Parathyroid Glands Scan The principle of this procedure is the same as for the thyroid scan, however a different isotope is used (technesium sestamibi) which is administered by an injection of the material into the vein. Images are made after 15 minutes and repeated after 2 hours. We did over 100 of these scans in 2005. Whole Body Scan Because of the thyroid cell's unique ability to gather in iodine, radioiodine can be used to search the body for thyroid cells or for thyroid cancer cells which have the ability to capture iodine. The procedure is generally done 48 hours after the oral administration of a test dose of isotope, but also 10 days after the administration of a therapeutic or treatment dose of isotope given to destroy thyroid cancer cells. The day before the whole body scan the patient is asked to drink 10 ounces of chilled citrate of magnesia, a laxative, to evacuate any isotope which may be in the contents of the intestinal tract. Images are made of the neck, the chest, and of the whole body while the patient lies on the scanner trolley. The whole body scan was done over 100 times in our office. I-131 As a Treatment Agent Overactive thyroid nodules and overactive thyroid glands can be painlessly treated by oral I-131. The calculated dose of the isotope is administered to the patient. It is important to determine that a female patient is not pregnant at the time of the treatment. There are important, but simple, public health safety measures which are explained to the patient. 260 patients were treated in 2005. Thyroid cancer can also be treated with this isotope. The procedure is the same but the dose of the isotope is larger. In the case of thyroid cancer, the patient must live "like a hermit" in his/her own home for 7 days in order to limit the exposure of healthy people to the effect of the radio isotope. The physicians of The Endocrine Group treated 49 patients with I131 for thyroid cancer in 2005.