Learn about the devastating complications I experienced, including vocal cord damage requiring an implant and nerve damage affecting my shoulder.

I discuss important research showing that many thyroid cancers don't require immediate surgery, including a Finnish cadaver study and Dr. Miyauchi's 30-year watch-and-wait approach in Kobe, Japan. 

After my experience, I've interviewed over 100 thyroid specialists worldwide for my Dr. Thyroid podcast and discovered many alternatives to surgery.

This episode also covers UCLA's lack of response to my complications and how medical institutions protect doctors through reputation management. If you've been diagnosed with thyroid cancer or nodules, please research all your options, including active surveillance and ablation, before rushing into surgery.

Spanish captions available - subtítulos en español disponibles.

WATCH PART 2

https://youtu.be/9OGUIILLlpg

Resources and academic research are listed at the footer of the following report:

https://docthyroid.com/what-happens-when-thyroid-surgery-turns-out-bad/

Doctor Thyroid Podcast: www.docthyroid.com

Contact: philipjames@docthyroid.com

YouTube
https://www.youtube.com/@DoctorThyroid

Against the backdrop of the city's iconic Café du Monde and a rigorous CrossFit session, the two explore the complexities of thyroid surgery, discussing why Dr. Kandil often advocates for ablation over traditional thyroidectomies to preserve patients' quality of life.

As the conversation unfolds, viewers examine Dr. Kandil's commitment to research, patient care, and innovation. They venture from the cafe to the gym and finally to Dr. Kandil's clinic, where modern technology meets compassionate healthcare. For anyone considering thyroid surgery or seeking alternatives, this episode explores non-surgical options and the science behind thyroid ablation.

Discover how one surgeon's philosophy and approach redefine patient outcomes—one thyroid at a time.

About Dr. Emad Kandil Dr. Emad Kandil is a renowned expert in endocrine and oncological surgery. He is the Chief of General, Endocrine, and Oncological Surgery at Tulane University in New Orleans, Louisiana. He holds the prestigious Elias Hanna Chair in Surgery and is celebrated for his groundbreaking work in minimally invasive thyroid treatments, including thyroid ablation. Dr. Kandil has performed over 1,000 thyroid ablation procedures, establishing himself as a leading figure in using this innovative treatment approach in the United States. www.emadkandil.com

About Philip James Philip James hosts the Doctor Thyroid podcast, a platform that provides patients with information on alternative thyroid treatments. His work focuses specifically on minimally invasive procedures like thyroid ablation. He aims to help patients avoid unnecessary thyroid surgeries, a mission close to him after his own experience with an unneeded surgery. www.docthyroid.com

After consultations with multiple doctors in New York who recommended surgery, Elizabeth sought an alternative in New Orleans with Dr. Kandil, who offered a less invasive option—thyroid ablation.

This video explores the benefits of microwave ablation (MWA) as an effective treatment for thyroid nodules, avoiding the complications of surgery and long-term medication dependency.

Dr. Kandil provides in-depth insights into the procedure, its success rates, and how it preserves thyroid function, challenging the traditional approach of immediate surgical intervention. For those with suspicious thyroid nodules, this discussion highlights the importance of seeking second opinions and understanding all available treatment options before making a decision.

About Baird Medical

Baird Medical LLC, established in 2012 and headquartered in Guangzhou, China, is a leading developer and provider of minimally invasive medical devices specializing in microwave ablation (MWA) technology. In the U.S., the company continues to expand its reach, recently receiving FDA clearance to market its microwave ablation devices for thyroid treatment.

@BairdMedical www.bairdmed.com NASDAQ: BDMD

Baird Medical's Assistance Center
888-508-6228 or erichuang@bairdmed.com

About Dr. Emad Kandil

Dr. Emad Kandil is a renowned expert in endocrine and oncological surgery. He is the Chief of General, Endocrine, and Oncological Surgery at Tulane University in New Orleans, Louisiana. He holds the prestigious Elias Hanna Chair in Surgery and is celebrated for his groundbreaking work in minimally invasive thyroid treatments, including thyroid ablation. Dr. Kandil has performed over 1,000 thyroid ablation procedures, establishing himself as a leading figure in using this innovative treatment approach in the United States.
www.emadkandil.com

About Philip James

Philip James hosts the Doctor Thyroid podcast, a platform that provides patients with information on alternative thyroid treatments. His work focuses specifically on minimally invasive procedures like thyroid ablation. He aims to help patients avoid unnecessary thyroid surgeries, a mission close to him after his own experience with an unneeded surgery.
www.docthyroid.com

This discussion is precious for medical professionals, researchers, and individuals interested in innovative, minimally invasive treatments for thyroid conditions. Dr. Kandil emphasizes the importance of practitioner expertise in ensuring successful outcomes and offers insight into the decision-making process for selecting the most appropriate treatment method.

This video offers expert-level insights if you're seeking an advanced, technical understanding of the latest thyroid ablation technologies and treatment options.

About Baird Medical

Baird Medical LLC, established in 2012 and headquartered in Guangzhou, China, is a leading developer and provider of minimally invasive medical devices specializing in microwave ablation (MWA) technology. In the U.S., the company continues to expand its reach, recently receiving FDA clearance to market its microwave ablation devices for thyroid treatment.

@BairdMedical
www.bairdmed.com
NASDAQ: BDMD
Baird Medical's Assistance Center 888-508-6228 or erichuang@bairdmed.com

About Dr. Emad Kandil

Dr. Emad Kandil is a renowned expert in endocrine and oncological surgery. He is the Chief of General, Endocrine, and Oncological Surgery at Tulane University in New Orleans, Louisiana. He holds the prestigious Elias Hanna Chair in Surgery and is celebrated for his groundbreaking work in minimally invasive thyroid treatments, including thyroid ablation. Dr. Kandil has performed over 1,000 thyroid ablation procedures, establishing himself as a leading figure in using this innovative treatment approach in the United States.

‪@EmadKandilMD-z3d‬
www.emadkandil.com

About Philip James

Philip James hosts the Doctor Thyroid podcast, a platform that provides patients with information on alternative thyroid treatments. His work focuses specifically on minimally invasive procedures like thyroid ablation. He aims to help patients avoid unnecessary thyroid surgeries, a mission close to him after his own experience with an unneeded surgery.

@DoctorThyroid 
www.docthyroid.com

We begin with the patient's journey, documenting her initial treatments with RFA, which resulted in limited success and the eventual regrowth of the thyroid nodule. Dr. Kandil then introduced MWA, leading to a remarkable 80% volume reduction in just three months. This transition illustrates the pivotal differences between RFA and MWA, such as the heat sink effect, and why MWA provides more precise and effective energy delivery, particularly for nodules with significant vascularization.

Dr. Kandil, having performed over 1,200 thyroid ablation procedures.

Key Moments:

00:10 — Explanation of the heat sink effect with MWA leading to 80% shrinkage
01:05 — Failure of RFA to induce significant nodule shrinkage
01:30 — Patient discusses the lack of pain during MWA
01:45 — Paradigm shift in the medical community regarding new ablation technologies
02:20 — Philip James introduces MWA's success where RFA failed 
03:14 — The first surgeon recommended surgery, which was ultimately unnecessary
04:00 — Discovery of the thyroid nodule during a routine health check
04:55 — The emotional impact of discovering a thyroid nodule
06:10 — The patient's positive experience with Dr. Kandil
06:45 — Is it cancer? Genetic markers and biopsy results
07:50 — Dr. Kandil explains biopsy issues, suspicious cells, and genetic markers
09:00 — One surgery versus multiple surgeries: using the best available information to decide
09:40 — The large, vascular nodule and implications for treatment
10:00 — Measuring tumor volume: a shift from centimeters to milliliters (100 ml)
10:30 — The importance of seeking a second opinion
10:50 — RFA failed to provide a satisfactory response
11:10 — Detailed comparison of MWA vs. RFA, including technical and clinical differences
12:00 — Heat sink effect with RFA vs. sustained energy delivery with MWA
12:20 — MWA's ultimate success in reducing nodule size
12:50 — Dr. Kandil's experience of performing over 5,000 thyroid surgeries
13:00 — Emphasizing quality of life and preserving the thyroid, as explained by Dr. Kandil
14:30 — The importance of having MWA as a treatment option
15:50 — Treating out-of-state patients and the widespread demand for ablation technologies 16:15 — The patient reacts to the decision to avoid surgery
16:50 — Failure of RFA highlighted again, reinforcing the shift to MWA
17:50 — Not every surgeon is equal: the importance of experience and options
18:30 — Discussing the "toolbox" of available treatments offered by different healthcare providers
19:30 — The sterile hospital experience vs. the warmer, more personalized care at Dr. Kandil's office
19:54 — Dr. Kandil's bedside manner: kindness, patience, and detailed explanations
20:40 — Encouragement for patients to explore all available options; the medical community's resistance to adopting new technologies like ablation
21:30 — Dr. Kandil's experience with over 1,200 cases of thyroid ablation, establishing him as one of America's top doctors in the field

