→ The thyroid gland has a rich blood supply made up of two main arteries on each side: the superior and the inferior thyroid arteries. The veins draining the thyroid gland tend to run along with the arteries. An additional major vein draining directly into the internal jugular vein is the middle thyroid vein. (Figure 1)
→ The lymphatic drainage from the thyroid gland is to lymph nodes located near the trachea and esophagus. The lymphatic drainage carries extra fluid from the body back to the heart and are filtered through lymph nodes in the center part of the neck next to the thyroid (i.e. central neck nodes) and to the lymph node in the side of the neck along the jugular vein (i.e. lateral neck nodes). These lymph nodes become important in cases of thyroid cancer.
→ Fine needle aspiration (FNA). FNA biopsy is the most accurate test for evaluating thyroid nodules.
→ The biopsy may be performed under ultrasound guidance. A very thin needle is guided into the thyroid nodule and a small sampling of cells is aspirated or sucked into the needle.
→ These cells are then examined under a microscope by a cytologist. An experienced thyroid cytologist is important to increase the accuracy of diagnosis.
→ Papillary cancer cells are fairly straightforward to diagnose under the microscope. A result of PTC on FNA biopsy is about 95-98% accurate. Some centers may perform special stains or molecular studies on these cells to help determine if they are in fact cancerous.
→ Baptist Hospital South Endocrinology clearly explains and posts notices that test result findings are the patients responsibility. Patient receives thorough instruction to mark calendar, when to call and advised not to call sooner.
→ Patient call at duly appointed time is greeted with scheduling of an appointment to hear those anticipated results. No appointment, no information.
Failing to schedule appointment for any reason is reason enough to withhold patient information.
→ Ignoring fact of patient ignorance regarding test results, and perhaps irritated by patients persistent refusal to schedule return appointment, Baptist South Endocrinology mails EOI ‘Will Call’ Schedule so patient will pony up and get a repeat ultrasound.
→ Unsuspecting patient gets coded diagnose on pre-printed EOI schedule and researches own illness.
→ Telling someone you are going to stick them with a very fine needle in the neck at their Adams Apple to retrieve tissue from the thyroid is scary. Letting them know an injection with a numbing agent [Lidocaine] will hurt more than the procedure is scary.
→ Informing anyone about to undergo such an in-office procedure that some patients complain of pain, others only minor discomfort is reasonable right up to and until disclosing patients exiting the office after the Lidocaine shot and never coming back.
→ Not informing needle-phobic patients PROCEDURE CAN BE DONE WHILE UNCONSCIOUS is inconsiderate. Using needle like a shovel with obvious patient distress is unconscionable. Asking to collect second or third sample from terrified patient laying on table in pain is just stupid.
Here’s a few things that Baptist Hospital South Endocrinology needs to explain BEFORE the Ultrasound, BEFORE the FNA [Fine Needle Aspiration, Fine Needle Biopsy, In-Office Patient Torment Procedure]:
→ Ultrasound. A thyroid ultrasound is a non-invasive imaging study in which sound waves are used to see an accurate picture of the thyroid gland as well as any enlarged lymph nodes.
→ The ultrasound can tell the nodule’s size, exact location, and whether it is solid or fluid-filled (i.e. cystic). An ultrasound cannot differentiate between cancer and benign tumors, but there are certain things that suggest cancer such as hypoechoic nodules with increased vascularity (i.e. blood vessels), microscopic calcium deposits (i.e. microcalcifications), and irregular borders.
→ An ultrasound is also useful to evaluate any enlarged lymph nodes. If suspicious or large lymph nodes are seen, they can be tested with a FNA biopsy. For patients with a diagnosis of cancer, a full neck ultrasound looking specifically for enlarged lymph nodes (i.e. lymph node mapping) should be performed prior to any surgery.