Michael R. Anderson (Host): Hello everyone and welcome to this episode of The FortCast, Vodcast. I'm your host, Dr. Michael Anderson, ear, nose and throat, physician and President, and CEO of Fort Healthcare. I have a wonderful guest today to discuss the topic of thyroid nodules and we'll get into that. But first, please let me introduce Dr. Matt Sdano. Dr. Sdano, thank you very much for being on this episode of the FortCast.

Matthew Sdano, MD: Thanks for having me, Mike. It's nice talking with you.

Host: And Dr. Sdano is our newest ENT otolaryngologist. I've been with the organization for roughly 20 plus years, but tell us a little bit about yourself, how long you've been with Fort Healthcare and, what you enjoy most about practicing here at Fort Healthcare.

Matthew Sdano, MD: You know, Mike, I was happy to start here about a year ago, and it's been an excellent experience. I think one of the things I love about Fort is that it's small enough that I've met many people and things just function extremely well here. We've got some really great primary care physicians. I love working with the staff in our operating room. So it's been an excellent experience in this last year.

Host: Well, I tell you, we love having you Dr. Sdano. For those that don't know, Dr. Sdano does all aspects of otolaryngology, ENT, but definitely focuses a lot on the endocrine part of it, namely thyroid and parathyroid disease. And that's what we're going to talk a little bit about today is, and we're going to focus a little bit tighter on the thyroid gland.

So Dr. Sdano, what is the thyroid gland and where does it exist? So, just kind of let our audience know a little bit about the thyroid in general.

Matthew Sdano, MD: I think you're right, Mike. There's so much talk in the lay press about thyroid stuff. The thyroid gland is a gland that sits low in your neck here, and it makes something called thyroid hormone and thyroid hormone courses through our entire body. And I think that the simplest way that I think about, it's just involved in our metabolism.

When your thyroid level is working appropriately, you feel good. When it's too low, we see people that are tired and just don't feel very good. They get some changes to their hair. When it's too high, they feel uncomfortable. They're kind of too much energy, too hyper. They don't sleep well. And so it's kind of just involved in our, we say homeostasis, making us feel ourselves.

Host: I tell you, when you start messing with people's hair, that gets their attention. So like most glands of the body, we humans can sometimes experience a little growth in there, a little bump. And that's what we refer to a thyroid as to a thyroid nodule. So Dr. Sdano, do you see a lot of patients with thyroid nodules or tell us a little bit about those little tiny growths that can happen in the thyroid gland.

Matthew Sdano, MD: We do. As ear, nose, and throat doctors, we see many patients that have lumps and bumps in their neck. And it's our job to help them figure out what we're dealing with. One of the more common things we see are these thyroid nodules and that can present with someone just feeling it in their own neck.

Sometimes we see patients that have had CAT scans of their neck or of their lungs, and it shows this area and there's something out of the ordinary there. And so as physicians that work in that area, it's our job to help patients figure this out. Thankfully, most of these lumps and bumps are not cancerous, but we have to take them all seriously, and it's kind of our job to help patients navigate that road.

Host: Absolutely. So just to recap there, the thyroid nodules, they can be picked up either by a patient actually feels them, or they can get picked up on other x-rays that patients have, for other reasons. And I'd like to go back to something you said, Dr. Sdano, you said most of them are benign. So if somebody has a thyroid nodule and another doctor picks it up and they send that patient to you, what is your approach to how do you educate the patient and what's your approach to try to determine whether that nodule, that bump in the thyroid gland is cancerous or not?

Matthew Sdano, MD: Probably the easiest thing to do is to get a thyroid ultrasound. And the nice thing about that is that it doesn't involve an IV. It's a really short test. And the ultrasounds give us this really good picture of the thyroid gland. Then if there are these lumps and bumps in the thyroid gland, the ultrasound helps us to kind of characterize them.

We've gotten good at saying, boy, your lump looks very benign under ultrasound, and that's all that we need to do. But then there's other people that have a nodule and the ultrasound shows a little bit of concerning characteristics. And then we say to patients, well, we're worried enough about that nodule that we need to get a sample of it.

Even that's not a very difficult thing to do. We do something called a fine needle biopsy. Essentially, we numb up the neck really, really carefully. Then using an ultrasound wand, we take some really, really fine needles and sample the nodule. And as we've talked about, the great majority of time we prove to patients that this isn't something they need to worry about. But every once in a while things are more concerning and then we have to kind of go from there.

