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Multidisciplinary Thyroid Nodule Clinic Gives Patients Comprehensive Services

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(608) 263-7502
 
UW Health Services
 
A Nodule Nexus
 
MADISON - It's estimated that about half of the US population will develop a thyroid nodule at some time in their life. For the significant majority of these people, the nodule will be too small to feel or see, and will cause no problems. But for 4 to 7 percent of patients, the lump will be large enough for a physician to feel, or could become large enough to cause problems breathing or swallowing.

Once a thyroid nodule is detected, patients can spend months making the rounds of medical professionals, from ultrasound specialists to endocrinologists to surgeons.

"It can be a lengthy and frustrating process," says UW Health endocrine surgeon Rebecca Sippel, MD. "We've changed it from months and multiple office visits to one day and one place."

That place is the UW Health Multidisciplinary Thyroid Clinic, a twice-weekly collaboration of UW Health surgeons, endocrinologists and pathologists dedicated to the evaluation and treatment of thyroid nodules. Patients referred to the Thyroid Clinic can go from initial assessment to treatment plan in half a day.

"On that first visit, a patient will meet with an endocrinologist, have an ultrasound-guided biopsy if needed and get an immediate preliminary reading from a pathologist," Dr. Sippel says. "If surgery is needed, the patient can then meet with a surgeon specializing in thyroid surgery and can leave the visit with an operation date in hand."

Fine needle aspiration and same-day pathologic evaluation allow the clinic to determine if a nodule is among the 5 percent that are malignant or the 15-20 percent that are suspicious, which would require a thyroidectomy. Surgery is also an option for benign nodules that interfere with swallowing or breathing.

If surgery isn't required, the UW Health endocrinologist works with the patient and his or her primary care physician to create a follow-up treatment plan, including medication to supplement or replace thyroid function, along with follow-up imaging as needed.

"This clinic was created to be a resource, especially for primary care physicians," Dr. Sippel says. "Most nodules are first detected quite incidentally by a primary care provider. We want to work with those providers as part of the care team, helping them expedite the work-up of their patients."

The cause of thyroid nodules is largely unknown, though some nodules appear to have a strong hereditary component. Women are more likely to have thyroid nodules than men, and the likelihood for a palpable nodule rises with age. Recent research has shown that the risk of malignancy is not tied to the nodule's size, and that contrary to prior belief, multi-nodular goiters share a similar risk for malignancy as solitary thyroid nodules.

The UW Health Multidisciplinary Thyroid Nodule Clinic has been seeing patients for about three years, and doubled availability last July to meet growing demand. Referring physicians can often get their patients into the clinic in as little as two weeks.

To refer a patient to the UW Health Multidisciplinary Thyroid Nodule Clinic, call (608) 263-7502.
 
Date published: 4/28/2008