About Baird Medical

Baird Medical LLC, established in 2012 and headquartered in Guangzhou, China, is a leading developer and provider of minimally invasive medical devices specializing in microwave ablation (MWA) technology. In the U.S., the company continues to expand its reach, recently receiving FDA clearance to market its microwave ablation devices for thyroid treatment. @BairdMedical www.bairdmed.com

About Dr. Emad Kandil
Dr. Emad Kandil is a renowned expert in endocrine and oncological surgery. He is the Chief of General, Endocrine, and Oncological Surgery at Tulane University in New Orleans, Louisiana. He holds the prestigious Elias Hanna Chair in Surgery and is celebrated for his groundbreaking work in minimally invasive thyroid treatments, including thyroid ablation. Dr. Kandil has performed over 1,000 thyroid ablation procedures, establishing himself as a leading figure in using this innovative treatment approach in the United States. ‪@EmadKandilMD-z3d‬ www.emadkandil.com

About Philip James
Philip James hosts the Doctor Thyroid podcast, a platform that provides patients with information on alternative thyroid treatments. His work focuses specifically on minimally invasive procedures like thyroid ablation. He aims to help patients avoid unnecessary thyroid surgeries, a mission close to him after his own experience with an unneeded surgery. @DoctorThyroid www.docthyroid.com

Based at Tulane University, Dr. Kandil has successfully treated numerous patients using this minimally invasive procedure, which allows for the targeted destruction of cancerous thyroid nodules without removing the thyroid gland.

00:01 - 08:03 The patient story told by Vanessa: "you have thyroid cancer"
08:04 - 12:38 Dr. Kandil discusses treating thyroid cancer without surgery

In this case, Dr. Kandil treated Vanessa, who was initially diagnosed with a 1.5 cm thyroid nodule and advised by her first doctor to undergo a total thyroidectomy. Concerned about the lifelong consequences of surgery, including the need for thyroid hormone replacement, Vanessa sought out Dr. Kandil, who recommended thyroid ablation.

🛑 Three months after the procedure, her follow-up ultrasound revealed no detectable cancer, highlighting the effectiveness of ablation.

The video thoroughly discusses the thyroid ablation process, including Dr. Kandil's patient-centered approach, the technical aspects of the procedure, and the post-ablation outcomes. Thyroid ablation is a promising option for patients with small, early-stage thyroid cancers who wish to avoid surgery and its associated complications. Dr. Kandil shares insights into why ablation may be a preferred treatment for preserving the thyroid while achieving cancer-free results.

Key points covered:

🔹 Dr. Kandil's expertise in thyroid ablation and patient care

🔹 The non-surgical alternative for treating thyroid cancer

🔹 Patient outcomes following thyroid ablation

🔹 Comparison of thyroidectomy and ablation techniques

This video is intended for viewers seeking an evidence-based understanding of thyroid ablation as a viable alternative to surgery.

About Baird Medical

Baird Medical LLC, established in 2012 and headquartered in Guangzhou, China, is a leading developer and provider of minimally invasive medical devices specializing in microwave ablation (MWA) technology. The company focuses on advanced treatments for thyroid nodules, offering patients a non-surgical alternative to traditional procedures. Baird Medical's MWA devices are used globally for the treatment of both benign and malignant tumors, including thyroid, liver, and lung cancers.

With a solid commitment to innovation and improving patient outcomes, Baird Medical has become the first company in China to receive a Class III medical device registration certificate for MWA systems. In the U.S., the company continues to expand its reach, recently receiving FDA clearance to market its microwave ablation devices for thyroid treatment.

@BairdMedical 
www.bairdmed.com

About Dr. Emad Kandil
Dr. Emad Kandil is a renowned expert in endocrine and oncological surgery. He is the Chief of General, Endocrine, and Oncological Surgery at Tulane University in New Orleans, Louisiana. He holds the prestigious Elias Hanna Chair in Surgery and is celebrated for his groundbreaking work in minimally invasive thyroid treatments, including thyroid ablation. Dr. Kandil has performed over 1,000 thyroid ablation procedures, establishing himself as a leading figure in using this innovative treatment approach in the United States.

Dr. Kandil's commitment to advancing thyroid care focuses on offering patients non-surgical alternatives, such as ablation, to avoid traditional surgery. This allows for reduced recovery times and better preservation of thyroid function. His contributions to the field include over 400 research publications and numerous lectures worldwide. His research interests include endocrine tumor genetics and the development of targeted therapies for thyroid cancer.

About Philip James
Philip James hosts the Doctor Thyroid podcast, a platform that provides patients with information on alternative thyroid treatments. His work focuses specifically on minimally invasive procedures like thyroid ablation. He aims to help patients avoid unnecessary thyroid surgeries, a mission close to him after his own experience with an unneeded surgery.

In addition to his podcast, Philip is the author of Say No to Thyroid Surgery, a book that advocates for patients to explore non-surgical options. He educates and empowers thyroid patients globally through his websites and social media, offering them access to cutting-edge treatment information and expert interviews with leading medical professionals.

His passion stems from a desire to help others make informed health decisions and to provide a resource for those seeking alternatives to conventional thyroid surgery.

@DoctorThyroid www.docthyroid.com

In recent years, a medical revolution has been quietly taking place in the treatment of thyroid conditions. Thyroid ablation, a procedure that offers an alternative to traditional surgery, is gaining popularity across the globe, particularly in the United States following its FDA approval. Dr. Giovanni Mauri , a leading interventional radiologist from Milan and recognized as one of the top 2% scientists by Stanford University, shares insights into the advancements and challenges of this transformative treatment.

The concept of thyroid ablation isn't new; Italy saw its inception 25 years ago with experimental treatments beginning in the year 2000. However, the last three years have marked a significant turn with rapid expansion and adoption of the technique worldwide. According to Dr. Mauri, this surge is largely thanks to procedural innovations and international collaborations, notably from South Korea, where specialized devices have propelled the practice forward.

The Power of Information

Dr. Whyte begins by emphasizing the importance of quality information, which he argues is more accessible than ever thanks to digital advancements. "Better information leads to better health," he says, echoing WebMD's philosophy. In the era of the internet, the adage "knowledge is power" holds particularly true in the realm of healthcare. Quality information equips patients with the power to make informed decisions about their health, turning them into advocates for their own care.

Sorting Fact from Fiction

The challenge for many, Dr. Whyte notes, is the overwhelming amount of information available—an issue compounded by the rapid pace at which medical knowledge evolves. "Medical knowledge doubles about every 73 days," he states, highlighting the difficulty for even the most diligent professionals to stay current. In this environment, patients must become their own advocates and learn to differentiate between reliable information and misleading data.

Whyte is concerned about the rise of misinformation, which can equate unverified opinions with scientific evidence. He stresses the importance of scrutinizing health information with the same rigor one might apply to financial decisions. This means considering the source's credibility, transparency, and the replicability of the data. Reliable sites like WebMD help users navigate this by providing clearly dated and expert-reviewed content.