Host: Gotcha. So you see a patient with a nodule and you kind of educate them on, on the odds of it being benign or cancerous. You get an ultrasound to evaluate it, and if necessary, you do a little biopsy that involves putting a needle into the nodule. Would that, does that, sound accurate?

Matthew Sdano, MD: That's totally accurate and one of the things, I think we just do a really nice job here at Fort. When patients do need a biopsy, we've got an excellent team in our radiology department and I work with them to do the biopsies and it's no fun having to have to do these things or having them done to you, but we have a really nice atmosphere for patients and we tend to get the results really quickly these days. So within a few days, people know the results and that just helps to put them at ease, I think.

Host: Absolutely. And I think it's important for our viewers and listeners to know that you are the one actually performing the biopsy. That is the case, correct?

Matthew Sdano, MD: Yeah, that's a really good point. Ao when I meet patients in the clinic, then I say to them, I'll be the one kind of, shepherding you through this process. So I'm the one that meets them for the biopsy. I do the biopsy and then I'll be the one calling them to talk about the results.

It's a little bit different than at a bigger institution where they would probably be sent to a different radiology doctor or someone else to do the biopsy that they don't know. So I think it's just a little bit more comforting to see a face that they know when they come in for the biopsy.

Host: When someone feels a lump in their neck or a mass in their neck or something is found on a CT scan for another reason, it can be a pretty scary endeavor to have that mass looked at. So I want to get back to something you said and maybe you can give us a little bit more insight.

You mentioned that the odds of a thyroid nodule being benign is higher than that of being a cancer. Do you know approximately the odds of it, being benign versus a cancer without the biopsy of course. Just in relation to the population.

Matthew Sdano, MD: Exactly. Just in general, about 95% of these nodules are benign. So, in these situations, it's our job to kind of comfort patients and tell them, you know what, the greatest likelihood is that this is going to be okay. But we're also in a situation where we don't want to miss something that could be become problematic.

So, you know, we just try to offer our support and thankfully most of these turn out very good. But we're also in a specialty where we see neck masses in different areas and different symptoms. And so, we take these lumps and bumps really seriously because we also see different kinds of head and neck cancers, and we want to make sure that someone isn't suffering from a different kind of head and neck cancer.

Host: If somebody does have a benign nodule, so you do the biopsy, you see them back in the clinic, you review the results, and if it's completely benign, is there any sort of further monitoring that goes into that nodule or, or how do you approach that?

Matthew Sdano, MD: It's a little bit controversial, but lately we're realizing that with a good biopsy and an optimistic result, if we get a result and it looks, it looks like this is benign, we don't have to look again until about two to three years down the line. And if we get an ultrasound, say two years later and things look exactly the same, we don't need to repeat the biopsy.

And so that's really nice. And conversely, sometimes we see patients in the clinic and they'll say, geez, I had a biopsy done five years ago. And then when we can look back through the chart and we can say, boy, this thing hasn't changed. We don't need to repeat those things that people have had done unless there's a drastic change.

So, if anything, the current guidelines kind of show that if you do a good biopsy and you get good results, very little follow-up is needed.

Host: Well, that's wonderful to hear and it's a big relief for our patients, certainly to not have to monitor that so closely with a benign biopsy. Now just to touch base, because I think this could be a whole separate topic, and that's thyroid cancer. But if somebody does have a thyroid cancer, Dr. Sdano, what is the most common type of thyroid cancer that exists?

Matthew Sdano, MD: The most common type is something we refer to as well differentiated thyroid cancer, and the most common one of those is called a papillary thyroid malignancy. There's also something called a follicular thyroid cancer. So those are the two most common ones that we see. Good news with that is that, both of those are very survivable situations. It's unusual that either of those cancers becomes a problem long-term, as long as we take good care of it. Interestingly, we're finding more and more younger patients with these cancers. Thankfully, they tend to do very well as well.

Host: That's good to hear and certainly stay tuned for a future vodcast because that can be a topic in and of itself, but that's a wonderful overview on the thyroid nodule. They are pretty common. It's, uh, something that needs to be worked up, but the vast majority are benign. So those are all very favorable outcomes.

 Dr. Sdano, I can't thank you enough for being on this episode of The FortCast today. I've learned something. I'm sure our viewers and listeners are going to learn something. So thank you.

Matthew Sdano, MD: Of course I was happy to do it and it's nice speaking with you, Mike.

Host: Alright, well, Dr. Sdano, have a good rest of your day. Thank you. And I'd like to say thank you for tuning in to this episode of the, the FortCast. Please share it on your other streaming platforms, and I look forward to seeing you in the future. Thank you.