POSTGRADUATE COURSE in DIAGNOSTIC of THYROID DISEASE
from the algorithm to the individual diagnosis
Welcome on thyrosite.com
The author of this homepage was favored by fortune to become internist, expert of ultrasonography and also clinical cytology for more than two decades. He has treated more than 100.000 thyroid patients since 1995 based on the protocol which claimed to be official only 11 years later. He does not intend to be immodest when he supposes that he has had some influence and role in the paradigm shift as he was one of the first thyroidologists in 1999, who published the algorithm which was identical with the guidelines of ATA and ETA disclosed in 2006.
The fundamental elements of this homepage are the personal experience gained by the evaluation of more than 140,000 thyroid patients. The author hopes that his experience will be welcomed by colleagues working in the field of thyroidology and also by colleagues becoming thyroidologist in the future.
We present here the most important publications of our team.
Dr. Tamas Solymosi, M.D. Ph.D. internist, clinical cytologist, expert of sonography
The essence of the site
A QUICK TOUR can be reached directly.
The images and videos are the fundamental of the site. We demonstrate thousands of ultrasound and cytological images and hundreds of videorecords. These are presented in the form of case histories.
The differential diagnostic is the essence of our professional. The growing section of Pitfalls serves as base to discuss the various issues in thyroidology.
We give a textbook of thyroid sonography and cytology, too. >>>
Contributors to thyrosite.com
The clinical investigation, the cytological and sonographic examinations were performed by myself in all of these cases. Nevertheless, I am only one member of our team. I am very thankful to my colleagues for the possibility to work with them for more than 25 years.
Dr. Gyula Lukacs Toth, MD is the leading pathologist in our team. He is the head of the Department of Pathology, Bugat Hospital, Gyöngyös. I think that in the case of thyroid disorders the fundamental is the pathology and therefore the pathologist. His work serves as a really very stable fundamental of the evaluation and therapy of our patients. >>>
After the paradigm shift in the thyroid
After a continuous debate in the literature that has lasted for two decades, the American Thyroid Association and the European Thyroid Association have published new guidelines of evaluation of nodular goiter in 2006. While there are some differences between the two protocols, they are quite identical regarding their principles. They provide the key role of ultrasonography in the evaluation of thyroid disease and the key role of fine needle aspiration cytology in the evaluation of nodular thyroid goiter. >>>
The influence of iodine intake
An iodine deficiency is well known to increase the prevalence of benign nodular goiter. Hence, there is a low risk of malignancy in an iodine-deficient (ID) thyroid nodule as compared to a nodule from an iodine-sufficient (IS) region. Iodine intake exerts a significant impact on the proportions of the various cancer types too. Follicular and anaplastic carcinomas are more prevalent in ID areas, while papillary carcinomas predominate in IS areas. 85-95% of papillary carcinomas are correctly diagnosed by FNAC, whereas the most important limitation of FNAC is its inability to differentiate benign from malignant follicular lesions. >>>
About several issues in thyroidology
Here we discuss about fundamental problems in the field of nodular goiter which has a huge effect on the whole evaluation process. These issues are the following:
- Histopathological discrimination between a follicular adenoma and a well-differentiated follicular carcinoma.
- About the inadequate use of term "nodule" in sonography.
- Who has to perform ultrasonography?
- Waiting for the wonder gun... >>>
A new approach toward a better diagnostics
In the usual way of decision in a nodular goiter patient, the palpation and the ultrasonography serves to select patients for cytology, while the latter decides whether a patient has to be operated on or not. Unfortunately, for well-known reasons, the diagnostic power of cytology is far from the ideal. We demonstrate our experiences with a new approach on several cases. There are two fundamental of this new approach. First, the systematic combination of sonographic and cytological properties in the final diagnosis. It means that US serves not only as the basis for selection but also is considered with conjunction of cytology in the diagnosis. Second, we propose not to operate routinely on certain follicular lesions at once but we involve the results of regular follow-up for which the basis is repeat sonographic volumetry of the nodule. >>>