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COV ER FE AT UR E "Radioactive iodine ablation to treat hyperthyroidism essentially shuts down the hormone factory that's overproducing. The treatment doesn't kill the gland; it destroys its ability to function." — Abraham Port, MD, Medical Director of Breast Imaging and ultrasound specialist for South Nassau Communities Hospital, and Medical Director of Breast Imaging at Complete Women's Imaging thyroid malignancy that only high-quality imaging details." Dr. Port notes that ultrasound imaging offers 1–3 mm resolution of thyroid nodules that illuminates even the smallest details. Ultrasound imaging can evaluate in great detail nodules as small in size as 1–3 mm. "Dermatologists are trained to distinguish benign freckles and acne from malignant spots; similarly, we're trained to differentiate differences in thyroid anatomy," Dr. Port explains. "Smooth and clear nodules are normal and need no further treatment; however, a number of anatomic irregulari- ties can suggest malignancy, and these need to be surgically removed." Ultrasound imaging identifies whether or not thyroid nodules are hypoechoic — typically an indicator of a benign mass — as well as if there is any increased intermodal vascularity, infiltrated margins or micro- calcification, which suggest malignancy. The nodule's shape is another important consideration. If it is taller than it is wide, the chances of malignancy are greater. These characteristics help the radiologists determine if there is necessity for biopsy, which they can perform at the time of ultrasound. Ultrasound guidance provides great measures of accuracy to remove tissue samples. After closely examining the slides, pathologists use the Bethesda System for Reporting Thyroid C y t o p a t h o l o g y, a nu mer ic a l ra n k ing device divided into six diagnostic categories, to indicate the presence of cancer. Equipped with pathol- ogy results, the team confers to determine how to proceed. Because the decision can be complicated by variables present in patient histories, the Thyroid Center's collaborative process remains critical throughout the treatment plan. Case Studies in Complexity A patient who has a 5 mm nodule with no calcifications or other anatomical characteristics suggesting malignancy, and who also has no history of radiation to the head and neck, family history of thyroid cancer, or other risk factors, presents a fairly straightforward case. The recommended treatment would be surveillance. "The vast majority of patients don't need surgery," Dr. Lomasky says. "Such interven- tion is only necessary for the approximately 5 percent of nodules that are malignant. The best approach for most patients is serial monitoring to track any changes in the nodule's size and structure." Such surveillance can last a lifetime without physicians witnessing changes that indicate malignancy. Other cases, however, require more aggressive intervention. Patients who have a family history of thyroid cancer and whose sonographic images show a nodule greater than 1.5 cm with calcifications are sent for biopsy. If pathology reports confirm cancer, then surgical excision is indicated. Treatment planning becomes compli- cated when pathology reports indicate a Dr. Port performs a thyroid sonogram to detect a possible cancerous nodule in a patient. Dr. Lomasky and colleague Yael L. Oppenheim, MD, counsel a patient on the procedure for testing a thyroid nodule. 8 | Long Island MD NEWS ■ M D N E W S . CO M