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• It was easy to get an appointment.

  Agree

• The wait time was short during my visit.

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• The staff was professional and friendly.

  Strongly Disagree

• My problem was accurately diagnosed.

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• The doctor spent enough time with me.

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  5

  Staff

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  Knowledge

  He is an able and highly qualified doctor. He has a level of informed integrity that sometimes seems lacking in thyroid medicine these days. It’s obvious he’s not into ‘woo’ and has taken a beating for publicly speaking out against it when it comes to thyroid disease. It actually would be nice if more endocrinologists spoke out in the same manner.

  1 MOMSTAMPS

  

  12/08/14

  Madeleine Moskowitz 38 Friends

  He is a thyroid specialist. My husband swears by him. He is in Santa Monica. He also treats my 13 year old

  Lolay

  Los Angeles thyroid cancer specialists- Does anyone know a good one? I was told it is best to use an endocrine oncologist. Recently had a thyroid papillary cancer and had the right lobe removed. Doctors kept calling it a benign nodule, FNA/ultrasound/lab tests were all normal excet TPO-Ab. Post op thyroglobulin is elevated.

  Reply

• Someone at my allergy office who was diagnosed with the same thyroid cancer 2 yrs ago sees Richard Guttler, MD in Santa Monica and his website is thyroid.com, where I found alot of info & he has a full diagnostic center there. I hope this helps.

Dr.Guttler’s Thyroid Newsletter
May 1 2004

Well the thyroid wars have entered a new stage.
M.S. uses doctors to support her feeble claim to being a thyroid
patient guru.
M.S. has a medical doctor and his PHD wife coming out in support for
her about.com website. The doctor spent a few paragraphs giving their
credentials, before he proclaimed support for the self proclaimed
“reporter” on Thyroid.
about.com.
They have no research into thyroid related diseases.
Popular culture Books are not research. Thyroid research is published
in medical journals that are reviewed by other experts for accuracy.
Then these are quoted in Thyroid textbooks. This doctor and wife have
clearly stated on their website that people can be hypothyroid with
normal tests! That is grounds for not paying any further attention to
them as experts in thyroid disease.

Why should patients
pay any further attention to any doctor who is selling 10 step
programs, books, and advocating that, obese, fatigued, cold, and
muscle aching people with 100% normal T4,T3, And TSH tests, are
hypothyroid!
That is scientifically impossible!

The other physician supporting M.S. is not a thyroid expert either. He
has a website that is related to Chronic Fatigue/ fibromyalgia. There
is no relationship between that entity and Hypothyroidism. End of
story.

Now to real thyroid issues:

Thyroid Surgery can be more risky, if you go with the average surgeon
with their average complication rate.
Do not believe everything you hear from your HMO family doctor or
surgeon.

Surgery by surgeons with only limited experience can be harzardous to
your health. What do you need to ask of your surgeon before you let
them operate on your thyroid? How many did you do last year.
What is the complication rate? Can they confirm it with hospital
statistics?
They need to show you a record of 50-150 thyroidectomies per year.
The reccurent nerve that supplies your voice runs near the thyroid.
Many variations of the nerve are seen. I have seen the nerve run into
the body of the thyroid, circle back and leave at the same spot it
entered.
If the surgeon did not know of this variation, they would have cut
the nerve And you would be hoarse for months, and have permanent
damage.
You need to insist that a specialist dose your surgery.

Recently, an attorney from a large HMO called to threaten me about
some statements I made about the state of thyroid surgery at their
HMO. ” I will sue your … off, and cost you thousands of dollars in
legal. “That is libel”. Lets us look at the problem.
If a patient sees a private physician, and they find thyroid cancer,
he has two choices.One, go with the community standard, and have
surgery with a non-thyroid surgeon, who does less than 50
thyroidectomies a year, and on the average has a 4-10% chance of
complications.
Or look for a thyroid surgeon who does 50-150 cases a year,and with a
lower complication rate, that is seen with specialists thyroid
surgeons.
HMO patients are not given that option. They get average care at the
community standards level. When they ask for better, that are told
they do not need a specialist.
Why is thyroid surgery different than cardiac surgery? Both should be
done by specialist surgeons. However it is potluck, rather than the
best for the poor thyroid patients, and Rolls Royce treatment for the
cardiac patients.

