Minimally invasive treatment for thyroid nodules
Since 1996
One of the first thyroid health websites on the internet — launched in 1996 from the Santa Monica Thyroid Diagnostic Center by Dr. Richard B. Guttler, M.D., F.A.C.E.
thyroid.com has been online continuously since 1996 — making it one of the longest-running thyroid health resources on the internet. The Wayback Machine at web.archive.org records 511 captures of the site from December 19, 1996 through January 7, 2025. What began as the website of a private thyroid diagnostic center in Santa Monica, California grew into a comprehensive patient education resource serving thyroid patients across the United States and around the world.
After graduating from the University of Illinois College of Medicine in Chicago, Dr. Guttler began his internship at the University of Southern California (USC) Medical Center in 1967. This was the foundation year of his clinical training — the beginning of a medical career that would span more than five decades.
From 1969 to 1971, Dr. Guttler served as a Captain in the United States Army Medical Corps. His military service proved to be far more than a duty obligation — it became the unexpected launching point for his entire career in thyroid medicine.
During his Army service, Dr. Guttler investigated and wrote papers on a meningitis outbreak among soldiers under his care. His research and clinical work on that outbreak caught the attention of Army medical leadership, and as a direct result he was awarded GI Bill funding to pursue advanced specialty training upon completing his service.
That funding enabled him to begin his Thyroid Fellowship at USC / Los Angeles County Medical Center — the fellowship that would define the rest of his professional life. In this sense, the Army was not a detour from his thyroid career; it was the reason it began.
Just after completing his Army service, Dr. Guttler began cross-training in thyroid cytology — the microscopic interpretation of fine needle aspiration specimens from the thyroid gland. Determined to learn from the very best, he traveled to Sweden to train with two world-renowned experts who had essentially defined the field: Dr. Torsten Löwhagen and Dr. Sixten Franzén of the Karolinska Institute in Stockholm.
Franzén and Löwhagen were the pioneers of fine needle aspiration cytology of the thyroid. Their work in the 1950s and 1960s established FNA as a safe, accurate, and practical diagnostic tool — transforming how thyroid nodules were evaluated worldwide and sparing countless patients from unnecessary surgery. Training with them in Sweden gave Dr. Guttler a foundation in cytopathology that few American endocrinologists of his era possessed.
This combination of world-class training in Sweden and sustained mentorship from Dr. Kini and Dr. Abele made Dr. Guttler one of the most cytologically sophisticated endocrinologists in the United States — a distinction that would later allow him to establish his own on-site thyroid cytopathology laboratory and to teach FNA cytology to a generation of endocrinologists through the AACE.
In 1980, Dr. Guttler traveled to Papua New Guinea as a Visiting Professor, where he performed the first needle biopsy of a thyroid nodule in the country and established a thyroid cytology clinic in liaison with the Santa Monica Thyroid Diagnosis Center. The hospital schedule board — photographed during the visit — records his name alongside the designation "Visiting Professor, 29.2.80."
This was part of a broader pattern of international contributions that defined Dr. Guttler's career. He would go on to perform the first thyroid needle biopsy at Nairobi Hospital in 1987, bringing the same diagnostic techniques to underserved medical communities across two continents.
In 1991, the medical world took notice when both President George H.W. Bush and First Lady Barbara Bush were diagnosed with Graves' disease within months of each other — an extraordinary coincidence that captured national attention. The simultaneous diagnosis of husband and wife with the same autoimmune thyroid condition was medically remarkable and statistically rare.
Dr. Guttler was invited to appear on the NBC Today Show to explain Graves' disease to a national audience and discuss the unusual circumstance of a married couple developing the same condition at the same time. The NBC Learn archives preserve a clip from the segment, titled "Hyperactive Thyroid Gland," showing Dr. Guttler at his lightbox reviewing thyroid scan images — the same diagnostic tools he used daily at the Santa Monica Thyroid Diagnostic Center.
The appearance brought national visibility to thyroid disease at a moment when public awareness was low, and it reinforced Dr. Guttler's standing as a leading voice in thyroid medicine at a time when the condition was rarely discussed outside specialist circles.