The Role of Technology in Personal Health

Dr. Whyte is a strong proponent of using technology to enhance personal health management. From wearables that track physical activity to apps that monitor sleep and dietary habits, digital tools offer a wealth of personalized data that can lead to healthier lifestyle choices. He shares his personal experiences with biohacking gadgets like Lumen, a device that measures metabolic fuel use, to illustrate how specific tools can help tailor health strategies to individual needs.

DIY Health: A Blessing and a Curse

The abundance of health-related information and tools can empower patients but also overwhelm them. Dr. Whyte calls this the "DIY approach" to health, where individuals take on the role of managing their own care without sufficient medical guidance. While he champions the use of technology, he cautions against its pitfalls, particularly when individuals rely too heavily on unvalidated sources or misinterpret the data.

The Future of Health Information

Looking ahead, Dr. Whyte is optimistic about the potential of AI and machine learning to transform healthcare. He envisions a future where AI can provide empathetic, accurate support that complements traditional healthcare services. However, he acknowledges that the technology is not yet perfect and emphasizes the importance of continuing to refine these tools to avoid the spread of "hallucinated" misinformation.

Empowering Patients Through Trustworthy Resources

In conclusion, Dr. John Whyte advocates for a balanced approach to digital health information. By critically evaluating sources, utilizing technological tools judiciously, and always seeking professional advice when necessary, patients can take charge of their health confidently and safely. In an age where information is both a resource and a hazard, being a discerning consumer is perhaps the most important skill of all.

Dr. John Whyte is the Chief Medical Officer at WebMD, where he leverages his extensive background in both medicine and public health policy to enhance healthcare information accessibility and accuracy for the public. A passionate advocate for consumer-centered healthcare, Dr. Whyte is dedicated to empowering individuals with reliable and actionable health data. With a medical degree from the University of Pennsylvania School of Medicine and a master's degree in public health from Harvard, he has served in leadership roles at the Food and Drug Administration and Discovery Channel Global Education Partnership, among others. Dr. Whyte is a prolific author and speaker, focused on improving patient education and health outcomes through innovation in digital health and media.

FIND MORE INFO ABOUT THYROID ABLATION, CLICK HERE

Are you an ablation doctor or searching for one?

Get listed on the directory at www.rfamd.com ✅

🔷🔷🔷🔷

About Philip James

As the host of the popular RFAMD and Doctor Thyroid podcasts, Philip James remains committed to sharing inspiring stories, valuable insights, and groundbreaking discoveries in the world of healthcare, making a positive impact on the lives of countless listeners.

Philip's thought-provoking interviews have covered a wide range of healthcare topics, from cutting-edge technologies and surgical advancements to patient experiences and the impact of medical research on society.

Durante una entrevista detallada en el podcast RFAMD, el anfitrión Philip James conversó con la Dra. Ana Voogd, una distinguida cirujana de cabeza y cuello con más de 30 años de experiencia, sobre la integración gradual de la terapia de ablación tiroidea en el panorama médico de Argentina.

La Dra. Voogd, que dirige el departamento de cirugía de cabeza y cuello en uno de los hospitales más grandes de Argentina, proporcionó perspectivas valiosas sobre el enfoque evolutivo del país hacia el cuidado del tiroides.

Un Paso Hacia Procedimientos Menos Invasivos

La Dra. Voogd explicó la ablación tiroidea en términos sencillos, destacando su carácter no quirúrgico y percutáneo, que utiliza agujas para crear necrosis dentro de los nódulos tiroideos. Este proceso detiene efectivamente el crecimiento del nódulo y mejora los síntomas sin necesidad de cirugía, marcando un avance significativo en la mejora de la calidad de vida del paciente y en la preservación de la glándula tiroidea.

A la Par con los Estándares Internacionales

La adopción de técnicas de ablación tiroidea en Argentina, que han sido utilizadas durante décadas en países como Corea del Sur e Italia, es relativamente reciente. La Dra. Voogd señaló la llegada de equipos especializados para la ablación por radiofrecuencia hace dos o tres años como un punto de inflexión, lo que permitió a los proveedores de atención médica locales ofrecer este tratamiento. Aunque Argentina está poniéndose al día, la introducción de esta tecnología ha sido recibida con entusiasmo tanto por los profesionales médicos como por los pacientes, ofreciendo una opción no quirúrgica para tratar los nódulos tiroideos y, en algunos casos, el cáncer de tiroides.

Desafíos de Acceso y Asequibilidad

La conversación con la Dra. Voogd también abordó los desafíos de acceder a la ablación tiroidea en Argentina, donde la disponibilidad del procedimiento varía significativamente entre los sectores de salud pública y privada. En el sector público, la ablación tiroidea no es ampliamente aceptada, mientras que el sector privado ofrece más flexibilidad pero con costos variables. La Dra. Voogd señaló que, aunque el costo del procedimiento está influenciado por el precio de consumibles como las agujas, sigue siendo comparable a los precios internacionales, haciéndolo accesible para aquellos con seguro adecuado o los medios financieros para la atención privada.

Resultados Alentadores y Alta Satisfacción del Paciente

La Dra. Voogd compartió sus experiencias positivas con la ablación tiroidea, mencionando el tratamiento de más de 100 nódulos con reducciones notables en tamaño y alivio de síntomas. Estos resultados sugieren que la ablación tiroidea podría cambiar significativamente el paisaje del tratamiento tiroideo en Argentina, ofreciendo una alternativa efectiva a la cirugía convencional.

Una Perspectiva Más Amplia y Perspectivas Futuras

Al concluir la entrevista, la Dra. Voogd enfatizó la importancia de crear conciencia sobre la ablación tiroidea entre los pacientes con nódulos tiroideos. Animó a los pacientes a considerar esta opción de tratamiento innovadora, que permite un rápido retorno a las actividades diarias, sin cicatrices visibles y con mínimas molestias post-procedimiento. Destacó un caso particularmente memorable de un paciente que experimentó una mejora significativa después de años de sufrimiento, ilustrando el profundo impacto de la ablación tiroidea en la vida de los individuos.

En resumen, las perspectivas compartidas por la Dra. Ana Voogd en el podcast RFAMD iluminan el abrazo gradual de Argentina hacia la ablación tiroidea como opción de tratamiento. Este cambio hacia métodos menos invasivos representa un desarrollo significativo en el sistema de atención médica del país, ofreciendo resultados de tratamiento mejorados y mejorando la calidad de vida para los pacientes con condiciones tiroideas.

FIND MORE INFO ABOUT THYROID ABLATION, CLICK HERE

Are you an ablation doctor or searching for one?

Get listed on the directory at www.rfamd.com ✅

🔷🔷🔷🔷

About Philip James

As the host of the popular RFAMD and Doctor Thyroid podcasts, Philip James remains committed to sharing inspiring stories, valuable insights, and groundbreaking discoveries in the world of healthcare, making a positive impact on the lives of countless listeners.

Philip's thought-provoking interviews have covered a wide range of healthcare topics, from cutting-edge technologies and surgical advancements to patient experiences and the impact of medical research on society.

In the rapidly evolving field of medical treatments, thyroid ablation stands out as a significant advancement, offering a non-surgical option for patients with thyroid nodules. However, the quick adoption of this technique across the United States has raised concerns among experts about its application and the potential risks involved. In a recent interview on the RFAMD podcast, hosted by Philip James, Dr. Jagdish Dhingra, a seasoned thyroid surgeon with over 25 years of experience, shared his insights on the dangers of the rapid embrace of thyroid ablation and the critical importance of skilled ultrasound technique in its success.

Goodwill missions to Africa

Dr. Dhingra, known for his extensive work and goodwill missions in Africa, particularly Rwanda, where he volunteers to perform surgeries on women affected by large goiters, emphasizes the need for caution. His annual trips to Africa highlight his commitment to addressing thyroid-related conditions and his expertise in managing complex cases.

