Lee N. Metchick, M.D.  F.A.C.E
Thyroid Institute of Central Florida
Lee N. Metchick, M.D.  F.A.C.E
Thyroid Institute of Central Florida
Expertise in Treatment
Most types of thyroid cancer can be curable when caught early, but often may require aggressive treatment using surgery and/or chemotherapy and radiation.  Our  Institute also uses targeted medical chemotherapy for thyroid cancer, which involves the use of specialized drugs to inhibit proteins that cause the cancer to grow.
The thyroid gland is a primary component of the endocrine system, which monitors metabolism, growth, tissue function and mood. Located at the front of the neck, the thyroid gland is about the size of a quarter and shaped like a butterfly, with two distinct sides called “lobes.” Take a minute to review this 60 second video
The two types of nodules are:
  • Malignant nodules, or thyroid cancer, which can grow and spread to other organs if not treated. 
  • Benign nodules, which represent more than 95 percent of the cases, are non-cancerous, and can grow and cause symptoms but do not spread, and often do not need to be removed. 
  • Lump in the neck
  • Pain or  pressure in the neck
  • Difficulty swallowing 
  • Enlarged thyroid
  • Hoarseness

Thyroid Nodules
Risk Factors:
  • Age: 20 percent of people older than the age of 50 will develop a thyroid nodule; the risk increases with age
  • Gender: Women are more likely than men to develop thyroid nodules.

Diagnosis: We can determine what kind of nodule you have using these tools:

  • Physical Exam: Your doctor will feel your neck to identify the presence of nodules.
  • Blood Tests:  Your doctor will test your blood for elevated or low levels of thyroid stimulating hormone (TSH).
  • Thyroid Scan:  Your doctor will give you an oral radioactive substance to track its path through the bloodstream.  Nodules absorbing more radioactive substance than the surrounding thyroid tissue are considered to be “hot,” or non-cancerous. 
  • Thyroid Ultrasound:  With an ultrasound, your doctor will see the thyroid nodules.  Ultrasounds help doctors find nodules too small to detect in other ways.  Ultrasounds also help doctors see the size and shape of nodules, and determine whether they are non-cancerous, liquid-filled cysts. 
  • Fine-needle Aspiration: In an FNA, a very fine, thin needle is inserted into the thyroid, and aspirates (or "suctions") cells and/or fluid from a thyroid nodule or mass into the needle. The sample obtained can then be evaluated for the presence of cancerous cells.
Conditions Treated - Thyroid Nodules
Conditions Treated - Thyroid Cancer
There are 4 primary types of thyroid cancer:

  • Papillary thyroid cancer is the most common form, occurring in more than 80 percent of diagnosed cases.    It appears as a dense, uneven mass within healthy thyroid tissue.  Cure rates are 80-90 percent.

  • Follicular thyroid cancer is second to papillary in frequency, but is more aggressive.  Like papillary, follicular cancer occurs within thyroid tissue, but carries a greater risk of spreading to the blood channels and then metastasizing to other major organs.  Nevertheless, cure rates are generally high.

  • Medullary thyroid cancer is the third most common type, accounting for about five percent of diagnosed cases.  This type develops from a particular kind of thyroid cell called “C cells.”  Medullary cancer can spread quickly to lymph nodes, lungs or liver, and is most effectively treated before this occurs.

  • Anaplastic thyroid cancer accounts for about two percent of diagnosed cases.  Anaplastic cancer cells look very different from normal thyroid cells, and often derive from a pre-existing papillary or follicular cancer.  This cancer can quickly spread throughout the body and is very difficult to treat and cure.
Thyroid Cancer
FNA- Frequently Asked Questions.
How Does FNA Differ From Needle Core Biopsy?
In a needle core biopsy, a thicker, large needle is used to obtain a "core" tissue sample for analysis, and the larger sample that can be recut for smaller samples that can be sent out for further analysis. Needle biopsies are typically done using local anesthesia, and these procedures have slightly greater risk of bleeding associated with them, so they are more often done by a surgeon in outpatient or ambulatory surgical facilities.

