Endocrine Neck Ultrasound Laboratory of Southern California
1328 16 th St Second floor
Santa Monica, CA 90404
Richard Guttler, MD Director
310-458-1638 • 310-395-8147 FAX
thyroid@endocrineneck.com

Accreditation Certification

New Molecular Genetic Marker Test to identify Benign Nodules

A new approved molecular marker test to determine if a suspicious nodule is benign is now available. It inspects 143 genes that are expressed in benign nodules. We can run this test now. Click here to read more about it.

ACE Awards 100th ECNU Credential

(From the First Messenger magazine of the AACE, September 2010 issue)

...To date, there are 105 ECNU-certified endocrinologists and this number is continually growing. Reaching this milestone of more than 100 certificants is a testament of the endocrinologists’ commitment to achieve a new level of professional growth and recognition in the field of ultrasomography. As Chair of the ACE Neck Ultrasound Certification Council, I am extremely proud of this accomplishment and I look forward to furthering the mission of the ECNU Program.

For more detailed information regarding the ECNU Program and how to become certified, please visit http://www.aace.com/college/ECNU/.

Procedures:

Real Time endocrine neck ultrasound with power Doppler

1. Diagnostic US
2. Pre-operative Lymph node mapping
3. Thyroid cancer follow-up lymph node mapping

Ultrasound Guided Ultrasound FNA

1. Nodules
2. Cysts
3. Cancer suspicious lymph nodes with cancer marker washings for:
   a. Thyroglobulin
   b. Calcitonin
   c. Flow cytometry
4. Suspect parathyroid adenoma with PTH washings

Ultrasound Guided Therapeutic Interventions:

1. Percutaneous Ethanol Injections PEI for thyroid and parathyroid cysts
2. PEI for thyroid cancer lymph node ablation

Dr.Richard Guttler, a thyroid cancer physician specialist, and thyroid ultrasonographer, is the director of the Santa Monica Thyroid Center since 1974. Dr. Guttler is the sole owner of the Endocrine Neck Laboratory of Southern California. This is an extension of the thyroid center, offering endocrine neck studies for endocrinologists and others interested in high quality thyroid studies performed personally by Dr.Guttler.. He is a clinical thyroidologist, board certified in Endocrinology. Founder, secretary, and past president of The Academy of Clinical Thyroidologists. He personally treats thyroid cancer.

At the center, Dr. Richard Guttler uses the ultrasound to diagnose cancer by guiding the needle into selected areas of the suspicious nodule. This is called Fine Needle Aspiration Biopsy. He is a thyroid cytopathologist, member of the American Society of Cytopathology, and prepares and reads his own biopsy slides. Also, he uses ultrasound guided ethanol injections, PEI, to treat thyroid nodules that are cystic, eliminating the need for surgery. PEI is also used to kill cancer lymph nodes in patients, when surgery is risky option.

Dr. Guttler can help the surgeon locate abnormal nodes in previously operated neck to decrease the risk of complications, by placing a small amount of methylene blue dye on the node one hour before the surgery.

The center uses radiation sparingly, but when it is needed the center can give 150 Millicuries as an outpatient to medium and high risk patients. Low risk cancer patients will not be given radioiodine, as it is not helpful and can cause cancer years later. The nuclear medicine section can treat Graves’ disease, toxic nodular goiters, nontoxic goiters, as well as thyroid cancer.

Hypothyroidism is usually due to Hashimoto’s chronic thyroiditis. Thyroid hormone therapy is needed, to keep the TSH normal, because high TSH is a risk factor for nodules, and cancer in thyroiditis. Finally, low dose radioiodine is an alternative to surgery, for treating large non-toxic goiters, especially in elderly.

For physicians wanting to become top-level thyroidologists, Dr. Guttler now offers a 3-day course covering the current best practices for thyoid diagnosis and treatment. You can read more about this course here.

Classes Available at the
Thyroid Center of Santa Monica

Dr. Guttler offers a range of classes covering state of the art diagnostic and treatment options for thyroid patients. These classes range from one hour workshops focusing on specific skills to complete courses designed to give the student the background needed to become a certified master thyroidologist.

Workshops and Masters classes are open to endocrinologists. In addition, FNA physicians wanting further education may attend the FNA workshops.

Workshops

For those needing brushups on current methods, these workshops are a fast and inexpensive way to get the needed skills. The current workshops offered are:

1. FNA Physician Free Hand or Needle Guide Ultrasound Guided Needle Placement
2. FNA Physician Slide Preparation
3. On-site Quality Assessment of FNA Samples
4. Ultrasound Guided Cyst Drainage and Therapy with Ethanol (PEI). PEI for Cancer Lympth Nodes

Each workshop is one hour in length and covers the chosen topic in depth. Click here for more information.