In an enlightening episode of the RFAMD podcast, hosted by Philip James, Dr. Emad Kandil from Tulane University casts a new light on the treatment of thyroid conditions, challenging conventional surgical approaches and advocating for the pioneering method of thyroid ablation. This interview not only delves into Dr. Kandil's personal journey into medicine but also explores the evolving landscape of thyroid treatment, highlighting the potential benefits of ablation over traditional surgery.

Personal Journey to Medicine

The episode begins with a personal anecdote from Dr. Kandil, tracing his initial passion for mathematics and critical thinking to a pivotal moment in his youth involving his brother's seizure. This incident, occurring in his native Egypt, steered him away from engineering towards a career in medicine, driven by a newfound desire to make a tangible impact on people's lives.

Thyroid Ablation: A Minimally Invasive Alternative

With thousands of thyroid surgeries under his belt, Dr. Kandil is not your typical advocate against surgery. However, his pioneering work in thyroid ablation in the United States, with nearly a thousand procedures to his credit, positions him uniquely in this field. Thyroid ablation, he explains, is increasingly being used to treat a variety of thyroid conditions, ranging from benign nodules to certain thyroid cancers, offering a less invasive option with fewer complications and a lesser impact on patients' quality of life.

Challenges in Adopting New Medical Techniques

The conversation takes a critical turn as Dr. Kandil addresses the challenges in the widespread adoption of thyroid ablation. He emphasizes the need for proper training and expertise among physicians to prevent complications. His concerns extend to the rapid expansion of training programs, warning against unqualified practitioners who might cause more harm than good.

Patient-Centric Approach and Recovery

Dr. Kandil also sheds light on the patient experience during and after thyroid ablation. He notes that most procedures are performed under local anesthesia, with some patients preferring sedation. The recovery is notably swift, with many patients able to leave the same day, which is a significant advantage over traditional surgery.

Navigating the Healthcare System

A significant portion of the interview is dedicated to discussing the cost of thyroid ablation in the United States and the challenges patients face due to the lack of insurance coverage for this new procedure. Dr. Kandil stresses the importance of patient education and advocacy, urging patients to thoroughly research their options and seek second opinions.

Looking Towards the Future

In his concluding remarks, Dr. Kandil reflects on the future of thyroid treatment. He envisions a shift towards fewer surgeries, enhanced by advancing technologies and precision techniques. His message is clear: the medical community must adapt to new, less invasive methods that prioritize patient well-being and quality of life. Dr. Emad Kandil's interview with Philip James marks a significant step in bringing attention to thyroid ablation as a viable alternative to surgery. His insights and personal journey serve as a beacon for both medical professionals and patients navigating the complex world of thyroid treatment. As this method gains traction, it promises to reshape the landscape of thyroid care, prioritizing minimally invasive procedures that offer better outcomes and improved quality of life for patients.

Are you an ablation doctor or searching for one?

Get listed on the directory at www.rfamd.com ✅

🔷🔷🔷🔷

About Philip James

As the host of the popular RFAMD and Doctor Thyroid podcasts, Philip James remains committed to sharing inspiring stories, valuable insights, and groundbreaking discoveries in the world of healthcare, making a positive impact on the lives of countless listeners.

Philip's thought-provoking interviews have covered a wide range of healthcare topics, from cutting-edge technologies and surgical advancements to patient experiences and the impact of medical research on society.

Palo Alto, CA — In a recent episode of the RFAMD podcast, host Philip James welcomed a trailblazer in the field of thyroid treatment, Dr. Julia Noel of Stanford University School of Medicine. Known for her pioneering work in thyroid ablation, Dr. Noel shared insights on the evolving landscape of thyroid care, emphasizing innovative ablation technologies that are reshaping patient experiences.

From Mathematics to Medicine

Dr. Noel's journey into the medical field was not typical. Initially drawn to mathematics, inspired by her father, she found her calling in surgery, where she could blend problem-solving skills with a hands-on approach. This unique blend of analytical thinking and surgical precision has defined her career.

Ablation Over Surgery: A Paradigm Shift

Central to Dr. Noel's practice is thyroid ablation, a technique that offers an alternative to traditional surgery. With over thousands of surgeries to her credit, she has been a vocal advocate for techniques like radiofrequency, ethanol, and microwave ablation. These methods, she notes, are crucial in reducing the need for invasive procedures, preserving thyroid function, and improving quality of life.

The Technology at the Forefront

During the interview, Dr. Noel highlighted the rapid advancement in ablation technology. She pointed out that while radiofrequency ablation is currently the most user-friendly and researched method, emerging technologies promise even more groundbreaking developments. These future techniques may not even rely on heat generation, opening new avenues for treatment.

Navigating the Risks

With any medical procedure come risks, and thyroid ablation is no exception. Dr. Noel candidly discussed potential complications like voice changes, discomfort, and nodal rupture. However, she reassured that most of these risks are minor and reversible, underlining the importance of skilled execution and patient awareness.

A Surge in Patient Education

An interesting aspect of Dr. Noel's work is her approach to patient education and outreach, particularly through social media. She stressed the importance of accurate, high-quality information in guiding both patients and physicians, acknowledging the growing role of digital platforms in patient advocacy.

Challenges in Training and Standardization

As thyroid ablation gains popularity, Dr. Noel emphasized the need for standardized training and guidelines. She expressed concern over the "Wild Wild West" atmosphere as more doctors seek to learn these techniques, underscoring the need for cautious and well-guided adoption of the technology.

The Cost Factor

Addressing the practical aspects of thyroid ablation, Dr. Noel spoke about the variability in insurance coverage and costs in the United States. She noted that while some patients on the West Coast enjoy substantial coverage, others face significant out-of-pocket expenses, highlighting the need for broader insurance acceptance.

Looking to the Future

Dr. Noel's vision for the future of thyroid treatment is one of optimism, contingent on the acceptance of new medical codes and continued technological innovation. She sees a world where thyroid nodules and cancer are treated more efficiently and less invasively, a testament to the dynamic nature of medical progress.

Dr. Julia Noel's interview on the RFAMD podcast provides a compelling look into the future of thyroid care. Her dedication to advancing treatment options, patient education, and the safe adoption of new technologies sets a benchmark in the field of thyroid health. As these technologies evolve, Dr. Noel's insights offer a valuable perspective on the potential for improved patient care and the importance of informed medical choices.

Are you an ablation doctor or searching for one?

Get listed on the directory at www.rfamd.com ✅

🔷🔷🔷🔷

About Philip James

As the host of the popular RFAMD and Doctor Thyroid podcasts, Philip James remains committed to sharing inspiring stories, valuable insights, and groundbreaking discoveries in the world of healthcare, making a positive impact on the lives of countless listeners.

Philip's thought-provoking interviews have covered a wide range of healthcare topics, from cutting-edge technologies and surgical advancements to patient experiences and the impact of medical research on society.

• LinkedIn

www.rfamd.com

Thyroid disorders, particularly those requiring surgery, have long been a concern for patients due to the potential lifelong dependence on medication and associated quality of life changes. However, a significant shift is occurring in thyroid treatment with the advent of thyroid ablation, a technique that is rapidly gaining preference among patients and physicians alike.

The Rise of Thyroid Ablation

In a recent podcast interview on RFAMD, Dr. Erivelto Volpi, a renowned head and neck surgeon from São Paulo, Brazil, shared his extensive experience in thyroid ablation. Dr. Volpi, who has performed around 8,000 thyroid surgeries and 400 thyroid ablations in over 35 years, notes the growing trend towards thyroid ablation. He attributes this shift primarily to the preservation of the patient's quality of life, a crucial factor often overshadowed in traditional surgical approaches.

Why Patients Prefer Thyroid Ablation

Dr. Volpi explains that most patients seeking thyroid ablation do so not just to avoid surgery but to maintain their quality of life. They fear the changes that lifelong medication post-surgery might bring, having seen friends or family struggle with hormone replacements. Thyroid ablation, which involves radiofrequency or microwave treatment, offers an effective alternative. It shrinks benign thyroid nodules and even treats initial cancers, preserving thyroid function and thus the patient's pre-existing quality of life.