Graves' disease is an autoimmune disorder in which the immune system produces antibodies that stimulate the thyroid gland to produce excess thyroid hormone — causing hyperthyroidism. Symptoms include rapid heartbeat, weight loss, heat intolerance, tremor, and in some cases, eye involvement (thyroid eye disease). It is the most common cause of hyperthyroidism in the United States. The simultaneous diagnosis of both a husband and wife is exceptionally rare, as Graves' disease is not contagious — making the Bush case a subject of genuine medical interest.
In 1996, Dr. Richard B. Guttler, M.D., F.A.C.E. launched thyroid.com from the Santa Monica Thyroid Diagnostic Center, located at 1328 16th Street, Santa Monica, CA 90404, in the Swezey Institute Building. At a time when most medical practices had no web presence at all, Dr. Guttler recognized the internet as a transformative tool for patient education and physician referral.
The original site described the Center as "a comprehensive, state-of-the-art center for the diagnosis and treatment of thyroid disease, specializing in the performance and interpretation of thyroid biopsy cytopathology." It was immediately rated a 3-Star Site by Magellan — one of the leading web directories of the era — a recognition of its quality and depth at a time when reliable medical information online was scarce.
The homepage navigation reflected the full scope of the Center's services: Patient Information, Physician Information, Nuclear Medicine, On-Site Thyroid Laboratory, Cytopathology, Ultrasound, Off-Site Support, and Thyroid Fun Stuff. The site was designed by RG Images and last updated 9/1/96. Copyright 1996.
Contact information listed on the original site: Phone (310) 393-8860, Fax (310) 395-8147, Outside California (800) 408-4909, E-Mail: [email protected].
The Center featured a Biodex Atomlab rectilinear scanner. All thyroid scans and uptakes were performed on site by Dr. Guttler, including:
PET, MRI, and CT scans were performed at local off-site facilities. St. John's Hospital and UCLA Santa Monica Hospital were used for in-patient radioactive iodine cancer treatment.
Dr. Carole A. Spencer, Ph.D.
Lab Director: Carole A. Spencer, Ph.D., M.T. — an acknowledged world leader in thyroid biochemistry, also director of the CAP-accredited USC Endocrine Services Laboratory annexed to the LAC-USC laboratory. Both laboratories ran complementary thyroid testing methods and quality control procedures, so results could be combined for research publications.
Dr. Spencer was one of the foremost authorities on sensitive TSH assay development in the world. Dr. Guttler worked closely with her for many years and co-authored research papers with her at USC — a collaboration that shaped his approach to TSH measurement and thyroid biochemistry for decades.
Chief Technician: Michael A. Takeuchi
All lab work was completed within 48 hours. The lab was fully licensed and certified to perform:
Cancer marker testing — Thyroglobulin, Calcitonin, and DNA — was performed off-site.
All cytopathology interpretations were performed on site by Dr. Guttler. Rapid turnaround meant less stress and worry while patients waited for results. Services included:
All cytopathologic materials were prepared by UCLA Santa Monica Pathology — John McGill, Director.
Alongside the on-site thyroid laboratory, Dr. Guttler introduced thyroid ultrasound as a core diagnostic tool at the Santa Monica Thyroid Diagnostic Center — at a time when the medical establishment was deeply skeptical. Academic physicians widely dismissed ultrasound as worthless for thyroid diagnosis, dismissing it as nothing more than a money-making procedure with no real clinical value.
Dr. Guttler disagreed. He presented a Grand Rounds lecture at USC on the use of ultrasound in thyroid diagnosis — and it changed minds. Colleagues who had been dismissive began to recognize what he had seen from the start: that ultrasound offered unparalleled, real-time visualization of thyroid nodules and surrounding structures that no other tool could match.
Today, thyroid ultrasound is considered essential in the diagnosis and treatment of thyroid nodules and cancer. The photo below shows Dr. Guttler's first ultrasound machine — the equipment he used when almost no one else in the field believed it mattered.
In the late 1990s, Dr. Guttler traveled to Orlando, Florida to train in ultrasound-guided ethanol ablation for thyroid cysts at the thyroid clinic of Dr. Jack Baskin — one of the leading experts in the United States on the use of ethanol to treat cystic thyroid nodules.
Dr. Baskin subsequently published the definitive reference work on the subject in 2000, cementing his reputation as the authority on ultrasound-guided ethanol therapy for thyroid cysts. His clinic in Orlando was one of the few places in the country where this technique was being taught and refined at that time.