What is an Ultrasound-Guided FNA?
When a nodule is palpable - meaning, you can feel it with your hand - most practitioners don't need to use ultrasound to guide the FNA process.

Some nodules are very low lying or can only be felt when you are swallowing, or can't be felt but were picked up by ultrasound, cat scan or MRI. In these cases, a practitioner may use ultrasound to ensure that the FNA is accurately performed.

Is FNA Risky?
Thyroid FNA is generally considered safe, and almost never results in any complications.

Will It Hurt?
That depends on the skill of the practitioner, your own perceptions of pain. Dr. Metchick has performed 1000's of biopsy's and feedback from our patients are posted for your review.

How Will it Feel Afterwards?
You might have slight pain with some swelling and bruising at the injection locations, and possibly slight discomfort in swallowing
FNA- Testimonials loading....
Hyperthyroidism occurs when the thyroid produces too much thyroid hormone, which controls metabolism.
Factors leading to the development of hyperthyroidism include:
•Graves' disease: This autoimmune disease produces antibodies that attack and stimulate the thyroid gland and commonly leads to hyperthyroidism.
•Thyroid nodules: Some thyroid nodules can produce excess hormone and enlarge the thyroid.
•Thyroiditis: A thyroid inflammation, often caused by a virus, can result in excess hormone leakage into the bloodstream.
•Genetics: Hyperthyroidism tends to run in families.
•Gender: Hyperthyroidism affects more women than men

Risk Factors
Hyperthyroidism is associated with a wide variety of symptoms, including:
•Irregular heartbeat      •Extreme tiredness, coupled with insomnia      •Increased hunger, coupled with weight loss •Inexplicable anxiety or irritability    •Inexplicable feeling of being hot   •Increased sweating   •Changes in menstruation  •More frequent bowel movements  •Neck Swelling
We  can diagnose hyperthyroidism with the following tools:
•Blood Test: Your doctor will test your blood for elevated levels of thyroid hormone
•Iodine Thyroid Scan: Your doctor will give you oral radioactive iodine that permits imaging of the anatomy of the thyroid, and also can indicate how much the thyroid absorbs (uptake test) as a measure of how much over activity is present.

There are three primary ways to treat hyperthyroidism:
•Medication: Drugs that suppress the production of thyroid hormones can be effective if taken regularly.
•Radioactive Iodine Therapy: In larger doses than used for diagnosis, radioactive iodine can eliminate unhealthy thyroid cells.  One or two oral doses are generally sufficient to permanently cure the condition.
•Surgery: The thyroid can also be removed surgically, which will permanently cure the condition.

Radioactive iodine therapy is the most effective and permanent treatment for hyperthyroidism.
Hypothyroidism occurs when the thyroid does not produce sufficient key hormones, gradually slowing the body’s metabolism. 
Risk Factors
Factors that increase the risk of developing hypothyroidism include:
•Gender: Women are much more likely than men to suffer from hypothyroidism
•Age: Risk increases with age, and women older than age 50 are especially at risk
•Medications: Exposure to radioactive iodine or other thyroid-inhibiting drugs
•Radiation: Radiation treatments, especially in the upper body areas
•Surgery: Prior thyroid surgery
•Genetics: Hypothyroidism runs in families

Conditions that can cause hypothyroidism include:
•Thyroid inflammation, or thyroiditis
•Treatment for hyperthyroidism
•Surgical removal of part or all of the thyroid

Symptoms indicating hypothyroidism tend to increase in severity over time, and include:
•Excessive tiredness
•Abnormal weight gain  •Difficulty losing weight  •Inexplicable sensitivity to cold
•Inexplicable anxiety and depression  •Inexplicable forgetfulness
•Decreased interest in sex  •Extreme dryness of the hair and skin
•Loss of hair •Less frequent bowel movements •Muscle pain
•Changes in menstruation

A blood test is the most definitive method of diagnosing hypothyroidism.   Your doctor will measure the amount of thyroid hormone in your blood.