The Global Perspective and Acceptance

Thyroid ablation is not just a localized phenomenon. Dr. Volpi highlights its rapid adoption worldwide, with countries like South Korea, Brazil, Italy, France, Spain, Turkey, and Egypt leading in this practice. This global acceptance is partly due to patient advocacy and the internet, which have empowered patients to seek the best treatment options, often traveling across borders to access this care.

The Procedure and Its Benefits

Compared to conventional surgery, thyroid ablation is minimally invasive, with fewer complications like voice changes. Recovery is swift, often within 24 to 48 hours, significantly quicker than traditional surgery. This aspect further reinforces its preference among patients.

Are you an ablation doctor or searching for one?

Get listed on the directory at www.rfamd.com ✅

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About Philip James

As the host of the popular RFAMD and Doctor Thyroid podcasts, Philip James remains committed to sharing inspiring stories, valuable insights, and groundbreaking discoveries in the world of healthcare, making a positive impact on the lives of countless listeners.

Philip's thought-provoking interviews have covered a wide range of healthcare topics, from cutting-edge technologies and surgical advancements to patient experiences and the impact of medical research on society.

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Introduction

⦿ Host: Welcome by the host of the RFAMD podcast.

⦿ Guest: Introduction of Dr. Giovanni Mauri, a medical professional from Milan, Italy.

Dr. Mauri's Journey into Medicine

⦿ Childhood Influence: Inspired by his father, a radiologist.

⦿ Career Choice: Fascination with radiology and interventional radiology.

⦿ Family Background: His father worked in diagnostic radiology in an oncological hospital.

History of Ablation in Italy

⦿ Early Adoption: Discussion of pioneers in ablation treatments in Italy, starting in the 1980s.

⦿ Development: The evolution of ablation techniques, from ethanol ablation for liver cancers to radiofrequency ablation.

Dr. Mauri's Specialization

⦿ Scope of Ablation: Treating various cancers (liver, kidney, lung, bone, soft tissues) with thermal ablation.

⦿ Focus on Thyroid Ablation: Special emphasis on treating both benign and malignant thyroid diseases.

Patient Success Stories

⦿ Personal Case: A female patient treated multiple times for lymph node metastasis, avoiding further surgery.

⦿ Impact on Patients: Emphasizing the success and life-changing effects of successful thyroid ablation treatments.

Thyroid Surgery vs. Ablation

⦿ Patient Perspective: Benefits in terms of invasiveness and future hormonal treatment.

⦿ Medical Community: Surgeons appreciating the option of ablation to manage resources and time effectively.

Global Trends in Thyroid Ablation

⦿ FDA Approval: The significant impact of FDA approval in the U.S. in 2018.

⦿ Rapid Growth: Thyroid ablation as the fastest-growing field in ablation treatments worldwide.

Dangers of Rapid Growth

⦿ Training and Expertise: Emphasizing the necessity of proper training and the risks posed by inexperienced practitioners.

⦿ Comparison of Techniques: Differences between traditional surgery and ultrasound-guided ablation procedures.

Pioneers in Thyroid Ablation

⦿ Innovations: Introduction of specifically designed needles and techniques in Korea and Italy. ⦿ Global Adoption: The spread of thyroid ablation practices to countries like South America, North America, and Europe.

Risks of Thyroid Ablation

⦿ Medical Risks: Potential damages during the procedure, such as bleeding or nerve damage.

⦿ Technical Challenges: Importance of ultrasound skills and adjunctive techniques to minimize risks.

Risks of Thyroid Ablation

⦿ Medical Risks: Potential damages during the procedure, such as bleeding or nerve damage. 

⦿ Technical Challenges: Importance of ultrasound skills and adjunctive techniques to minimize risks.

Unsuccessful Cases

⦿ Benign Nodules: Rare unsuccessful cases, often due to initial under-treatment.

⦿ Malignant Tumors: Possibility of incomplete ablation, with options for re-treatment.

Selecting the Right Provider

⦿ Criteria for Choosing: Experience of the physician, ideally in a hospital setting for beginners.

⦿ Importance of Supervision: Emphasis on proper environment and supervision for new practitioners.

Addressing Skepticism

⦿ Literature and Communication: Using scientific evidence and open discussions to address concerns.

⦿ Surgical Alternatives: Emphasizing ablation as a reversible option compared to definitive surgery.

Types of Ablation

⦿ Radiofrequency vs. Microwave: Discussion on the advantages and risks of each type in thyroid treatments.

Guidelines and Clinical Experience

⦿ Lag in Guidelines: The delay in incorporating new treatments like ablation into official guidelines.

⦿ Individualized Treatment: Tailoring treatment options based on clinical experience, despite guidelines.

Guidelines and Clinical Experience

⦿ Lag in Guidelines: The delay in incorporating new treatments like ablation into official guidelines.

⦿ Individualized Treatment: Tailoring treatment options based on clinical experience, despite guidelines.

Patient Perception and Decision Making

⦿ Overdiagnosis and Overtreatment: Addressing the issue of overdiagnosis in thyroid cancer and the role of minimally invasive treatments.

⦿ Patient Preferences: Understanding patient choices in treatment options, including active surveillance.

Second Opinions and Treatment Choices

⦿ Changing Treatment Plans: Cases where patients change their mind after seeking a second opinion.

⦿ Informed Decision Making: The importance of providing comprehensive information to patients.

Innovations in Thyroid Treatment

⦿ New Technologies: Exploring new treatments like embolization, expanding the scope of minimally invasive procedures.

Conclusion and Rapid Fire Questions 

⦿ Future of Thyroid Treatment: Predictions about the shift towards ablation in the next decade.

⦿ Importance of Communication: The crucial role of clear communication in discussing cancer treatments with patients.

For podcast inquiries or if you would like to be a guest. Contact: philip@rfamd.com

In the world of medicine, it's not uncommon for patients to feel overwhelmed and uncertain when faced with a diagnosis that requires surgery. For Peter Miller, a 64-year-old man from the UK, this was certainly the case when he was diagnosed with thyroid goiter. Three specialists recommended thyroidectomy as the only viable treatment option, but Peter was hesitant to undergo such a procedure due to the potential risks and complications associated with it.

Fortunately, Peter took matters into his own hands and conducted his own research, which led him to an alternative treatment option – Radiofrequency Ablation (RFA). Through an article written by Philip James and the Philip James YouTube channel, Peter discovered Dr. Roberto Valcavi, an Appalachian doctor in Italy, who had experience performing the RFA procedure.

After discussing his options with Dr. Valcavi via email and video consultation, Peter underwent the RFA procedure in Italy. The results were remarkable – Peter experienced significant improvement in his symptoms, and he was happy to have avoided surgery.

Peter's story highlights the importance of being an advocate for your own health and well-being. Conducting research, seeking second opinions, and exploring all treatment options are crucial steps in making informed medical decisions. Peter's success with RFA also underscores the importance of raising awareness about this non-surgical treatment option.

Despite its efficacy, RFA is not widely available in many countries, and healthcare professionals may not be aware of it as a treatment option for thyroid goiter. It is crucial to raise awareness about RFA so that patients have access to all viable treatment options.

Peter's experience with RFA serves as an inspiration for patients who may be hesitant to undergo surgery for thyroid goiter. Being your own advocate, doing research, and exploring all treatment options can lead to better health outcomes. And with the help of knowledgeable medical professionals like Dr. Valcavi, patients can find the right treatment option that works best for them.

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About Dr. Roberto Valcavi

Roberto Valcavi MD, FACE, ECNU is specialist in Endocrinology and specialist in Internal Medicine. 20 years and 1800+ RFA procedures done; laser since 2000 and radiofrequency ablation starting in 2010.

At present, Dr. Roberto Valcavi is Director of the E.T.C. (Endocrine & Thyroid Clinic) in Reggio Emilia, Italy, dedicated to the diagnosis and therapy of endocrine neck (thyroid, parathyroid, lymph nodes) benign and malignant lesions. 

He is specialized in ultrasound- guided ablative therapy of thyroid nodules by radio frequency (RFA), minimally invasive surgery that is able to effectively treat more than 90 % of benign thyroid nodules and over 80 % of malignant thyroid nodules, saving the thyroid gland.