Ethanol ablation works by injecting a small amount of ethanol directly into a cystic nodule under ultrasound guidance, causing the cyst wall to collapse and the fluid to be permanently reabsorbed. For predominantly cystic thyroid nodules — those that are more than 50 percent fluid — it remains highly effective, achieving volume reductions of 80 to 90 percent in well-selected cases, with minimal risk and no need for surgery or general anesthesia.
This early training shaped Dr. Guttler's long-term approach to thyroid nodule ablation: use ethanol as the first-line treatment for predominantly cystic nodules, and reserve radiofrequency ablation for solid and mixed nodules. That distinction — learned directly from Dr. Baskin in the late 1990s — remains the standard of care recommended in the 2023 ATA ablation consensus statement.
For three consecutive years, Dr. Guttler taught a course on thyroid fine needle aspiration (FNA) cytology for endocrinologists at the national thyroid cancer symposium of the American Association of Clinical Endocrinologists (AACE). The course — Thyroid FNA and Diagnostic Cytology for Endocrinologists — was sponsored by AACE and brought together practicing endocrinologists from across the country.
Teaching FNA cytology to endocrinologists was a natural extension of Dr. Guttler's clinical work at the Santa Monica Thyroid Diagnostic Center, where he had been performing and interpreting thyroid biopsies since the late 1970s. His ability to perform the biopsy, prepare the slides, and interpret the cytopathology himself — without sending specimens to an outside pathologist — was unusual in the field and gave him a depth of hands-on expertise that translated directly into teaching.
The AACE symposium course reflected his standing as a national authority on thyroid cytopathology at a time when FNA biopsy was becoming the standard first-line diagnostic tool for thyroid nodules — a position it holds to this day.
Fine needle aspiration biopsy is the single most important diagnostic test for evaluating a thyroid nodule. A thin needle is inserted into the nodule under ultrasound guidance, and cells are withdrawn and examined under a microscope. The cytopathology interpretation — determining whether the cells are benign, suspicious, or malignant — drives the decision about whether surgery is needed. Dr. Guttler performed and interpreted thousands of thyroid FNA biopsies over his career, and his AACE course trained practicing endocrinologists to understand and apply cytopathology findings in their own clinical decision-making.
The Wayback Machine records 18 captures of the biography page (thyroid.com/guttler.htm) from January 26, 1997 through September 11, 2001, and 22 captures of the laboratory page (thyroid.com/lab.htm) from January 26, 1997 through May 22, 2001. Through the late 1990s, thyroid.com expanded its content significantly, adding dedicated pages for each service and a full biography of Dr. Guttler.
The biography page described Dr. Guttler as "an internationally respected authority on thyroid disease with considerable personal experience in all aspects of needle biopsy cytopathology and interpretation." He graduated from the University of Illinois College of Medicine, Chicago, and served his internship and residency at the University of Southern California (USC) Medical Center. He has been a licensed physician in the state of California since 1968, board certified by the American Board of Internal Medicine (1972) with further board certification in the subspecialty of Endocrinology (1973).
Dr. Guttler trained in FNA/Biopsy since 1977 with leaders in the field. Dr. Sudha Kini sponsored him for membership in A.S.C. He served a Special Research Fellowship at the National Institute of Health, Division of Arthritis and Metabolic Diseases, at USC School of Medicine under Dr. John T. Nicoloff from 1972 to 1974. His clinical Endocrinology Fellowship service came under the tutelage of Dr. Richard Horton, Chief of the Endocrine Division, USC LAC Medical Center.
He trained as a Royal Society of Medicine Travelling Fellow in London, England under Dr. Reginald Hall, and received further training in thyroid nuclear medicine and radioisotopes from Dr. Jan K. Siemsen, head of the nuclear medicine section at USC Medical Center. He has published and presented papers on cytopathology of the thyroid gland.
Among his most notable international contributions: in 1980, Dr. Guttler performed the first needle biopsy of a thyroid nodule in Papua New Guinea and established a thyroid cytology clinic there in liaison with the Santa Monica Thyroid Diagnosis Center. He also performed the first thyroid needle biopsy at Nairobi Hospital in 1987. He served as a volunteer doctor to the patients of the Venice Family Clinic.
