from the algorithm to the individual diagnosis

Personal view

This section of the homepage contains the most important publications of our team. In section 'New approach' we try to demonstrate a characteristic way of thinking in the differential diagnostics of thyroid diseases which not fully corresponds but in essential parts differs from the current algorithm. Beside these parts written on a scientific background, I try to demonstrate here my special personal point of view, as well.

As time goes on everybody gains more and more experiences in his or her speciality. It is not an easy task to communicate this personal experiences in the era of evidence based medicine and holiness of statistical significance… But If we remember our masters or elderly colleagues, sometimes we learned much more from a throwaway statement then from hundreds of pages of a well-written textbook. My diagnostic faults are also presented in case studies, so I hope that the readers will remember at least how to avoid diagnostic failures... I try to stay modest even in this section but surely some of my fixations fail, some or even the majority of my raisings are not important and may be some of my thoughts are too provocative.

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. >>>