View Full Profile: Dr. Roberto Valcavi

About Philip James

As the host of the popular RFAMD and Doctor Thyroid podcasts, Philip James remains committed to sharing inspiring stories, valuable insights, and groundbreaking discoveries in the world of healthcare, making a positive impact on the lives of countless listeners.

Philip's thought-provoking interviews have covered a wide range of healthcare topics, from cutting-edge technologies and surgical advancements to patient experiences and the impact of medical research on society.

• LinkedIn

Content on the RFAMD and Doctor Thyroid with Philip James websites and podcasts is for informational purposes only and not a substitute for professional medical advice. See our full Legal Disclaimer for details.

In this interview, Dr. Giovanni Mauri, an interventional radiologist specializing in ablation for the treatment of various conditions including thyroid cancer, shares his insights with Philip James on the Doctor Thyroid and RFAMD podcasts.

Dr. Mauri highlights one of the recent advancements in the field of ablation – the possibility of treating small thyroid cancers (up to one or two centimeters) without surgery. This innovative approach allows for the complete treatment of the cancer while preserving the thyroid gland.

He advises every patient diagnosed with thyroid cancer to be aware that ablation is a valid treatment option. He emphasizes the importance for both physicians and patients to know that this option exists, and encourages patients to seek advice about the possibility of being treated by ablation instead of surgery.

The interview concludes with Dr. Mauri extending an invitation for anyone with doubts about this procedure to reach out to him. His contact information is available in the episode description for those interested in learning more about treating thyroid cancer with ablation.

The discussion provides a fresh perspective on thyroid cancer treatment, focusing on non-surgical options and the potential benefits of ablation. The interview wraps up with a farewell from Italy.

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About Philip James

As the host of the popular RFAMD and Doctor Thyroid podcasts, Philip James remains committed to sharing inspiring stories, valuable insights, and groundbreaking discoveries in the world of healthcare, making a positive impact on the lives of countless listeners.

Philip's thought-provoking interviews have covered a wide range of healthcare topics, from cutting-edge technologies and surgical advancements to patient experiences and the impact of medical research on society.

• LinkedIn

Content on the RFAMD and Doctor Thyroid with Philip James websites and podcasts is for informational purposes only and not a substitute for professional medical advice. See our full Legal Disclaimer for details.

In a comprehensive interview conducted by Philip James from the RFAMD and Doctor Thyroid podcasts, Dr. Greg Randolph from Harvard Medical School shares his insights on patient-centered approaches for treating thyroid nodules. The interview focuses on thyroid ablation, a procedure that treats thyroid nodules without surgery.

Dr. Randolph emphasizes the importance of not only measuring the volumetric reduction of the nodule after ablation but also considering patient-reported outcomes. These outcomes include the patient's perception of the nodule, such as whether they still have a lump sensation in their neck or a visible lump. Despite the successful reduction of the nodule size on ultrasound, the patient may still perceive a visual or physical presence, thus it's critical to include what's meaningful for the patient in the outcomes.

He also discusses the importance of understanding a patient's concerns and expectations. Whether it's a benign nodule or a low-stage malignancy, each patient will have their own concerns and priorities. Some may fear the potential of a hidden cancer while others may be apprehensive about surgical procedures. Hence, the treatment decision should be apparent after a thorough discussion of the patient's preferences and the medical realities.

Lastly, he stresses the importance of physicians offering a variety of treatment options. For benign nodules or small cancers, patients should have the option to select from different rational treatments. Dr. Randolph also advocates for spending adequate time with the patient, allowing them to ask questions and make informed decisions.

This patient-centered approach fosters a less paternalistic, more collaborative physician-patient relationship, ensuring that the patient's desires and concerns are addressed during the treatment process.

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About Philip James

As the host of the popular RFAMD and Doctor Thyroid podcasts, Philip James remains committed to sharing inspiring stories, valuable insights, and groundbreaking discoveries in the world of healthcare, making a positive impact on the lives of countless listeners.

Philip's thought-provoking interviews have covered a wide range of healthcare topics, from cutting-edge technologies and surgical advancements to patient experiences and the impact of medical research on society.

• LinkedIn

Content on the RFAMD and Doctor Thyroid with Philip James websites and podcasts is for informational purposes only and not a substitute for professional medical advice. See our full Legal Disclaimer for details.

We recently had the unique opportunity to converse with esteemed Dr. Erivelto Volpi from Brazil at the Thyroid Ablation Conference held in Italy.

As an authority on thyroid treatments, he took the time to share his insights and valuable experience with us. Just a week before, we had caught up with him at the World Congress on Thyroid Cancer in London, and we were delighted to sit down with him again.

The conference presented a golden opportunity for specialists from around the globe to converge, exchange thoughts, and learn from the experts in the field. One area that stood out more than ever at this conference was the exploration of thyroid cancer treatment with ablation. Dr. Volpi explained, "it is a new field, and in selected patients, we can offer the opportunity to avoid surgery using thermal ablations technologies."

Dr. Volpi emphasized that it is crucial to understand that ablation is indeed a viable option for treating thyroid cancer. However, patient selection plays an integral role in determining its effectiveness. "Usually, nodules up to one centimeter located inside the thyroid parenchyma are considered suitable cases. The results in terms of the treatment outcomes are exactly the same as those from a conventional surgery," he noted.

Brazil has been at the forefront of using ablation as a treatment option for thyroid nodules for over a decade. As this methodology is now gaining momentum globally, including in the U.S. and countries like Indonesia, Dr. Volpi offers lessons from Brazil's experience.

His key piece of advice for doctors new to this treatment method is to begin with benign and small-sized nodules. "When you start to do RFA (Radiofrequency Ablation), always start with benign nodules and not so huge nodules. For patients with cosmetic or symptomatic nodules, RFA is a very good option when starting your learning curve," he advises. This strategy, he believes, will be beneficial not just for patients, but also for doctors who are beginning to learn this procedure.

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About Dr. Erivelto Volpi

Dr. Erivelto Volpi é um Cirurgião de Cabeça e Pescoço, especialista em doenças da tireoide e da paratireoide.

Dr. Erivelto Volpi teve toda seu treinamento no Hospital das Clínicas da Universidade de São Paulo, onde permanceu por 30 anos, 4 anos como médico residente em Cirurgia Geral e Cirurgia de Cabeça e Pescoçoe 26 anos como médico do Serviço de Cirurgia de Cabeça e Pescoço, onde atuou no atendimento e cirurgias de pacientes e no  treinamento de médicos residentes e estagiários, além da formação de alunos de graduação e pós-graduação.

Sua tese de Doutorado em 2011 foi sobre segurança em cirurgia de tireoide, especificamente na monitorização neuro-fisiológica intra-operatória dos nervos laríngeos (responsáveis pela movimentação das cordas vocais).

Dr. Volpi sempre esteve interessado em tratamentos minimamente invasivos, sendo um dos pioneiros no Brasil na realização de Tireoidectomias Minimamente Invasivas (MIVAT), tendo feito seu treinamento na Universidade de Pisa com o Dr. Paolo Miccoli.

Sempre preocupado em oferecer o melhor aos seus pacientes, Dr. Volpi em 2018 realizou seu treinamento em Ablação por Radiofrequência em Seoul, na Coréia do Sul com o Prof. Baek, o desenvolvedor da técnica de Ablação por Radiofrequência (RFA).

Retornando ao país, foi um dos primeiros médicos a realizar o procedimento, deste então tem tratado pacientes de todo o Brasil e da América do Sul, além de ter uma das maiores experiências da América Latina neste tratamento, hoje Dr. Volpi é responsável por um curso de treinamento em RFA, tendo já treinado médicos do Brasil, América Latina e EUA. 

View Full Profile: Dr. Erivelto Volpi

About Philip James

As the host of the popular RFAMD and Doctor Thyroid podcasts, Philip James remains committed to sharing inspiring stories, valuable insights, and groundbreaking discoveries in the world of healthcare, making a positive impact on the lives of countless listeners.

