Florida Thyroid Medical Services



	Our mission is to provide efficient patient care for the treatment of thyroid disease consistent with the highest standard of medical excellence and the latest innovative technology. From ultrasound exams to our on-site laboratory, the Thyroid and Endocrine Center of Florida is uniquely equipped to diagnosis and treat all aspects of thyroid disease.

	Thyroid Ultrasound
	Ultrasound Guided Thyroid Fine Needle Aspiration Biopsies
	Cytology Adequacy Assessment and Interpretation
	Radioactive Iodine Treatment

	Thyrogen Injections
	Thyroid Clinical Lab
	Pre-operative Ultrasound Mapping


	Ultrasound utilizes harmless sound waves to produce images of the thyroid. Ultrasound exams are done in "real-time" by Dr. Lupo during an office visit. The procedure is simple and painless. The patient lies flat with the neck slightly extended and gel is applied to help the sound waves travel through the skin. The ultrasound probe is moved around the neck to create real-time images of the thyroid and surrounding structures, including lymph nodes. The benefits to having an ultrasound done by a clinician in our office is that we are able to immediately read the results, discuss results with the patient and apply our knowledge of the patient's medical history to the ultrasound imaging, all without inconveniencing the patient with additional trips to a radiology department. This method is superior to a technician taking pictures, sending those pictures to a radiologist, who is then limited by having only a still shot image of the ultrasound study and no detailed medical history when the interpretation is made. Information gathered during the ultrasound procedure includes the size of the thyroid, detection of any inflammation in the thyroid, and the blood-flow through the thyroid. Thyroid nodules and cysts are measured and detailed descriptions of their characteristics are recorded. For thyroid cancer patients, we perform a review of the surrounding lymph nodes to help determine if the cancer has spread to these lymph nodes. Ultrasound follow-up has replaced nuclear medicine imaging for thyroid cancer recurrence detection. This is best done by an experienced clinician, not a technician.


		To better assess a thyroid nodule, a biopsy is often necessary. A fine needle aspiration biopsy (FNA) uses a small needle (smaller than most blood draw needles) to obtain cell samples from the thyroid nodule. This procedure is preformed under ultrasound guidance to ensure that the needle tip is within the targeted nodule at the time of aspiration. Dr. Lupo has preformed thousands of these procedures and uses the smallest needle possible to achieve an adequate cell sample. Local anesthesia can be used but is seldom needed for this procedure and most patients feel it is less uncomfortable than a visit to the dentist. FNA does not require any special preparation (no fasting), and patients usually return home or to work after the biopsy without any ill effects.


		FNA biopsies are sometimes limited by inadequate samples of thyroid cells for interpretation. To minimize this problem, Dr. Lupo prepares the slides then microscopically reviews each slide in order to determine adequacy. Slide review is done while the patient is still in our office. By utilizing this unique adequacy method, additional FNA biopsies can be performed if necessary to achieve adequacy. Using this method, the likelihood of inadequate sample is less than 2% -- much lower than the 15-20% that is reported to be the national average. The slides are then sent to an expert thyroid cytopathologist at the University of Arkansas for Medical Sciences, Dr. Nicole Massoll for further study and diagnosis. Some insurance companies are not contracted with the University of Arkansas for Medical Sciences and in these cases, either the patient elects to pay for the expert reading or the slides are sent to another facility. The results of the FNA biopsy are ready within three business days.


	Radioactive Iodine (I-131) has been used for over 60 years to treat hyperthyroidism and thyroid cancer. This treatment involved swallowing a small pill of radioactive iodine. The only part of the body which takes up the iodine is the thyroid – which is why this is considered a targeted radiation treatment to the thyroid. Dr. Lupo is licensed by the State of Florida Radioactive Materials Division to administer I-131 therapy for his thyroid patients. Hyperthyroid patients and patients with nodular goiter are treated in the office. Until recently, thyroid cancer patients were treated only in the hospital and confined for one to three days in a leaded room. With our license from the State of Florida however, we are the only Endocrinology practice in southwest Florida able to perform in-office I-131 treatment of most thyroid cancer cases. In doing so, we can avoid hospitalizations as the patient can be treated in our office and sent home the same day. In certain circumstances, a hospitalization may still be necessary. In these cases, Dr. Lupo then gives the I-131 dose at the hospital. Detailed radiation safety information is provided to the patients.