•Medication: Hypothyroidism
is effectively treated with hormone
replacement medication in pill form. 

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Primary hyperparathyroidism is an endocrine disorder in which the parathyroid glands (located in the neck, near or attached to the back side of the thyroid gland) produce too much parathyroid hormone (PTH). They produce parathyroid hormone, which controls calcium, phosphorus, and vitamin D levels within the blood and bone. When calcium levels are too low, the body responds by increasing production of parathyroid hormone. This increase in parathyroid hormone causes more calcium to be taken from the bone and more calcium to be reabsorbed by the intestines and kidney. When the calcium level returns to normal, parathyroid hormone production slows down.

One common disorder of the parathyroid glands is known as, primary hyperparathyroidism, is caused by swelling of one or more of the parathyroid glands. The swelling is usually due to a non-cancerous tumor (adenoma) that leads to the release of too much parathyroid hormone, which raises the level of calcium in the blood. The term "hyperparathyroidism" means too much parathyroid hormone. The disease is most common in people over 60, but can also be seen in younger adults. Women are more likely to be affected than men. Radiation to the head and neck increases your risk. Rarely, the disease is caused by parathyroid cancer.

Most cases of  primary hyperparathyroidism have no apparent symptoms. Some symptoms that are associated with primary hyperparathyroidism are loss of height (osteoporosis), depression, fatigue, increase incidence of fractures, kidney stone formation, loss of appetite, muscle weakness or pain, and nausea. 

Primary hyperparathyroidism has now become much more prevalent largely due to the use of multiple electrolyte panels blood assays (Comprehensive metabolic Panel) because calcium determinations are now more routinely obtained.

Primary hyperparathyroidism is the most common cause of hypercalcemia. It is important to distinguish between primary hyperparathyroidism and other causes of hypercalcemia, such as malignancy-associated hypercalcemia, which is the second most common cause of hypercalcemia. When the parathyroid hormone level is elevated or in the upper range of normal and hypercalcemia is present, abnormal regulation of serum calcium by the parathyroid gland(s) is most likely. A typical normal range for parathyroid hormone assay is typically given as 10-65 pg/ml, in individuals under the age of 45, the upper limit of normal for parathyroid hormone should be regarded to be closer to 45 pg/ml. This is because parathyroid hormone levels normally rise with age and the laboratory reference range doesn’t make a distinction. 

There are some exceptions to the rule that patients with hypercalcemia and elevated PTH levels have primary hyperparathyroidism. This includes use of two medications, lithium and thiazide diuretics. While many of these patients will still, in fact, have primary hyperparathyroidism, the only way to conform a diagnosis is to discontinue he medication and to monitor the serum calcium over the next 3-6 months.

There is only one way to cure primary hyperparathyroidism and that is with surgical intervention. While there are some alternative treatments that are available these are for patients whom for what ever reason should not undergo surgical correction. Sometimes, if you have mildly increased calcium levels due to primary hyperparathyroidism and no symptoms, you may just need regular checkups with your doctor.

Most patients with primary hyperparathyroidism, do ultimately require surgery to correct the underlying problem. If your kidneys do not work correctly, you have evidence of osteopenia or osteoporosis, or have kidney stones, you will require surgical intervention. In addition to surgery your treatment may include drinking more fluids to prevent the formation of kidney stones, avoiding certain medications, and using other medications.

For more information on parathyroid disease please refer to www.parathyroid.com

Biopsies performed almost 2000
Biopsies performed annually apx 250
Non-diagnostic rate <1%
Benign nodules about 85%
Malignant Nodule <5%
Thyroid ultrasounds performed monthly apx 200
The Low-Iodine Diet