Philip's thought-provoking interviews have covered a wide range of healthcare topics, from cutting-edge technologies and surgical advancements to patient experiences and the impact of medical research on society.

• LinkedIn

Content on the RFAMD and Doctor Thyroid with Philip James websites and podcasts is for informational purposes only and not a substitute for professional medical advice. See our full Legal Disclaimer for details.

A recent interview from the TNT conference on thyroid ablation in Italy, Philip James of the Doctor Thyroid and RFAMD podcasts had a one-on-one discussion with Dr. Catherine Sinclair, a seasoned head and neck surgeon from Melbourne, Australia. Having served at Mount Sinai in New York for 11 years before relocating back to Melbourne in 2021, Dr. Sinclair offers a unique perspective and extensive expertise in thyroid surgery and laryngology.

The Importance of Nerve Protection

As a specialist who's invested in both head and neck surgery and the voice box, Dr. Sinclair developed a keen interest in thyroid surgery due to the significant risks it presents to the vocal nerves during thyroid procedures, including during ablation. The laryngeal nerves, in particular, tend to be the patients' greatest concern during thyroid procedures due to the potential damage they might sustain.

Many patients seeking Dr. Sinclair's services are often singers or professional voice users who want to avoid surgery out of fear for their vocal nerves. As such, they prefer ablation. However, as she explains, it is crucial that they understand the risks to the laryngeal nerves and other vital structures in the area and the strategies used to mitigate these risks during ablation.

Limitations in Nerve Monitoring

In surgery, nerve monitoring is employed to keep track of and protect the nerves. But with ablation, patients are usually awake, which means the conventional nerve monitoring technology can't be used. This presents a significant area of research on how to protect the nerves when the patient is conscious.

Dr. Sinclair emphasizes that though the risk is slightly lessened with surgery, it still exists. To counter this, specific strategies are used to minimize potential damage, but it's never a guarantee that no injuries will occur.

Patients' Preparedness and Awareness

Patients must ask about the surgeon's experience, the number of ablations performed, and any potential complications that they should worry about. The more experienced the surgeon, the less likely there are to be complications of any kind, nerve injury included.

Contrary to some patients' assumptions, nerve monitoring isn't used in ablation since it requires general anesthesia. Early in her ablation experience, Dr. Sinclair used nerve monitoring on patients under general anesthesia. This procedure showed that nerve potentials remain stable as long as lower energy is used at the back of the thyroid gland where the nerves run. Furthermore, by minimizing time spent in the critical zones, nerve injury can be mostly prevented.

Real-time Vocal Assessment

During ablation, Dr. Sinclair often asks her patients to count in a monotone. This simple technique allows her to detect any changes in the voice, a potential indicator of nerve damage due to heat during the procedure. According to her, this method has helped prevent nerve issues.

State of Thyroid Ablation in Australia

Until recently, Dr. Sinclair was the only one performing thyroid ablations in Australia. Now, a colleague has started doing them in Western Australia. However, given the demand and the country's size, she anticipates more physicians will adopt this procedure. Her main concern is ensuring that it's done safely, with physicians possessing good ultrasound skills, interventional biopsy skills, and comprehensive knowledge of neck anatomy.

Final Thoughts

Dr. Sinclair's parting advice to those considering thyroid ablation or thyroidectomy is to have realistic expectations. They should understand that injuries can happen despite the best precautions. However, the experience of the proceduralist can help lessen complications, and there are strategies to reduce the likelihood of nerve damage. Patients should also be well-informed and know what questions to ask their proceduralist before opting for ablation.

Interested parties can reach Dr. Sinclair by email at Catherine@melbournethyroidsurgery.com. She encourages inquiries from both domestic and international individuals.

About Philip James

As the host of the popular RFAMD and Doctor Thyroid podcasts, Philip James remains committed to sharing inspiring stories, valuable insights, and groundbreaking discoveries in the world of healthcare, making a positive impact on the lives of countless listeners.

Philip's thought-provoking interviews have covered a wide range of healthcare topics, from cutting-edge technologies and surgical advancements to patient experiences and the impact of medical research on society. LinkedIn

Content on the RFAMD and Doctor Thyroid with Philip James websites and podcasts is for informational purposes only and not a substitute for professional medical advice. See our full Legal Disclaimer for details.

September is Thyroid Cancer Awareness Important, surgery isn't always necessary for treating thyroid cancer. In fact: as many as one in three people have thyroid cancer and do not die from it, rather, with it. 

In a recent episode of the Doctor Thyroid and RFAMD podcasts, Dr. Vaninder Dhillon, an esteemed laryngologist and ENT surgeon from Johns Hopkins, highlighted the critical issue of voice and swallow risks associated with thyroidectomy and thyroid ablation.

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The interview sheds light on the importance of preserving the voice and offered insights into innovative approaches to avoid surgery.

Dr. Dhillon, who has extensive experience in both laryngology and endocrine head and neck surgery, underscored the significance of the voice and swallow outcomes in patients undergoing these procedures. Her research and clinical practice focus on improving outcomes and quality of life for patients who may face post-operative issues with their voice and swallow, as well as those with general voice and swallow complaints.

One of the most common complications after thyroid surgery is vocal cord paralysis, which can have a significant impact on a patient's voice. While the overall percentage of patients experiencing voice issues after thyroidectomy varies, it can be as high as 30 to 50 percent, with temporary paralysis affecting up to 15 percent. Although permanent paralysis is rarer (1-2 percent), it remains a concern for patients.

During the interview, Dr. Dhillon emphasized the importance of differentiating between voice and swallowing outcomes, as the latter is often overlooked. Swallowing complaints are higher than voice complaints, with some studies showing up to 60 percent of patients experiencing temporary swallowing issues post-operatively.

Voice and swallow assessments are crucial before and after surgery. Dr. Dhillon stressed the need for a comprehensive evaluation, including endoscopy and video stroboscopy, to examine the larynx more closely during speech. These assessments help in identifying potential issues with the recurrent laryngeal nerve and the superior laryngeal nerve.

Dr. Dhillon's team has implemented voice and swallow tests before surgery, and they continue to monitor patients post-operatively to ensure any issues are addressed promptly. This proactive approach helps patients feel more confident and informed about the potential risks to their voice and swallow function.

The conversation also discussed the rise of radiofrequency ablation (RFA) as an alternative to surgery. RFA is a minimally invasive technology for treating thyroid nodules and thyroid cancers. While RFA has a lower risk of voice and swallow complications than surgery, Dr. Dhillon stressed the importance of a thorough pre-RFA laryngeal exam to ensure optimal outcomes.

However, Dr. Dhillon acknowledged that more research is needed to fully understand the potential voice and swallow risks associated with RFA. Standardized protocols and patient-reported outcomes can be vital in evaluating these risks and ensuring patient safety during the procedure.

Dr. Vaninder Dhillon highlighted the importance of safeguarding the voice and swallow function in thyroid surgery and ablation. By proactively evaluating and addressing potential complications, patients can make informed decisions and seek appropriate interventions to protect their vocal and swallowing abilities. The ongoing research and innovative approaches in this field offer hope for improved outcomes and a better quality of life for those affected by thyroid conditions.

About Dr. Vaninder Dhillon

Assistant Professor of Otolaryngology – Head and Neck Surgery

Vaninder "Vinny" K. Dhillon, M.D., is an assistant professor of otolaryngology – head and neck surgery at Johns Hopkins University School of Medicine, specializing in both children and adults. She practices out of Johns Hopkins Otolaryngology – Head and Neck Surgery in Bethesda, Maryland. Dr. Dhillon is also affiliated with Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center in Baltimore, Maryland, as well as Sibley Memorial Hospital in Washington, D.C.

Dr. Dhillon has an expertise in endocrine surgery, laryngology, otolaryngology, parathyroid diseases and surgery, swallowing disorders, thyroid diseases and surgery, and voice problems.

Dr. Dhillon earned her medical degree from Keck School of Medicine of University of Southern California. She completed a residency in otolaryngology at Los Angeles County and University of Southern California Medical Center.