	Thyrogen is a medication used to prepare thyroid cancer patients for I-131 diagnostic studies. It is an exact copy of the hormone TSH which is injected into the muscle (usually buttocks) on each of the two days prior to the I-131 dose. This allows I-131 imaging of the whole body without the need for the patient to come off thyroid medication. For thyroid cancer, the FDA has approved Thyrogen for treatment with I-131 post surgery, making this treatment much more tolerable than the current standard which requires patients to be off thyroid medication for several weeks. Please inquire about the use of Thyrogen to prepare for your I-131 cancer treatments. Thyrogen is also used to facilitate the treatment of large nodular goiters with I-131, often allowing significant reduction in the size of the goiter without surgery. This use is not yet FDA approved, but research is promising.


		Our thyroid function lab is a CLIA certified facility using state-of-the-art equipment to process blood samples for TSH, free T4 (Thyroxine), free T3 (Triiodothyronine), Thyroperoxidase (TPO) Antibodies, and Thyroglobulin (Tg) Antibodies. These five tests are the core thyroid function tests needed to evaluate and treat thyroid conditions.


		Cancer of the thyroid is uncommon, but with an estimated 37,000 new cases diagnosed each year and the 8th most commonly diagnosed cancer in women, thyroid cancer is on the rise. When thyroid cancer is detected, the typical treatment is surgery to remove the entire thyroid gland. When preparing patients for surgery, it is critical to evaluate the surrounding neck area for any abnormal lymph nodes to which the cancer may have spread. A comprehensive neck ultrasound is the most sensitive and effective method to determine if there are abnormal lymph nodes which would require surgery beyond removal of the thyroid alone. We call this type of exam a Pre-operative Ultrasound Mapping.
	Pre-operative Ultrasound Mapping identifies lymph nodes that can be biopsied to confirm metastasis in order to help the surgeon plan additional dissection of the involved lymph node compartments. A map is created for the surgeon that guides the extent of surgery. In more complicated cases, it is best to perform the pre-operative neck ultrasound with the surgeon present in our office in order to visualize the abnormalities and plan the surgical approach. If needed, during the surgery itself, we can talk to the surgeon about the anatomy and location of the metastatic lymph nodes in order to locate and remove the cancer. Unfortunately, many patients in the U.S. undergo thyroid cancer surgery without Preoperative Ultrasound Mapping and, in about 15% of cases, this results in leaving behind lymph nodes to which the cancer has already spread. These cancers are then “discovered” years later during cancer follow-up exams and usually require additional surgery. Our goal through Pre-operative Ultrasound Mapping is to increase the probability that the initial surgery is the only surgery patients will need. Pre-operative Ultrasound Mapping is performed for all our patients undergoing surgery for suspected thyroid cancer. We strongly believe this method improves the care of the thyroid cancer patient through a team approach between the thyroid specialist and the thyroid surgeon.

	MEDICAL DISCLAIMER: The information found on this website is for educational purposes only and is not providing medical or professional advice. It should not be used for diagnosing or treating a health problem or disease. It is not a substitute for professional medical care. If you have or suspect you might have any health problems, you should consult a physician.

The Thyroid & Endocrine Center of Florida | 5741 Bee Ridge Road Suite 500 Sarasota, Florida 34233 | Telephone: (941) 342-9750 | Fax: (941) 342-9788

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Endocrinologist specializing in ultrasound guided biopsy, thyroid biopsy, thyroid ultrasound, fine needle aspiration, radioactive iodine located in Sarasota, Florida Endocrinology center and thyroid doctor for treating thyroid cancer, thyroid nodule, thyroid cyst, parathyroid, thyroid and pregnancy, hashimoto's, hypothyroid, thyroid, thyroid disease, thyroiditis, thyroid cancer, grave's disease, hyperthyroid, hypothyroid, Dr. Richard Guttler, Nuclear Medcine, cytophology, Swezey Institute Building, Thyrogen, nodule, The Thyroid Doctors, Thyroidologist, hyperthyroid, goiter, autoimmune conditions, located in Sarasota, Florida Thyroid specialist for thyroid evaluation, thyroid blood work, thyroid labs, thyroid check up, thyroid exam, endocrinology consultation, endocrinology exam, and second opinion in Sarasota, Florida