As the internet matured through the 2000s, thyroid.com evolved from a clinical practice website into a broader patient education resource. The focus shifted from promoting the services of the Santa Monica Thyroid Diagnostic Center toward providing substantive, reliable thyroid health information to patients nationwide.
Dr. Guttler's decades of clinical experience — seeing thousands of thyroid patients over a 50-year career — gave the site an authority and depth that distinguished it from the growing number of general health information sites. The site addressed the questions patients actually asked: about diagnosis, treatment options, the emotional burden of chronic thyroid disease, and how to navigate a medical system that often moved too quickly.
Content expanded to cover thyroid cancer in depth, including the psychological dimensions of a cancer diagnosis that most clinical resources ignored. Dr. Guttler's direct, patient-centered voice — shaped by a career of sitting across from frightened patients — became the defining characteristic of the site.
Through the 2010s, the site developed its most distinctive body of work: a sustained examination of the emotional and psychological dimensions of thyroid disease. Dr. Guttler had long observed that the medical literature addressed the biochemistry of thyroid disorders in detail while largely ignoring what patients actually experienced — the fear, the anxiety, the grief of a chronic diagnosis.
The site addressed thanatophobia (fear of death) in the context of thyroid cancer diagnosis, the concept of thyroid disease as a lifetime disorder requiring lifetime management, and the emotional devastation that could accompany a new diagnosis. The "Questions Outline" — a structured framework for the questions every thyroid patient should ask their physician — became one of the site's most-used resources.
Dr. Guttler's willingness to engage directly with the hardest questions patients faced set thyroid.com apart from institutional health information sites. These were not topics found in standard patient education materials.
Dr. Guttler's pioneering work in thyroid radiofrequency ablation (RFA) began in 2017 — years before the procedure gained mainstream acceptance in the United States. His journey to bring this non-surgical alternative to American patients is a story of persistence, international collaboration, and an unwavering commitment to sparing patients from unnecessary thyroid surgery.
In 2017, Dr. Guttler traveled to Reggio Emilia, Italy to train with Dr. Roberto Valcavi — the world's foremost master of radiofrequency ablation for thyroid nodules. Dr. Valcavi pioneered RFA in Europe and his center in Italy became the global training ground for physicians seeking to learn the technique at the highest level. Dr. Guttler spent a week with Dr. Valcavi, learning hands-on how to become an RFA physician. That intensive training, combined with his earlier collaboration with Dr. Jung Hwan Baek in Korea and the support of two RFA companies committed to bringing the technology to the United States, gave Dr. Guttler the foundation to return home and champion RFA for American patients.
Dr. Leonardo Rangel — supervised Dr. Guttler's RFA procedures on patients in Brazil, August 2019.
Dr. Guttler's decades-long effort to bring thyroid RFA to the United States established him as a true pioneer in non-surgical thyroid treatment. Today, RFA is recognized as a safe and effective alternative to surgery for benign nodules, thyroid cysts, and selected small thyroid cancers — a standard of care that Dr. Guttler championed long before it was widely accepted.
In 2022, thyroid.com was rebuilt from the ground up — preserving the depth of content and the patient-centered voice that had defined the site for over 25 years, while bringing the design and technology into the modern era.
The rebuilt site retained the core mission: to provide thyroid patients with the information, context, and emotional support they need to navigate a lifetime of managing their condition. The six major topic areas — thyroid cancer, Armour Thyroid, thyroid symptoms, thyroid problems, the ten symptoms of thyroid problems, and the thyroid journal — were developed into comprehensive, in-depth resources.
The blog section, launched alongside the rebuild, continued Dr. Guttler's tradition of direct, substantive patient communication — addressing the questions that matter most to people living with thyroid disease.
From a 3-Star Magellan site in 1996 to a fully modern health information resource in 2022, thyroid.com has remained one of the longest-running and most trusted thyroid health websites on the internet — a reflection of Dr. Guttler's lifelong commitment to his patients.
thyroid.com has been registered and operated continuously since 1996. Dr. Richard B. Guttler, M.D., F.A.C.E. practiced as a private thyroid medical specialist for 50 years. The information on this site is for educational purposes and does not constitute medical advice.