Abstract
Dear Sir,
I recently read the article reviewing thyroid palpation techniques comparing the classic technique (T1) and Dr Gary Norsworthy's newer technique (T2) (JFMS Vol 10, page 558).
I congratulate the authors for their review of the two palpation techniques and agree that both techniques are useful screening tools for the detection of hyperthyroidism in cats.
While most veterinarians probably learn the classic technique first or have never learned of the T2 technique, I learned the T2 technique first during a sophomore year externship with Dr Norsworthy, and did not learn the T1 technique until almost 2 years later during my senior year clinical rotations. Having already practiced the T2 technique for over a year and a half, naturally I was more comfortable with that technique and it is still my technique of choice. Due to obvious bias, I cannot objectively say that one technique is superior or inferior to the other. However, I do not think it is accurate to say that the T1 technique is superior to the T2 technique until a group of evaluators with equal experience with each respective technique can be compared. In other words, a group of evaluators that are clinically more familiar with the T2 technique such as myself should be compared against a group of evaluators with equal experience with the respective T1 technique. Only then can the more reliable technique be determined. From personal experience, I would argue that clinical competency and preference are likely dependent on which technique an evaluator is introduced to first. This bias should be considered when comparing the two techniques.
Yet regardless of which technique yields more examiner agreement, alternative techniques still have a great benefit and should be made available for those who may be more competent with a less popular technique. This to me is no different than alternative techniques for performing cystocentesis or jugular venepuncture, and respective individual clinical preference and competency. Whichever technique safely yields the clinical sample is best for that scenario, and may differ from day to day even among one clinician. In short, what works best for most does not work best for all, nor in every scenario. Alternative screening techniques result in increasing our sensitivity for a disease by raising the odds of detecting positive cases of that disease.
In hindsight, I wish that I had been introduced to both techniques early on and at the same time, but I am grateful now to have two good ways to screen for a disease as common and important as feline hyperthyroidism. Furthermore, as these are both techniques that do not take much time, add value to my physical examination, and cost no extra to perform it makes sense to me that to increase my odds of finding disease, I should employ both techniques if necessary.