Masters Classes

Masters classes give the student the necessary skills to start their own thyroid-specific practice. The classes are 3 or 5 days long or longer as desired.

The 3 day course covers topics and skills needed for an endocrinologist to have an emphasis on thyroid conditions while the 5 day course is for those who wish to specialize on thyroid patients.

Click here for more information and view the videos below.

Masters Class

PEI Injection

Typical Pei treatment of recurrent benign thyroid

"45 Y/O male told to have surgery for a large recurrent thyroid cyst. He found my center on the web and flew out for a  few days. The cyst was 20 cc. I put ethanol in and when he was leaving to go home the cyst was gone.

He had no side effects from the injection. He will return in one year for a follow up ultrasound. However, PEI treatment is 90% successful in saving nnecessary surgery, which is the old standard of care for recurrent BENIGN thyroid cysts."

Feb 23rd, 2011

Dear Dr. Guttler,

I have returned to Missouri; the flight was great, and I had no pain except for a slight itchy feeling around the cyst --- no big deal.

I feel much better today.

With this mail, I would like to send an electronic postcard saying just "thank you". You have been my salvation; it was fun to be in California.

Best Wishes
(Patient's name withheld as per their request.)

General Endocrinologists, and Thyroid Surgeons:

After completing my American College of Endocrinology certification in endocrine neck ultrasound, ECNU, I applied for certification of my endocrine neck ultrasound lab by the American Institute of Ultrasound Medicine AIUM. On 8/12/2010 was informed that my referral ultrasound lab was certified. This means that I can now offer my tertiary care clinical thyroidology interventional ultrasound services to general endocrinologists, and thyroid surgeons without a consult. I can do studies for you by request. I will not need to do a consultation. I will report my findings directly to you. The patient will be treated similar to a visit to radiology, and not as my new patient.

Some ways I can help you include:

1. Recurrent biopsy proven benign thyroid nodule with at least 50% cyst fluid for PEI ethanol injections instead of the old method of surgical lobectomy.
2. Pre-Op lymph node mapping in FNA positive thyroid nodules, to help surgeons determine the extent of the first surgery. 30% of the time this causes a change in the extent of first surgery to include lateral neck dissections.
3. Long term yearly lymph node mapping for follow up of thyroid cancer, instead of
   I/131 body scans. This is the recommended method to follow cancer patients.
4. Thyroid cancer lymph node PEI ethanol ablation in recurrent disease in a previously operated lateral or central neck.
5. Parathyroid ultrasound for rapid localization of the adenoma, with confirming “gentle” one stick USGFNA and PTH washout.
6. Locate the hard to feel, biopsy proven recurrent cancer lymph nodes for the thyroid surgeon, by my tiny USG injection of methylene blue dye on anterior surface of the cancer node one hour before surgery.

Thanks,

Richard Guttler MD

Comments From attendees

March 15, 2011

To Whom It May Concern:

I recently attended Dr. Richard Guttler's thyroid seminar. It was quite informative and I am happy to say that I have learned and am currently using Dr. Guttler's techniques within my own clinic.

I highly recommend attending his courses in how to establish a successful thyroid clinic.

Sincerely,
/s/
Dr. Oscar Castro

February 18, 2011

Dr. Richard B. Guttler
Santa Monica Thyroid Diagnostic Medical Group, Inc.
1328 16th Street
Santa Monica, CA 904040

Dear Dick,

Thank you so much for the wonderful tutorial experience in your office this past December. It was an intense three days, but very valuable to me as a general clinical endocrinologist.

Although I have years of experience doing thyroid FNA, I have recently upgraded to utilizing ultrasound guidance. The time I spent in your office really improved my expertise in ultrasound-guided FNA techniques, reading ultrasounds, and of course lymph node mapping and biopsy for the evaluation and treatment of metastatic thyroid carcinoma. Courses run by our national organizations have been helpful, but lack the individualized attention a one-to-one preceptorship such as yours offers.

My exposure to nuclear medicine and thyroid cytopathology has given me new insight into what can be accomplished by the clinical endocrinologist. I intend to work on obtaining certification in those areas as well.

Thank also for your travel, accomodation and restaurrant recommendationis. Your advice did not disappoint, although I find it hard to imagine not having a great time in Santa Monica!

Please express my appreciation to your fine staff and the lovely patients I met. I will be back soon for another cytology lesson!

Warm regards,
/s/
Elaine C. Drobny, MD, FACE

Santa Monica Thyroid Diagnostic Center
Dr. Richard B. Guttler, Director
1328 16th Street • Santa Monica CA 90404
Phone: (310) 458 1638 • Fax: (310) 395 8147
Outside California: (800) 408 4909
E-Mail: Dr.Guttler@thyroid.com