Think about that, and fight for a thyroid surgeon.It could save you
unnecessary complications.

The Cancer patients: This is for you.
1. Low risk cancer patients with no evidence of disease, for 6-12
months diagnostic whole body scans add NO information when
thyroglobulin is undetectable, and no antibodies are interferring. Get
an independent opinion from a thyroidologist to see if further
radiation for scanning is really necessary.
2. Recombinant human TSH is better in follow up because of less side
effects, allows good quality of life by not allowing the cancer
patient to become hypothyroid.
You stay on Thyroxine while you are undergoing cancer testing.
3.Ultrasound, a safe and and harmless testing procedure is the BEST
test to look for local recurrence in their neck. Any nodule found by
U.S. can be biopsied, and washings taken to see if Thyroglobulin is
present. Cysts in the lateral neck will have few cells for diagnosis,
but will have high levels of thyroglobulin.
The days of knee jerk response following surgery of radio-iodine
therapy is over. Insist on a second opinion before you allow anyone to
treat you with radio-iodine therapy. There is no evidence it will cure
you, or even do any good, but it will add to your radiation burden for
then rest of your life.

Other thyroid notes:

More recent evidence against T4/T3 combination therapy. No matter what
Mary and her army of combination T4 and T3 users say about how great
they feel, there is more evidence that there is no scientific value
to these therapies. Studies published in J.of Clinical Endocrinology,
by Walsh et. al. Vol.88 (10) 443-50 2003, confirm that no improvement
in well being, cognitive function, or quality of life compared to T4
alone.
That the feeling of well being noted by people on Armour , and
Thyrolar, or Cytomel is is due to periods of overdose by spiking T3
blood levels should be a reason to switch back to
T4 only. The human thyroid makes T4 almost exclusively for export to
the rest of the body.
This is a buffer system. It then reaches the cells and the active T3
hormone is made locally.
There is no blood spike as seen with oral T4/T3, or T3 alone.

They are allways talking about hypothyroidism as the cause of
depression.Also that T4/T3 combos are better at fighting depressive
symptoms. Wrong!

Sawka, et. al.from Canada, reported in JCEM 88 ( 10) 4551-5 2003, that
there was evidence that combo T4,T3 Did Not improve depression over T4
alone.

Dr David Sarne, from my Medical school, U. of Illinois in Chicago
recently reviewed the
T4,T3 issue. The NEJM article by Buenevicus and his follow up article
caused many to go to their doctors and demanded new combination
therapy. Dr Sarne stated the studies were flawed. The conclusions did
not have enough positive results to to justify the need for T4/T3
combination therapy. The other two studies came to the opposite
conclusion. T4 alone was not inferior to combination therapy

Then why do some feel better on Armour,Thyrolar, or T3?
1.The dose of T4 may be inadequate. TSH must be at 0.5-2.0 for maximum
benefits.
Many doctors consider TSH of 3-8 to be adequate. It is not.
2. Some people feel better overdosed to a hyperthyroid state, and
complain when they are brought down to euthyroidism. There is a
withdrawal symptoms with return to normal, that can be mis-understood
by patient and doctor that the patient is hypothyroid with “normal”
tests. This withdrawal occurs for a 4-8 weeks, but corrects if you
keep the dose of T4 normal.
3.There is research needed to see if very small doses of T3 given by
timed release can mimic normal thyroid secretion.

The Thyroid Doctor signs off for this month

Richard B. Guttler, M.D.,F.A.C.E.\r\nSanta Monica Thyroid
Center\r\nwww.thyroid.com\r\n25 Million hits, and 600,000 visitors
last year. 150,000 th most visited site on the web.

Richard B. Guttler, M.D., F.A.C.E.
Clinical Professor of Medicine
USC School of Medicine
Director,
Santa Monica Thyroid Center