View Full Profile: https://www.rfamd.com/vaninder-dhillon/

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About Philip James

In 2013, his laryngeal nerve was severed, shoulder nerve damaged, parathyroids ruined, and residual cancer left behind — all for a 1 cm thyroid nodule.
Later, a vocal cord implant was inserted to help him speak.

The word he uses to describe his work as patient advocate is, 'tonglen'. Or, using his pain and hardship to help others.

LinkedIn

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In recent years, innovative methods in thyroid cancer management have drastically changed the field, and potentially the future of cancer treatments overall. A thought-provoking revelation comes from a discussion held at the World Congress on Thyroid Cancer in London, where a paradigm-shifting concept was discussed by two highly respected figures in the field.

Dr. Akira Miyauchi of Kuma Hospital in Kobe, Japan, and Dr. Michael Tuttle from Sloan Kettering Cancer Center, New York, unveiled a practice that goes against traditional medical protocol: favoring active surveillance over immediate surgery in managing papillary thyroid cancer. The method has been utilized at Kuma Hospital for 30 years, and in this time, not one patient has died from this type of cancer. This groundbreaking revelation was discussed in a live interview hosted by Philip James of the Doctor Thyroid podcast.

According to Dr. Miyauchi, the original proposal for this trial of active surveillance was approved and initiated in 1993. It is based on the principle that early intervention is not always critical. Instead, the method favors regular monitoring of the patient's condition to identify any changes in the cancer's progression.

"The most important thing might be the unclosing safety of the active surveillance. Compared to immediate surgery, the instances of unfavorable events such as vocal cord paralysis, hypoparathyroidisms, or patients with surgical scars, patients taking Levothyroxine – these instances are significantly smaller in active surveillance" explained Dr. Miyauchi.

The focus of active surveillance is not to disregard treatment but to delay intervention until necessary, allowing for better management of the disease. This, in turn, reduces the risk of complications often associated with early and possibly unnecessary surgery.

However, surveillance does not mean the absence of treatment. Many patients are proactive in their health management, adopting healthier lifestyles, engaging in physical activities, and sometimes utilizing alternative treatments. The goal remains the same: to halt or slow the progression of the cancer.

Dr. Tuttle reiterated that the outcomes and survival rates between early and delayed intervention are largely the same. Importantly, patients who do show a small increase in the size of the cancer or the appearance of small lymph nodes in the neck can still be efficiently treated with delayed surgery. This does not compromise their chance of a full recovery or increase their risk of recurrence or distant metastasis.

In the U.S., where active surveillance has been practiced for around 12 years, Dr. Tuttle's experience with patients who have needed to switch to surgery has been largely positive. Most were grateful for having been able to keep their thyroid for as long as they did, and many even reported feeling healthier due to the lifestyle changes they had implemented.

"Having seen a few now that are on the other side of that, I can tell you for most people they weren't upset they weren't sad that we had to do something but they felt like they'd given it their best" Dr. Tuttle explained.

This approach might, however, require a change in doctors' attitudes as well. It's not only about informing patients about their cancer but also managing their anxiety and uncertainty about the 'wait and see' strategy. The physicians' warm-heartedness, their reassuring demeanor, and the trust they establish with their patients are crucial factors that may significantly affect patients' psychological well-being.

The shift from immediate surgical intervention to active surveillance represents a revolutionary approach to managing thyroid cancer. The results from the Kuma Hospital trial are prompting the medical community to rethink its strategies and consider adopting this new method more broadly. Although active surveillance might not be the right choice for all patients, it presents an alternative and safe option for those with papillary thyroid cancer, potentially improving both their physical and psychological quality of life.

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About Philip James

In 2013, his laryngeal nerve was severed, shoulder nerve damaged, parathyroids ruined, and residual cancer left behind — all for a 1 cm thyroid nodule.
Later, a vocal cord implant was inserted to help him speak.

The word he uses to describe his work as patient advocate is, 'tonglen'. Or, using his pain and hardship to help others.

LinkedIn

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In a qualitative analysis, Dr. Louise Davies reports on the experience of US patients who self-identify as having an over-diagnosed thyroid cancer.

How likely is death as result of thyroid cancer?  In a study by H. Harach, he sites that when reviewing random autopsies, thyroid cancer was prevalent in 34% of the cadavers.  

Dr. Davies states, if diagnosed with thyroid cancer, important questions to ask, include:

1. How big is the tumor?
2. How was the tumor discovered?
3. Are there any symptoms?

Dr. Davies says those who choose to opt for no surgery are sometimes called stupid by those who know them, and end up feeling isolated and anxious, with little or no support.  

Louise Davies, MD, MS, FACS is an Associate Professor at Geisel School of Medicine
and Dartmouth Institute for Health Policy & Clinical Practice (TDI).

She is Chief, Otolaryngology at Veterans Administration, White River Jct., VT
Dr. Davies is an otolaryngologist - head & neck surgeon whose thyroid related research is aimed at defining and documenting the problem of rising thyroid cancer incidence and developing management approaches to the problem in ways that are safe and effective. Clinically, Dr. Davies cares for patients with both head and neck and thyroid cancer and general otolaryngology problems primarily at the VA hospital, with a limited practice at Dartmouth Hitchcock Medical Center. Her career is defined by her goal of helping patients and physicians make good decisions for their cancer care by providing clear, helpful data in useful formats at the needed time and place.

NOTES:

JAMA Abstract: Dr. Davies

Thyroid Stories Project

Dr. Michael Tuttle, from Sloan Kettering

Yasuhiro Itoa and Akira Miyauchi 

Nonoperative management of low-risk differentiated thyroid carcinoma

A Full Professor, he occupies the Temmy Latner/Dynacare Chair in Head and Neck Oncology at the University of Toronto, Faculty of Medicine. He is former Otolaryngologist-in-Chief at the Mount Sinai Hospital stepping down after fulfilling his 10 year appointment. He has an active practice focusing on head and neck oncology with a primary interest in endocrine surgery of the head and neck.

He has given over 500 scholarly presentations, has been invited as a visiting professor and surgeon internationally, and has published over 280 articles in the scientific literature. He has been involved in a number of administrative roles in the American Head and Neck Society and is also on the editorial board of a number of high impact journals focusing on head and neck oncology. He has recently been appointed to the National Institute of Health (in Washington DC) task force on the management of thyroid cancer.

He is the Director of the University of Toronto Head and Neck Oncology Fellowship, considered to be one of the top three such fellowships in North America.

He was the program chair and congress chair of the First and Second World Congresses on Thyroid Cancer held in 2009 and 2013 in Toronto. He was the Keynote speaker at the Congress held in Boston in 2017. He has been invited worldwide to deliver keynotes in the management of thyroid malignancies.

In this episode the following topics are discussed:

• Cost of thyroid surgery in varies depending on jurisdiction
• Surgery and active surveillance is a fixed cost
• Costs after surgery
• TG tests, ultrasound, thyroid hormone costs
• Contrary to some proponents, surgery is not more cost effective than active surveillance
• Hypo parathyroidism leads to daily doses of calcium and vitamin D
• If there is RLN damage, then there could be more surgery and voice therapy
• There are more costs than solely the surgical fee
• Levothyroxine costs
• Ramifications of degree of thyroid cancer
• Thyroid cancer is a low risk of death
• Many people die with thyroid cancer but don't die from it
• Possibility versus probability
• Emotional expense of malignancy and being labeled survivor
• Lead a normal life or the survivor label
• Lifetime cost of thryoidectomy
• Medical costs and cost of travel, time of work, baby-sitters, and all expenses that go into managing thryoidectomy for ancillary items
• How long can someone live without thyroid replacement hormone post thyroidectomy?
• Quality of life post thyroidectomy
• Psychological wellbeing
• Do not do a FNA for nodule under 1 cm

NOTES

Dr. Jeremy Freeman

Jeremy Freeman's scientific contributions

LinkedIn

Dr. Baek, a specialist in thyroid RFA, believes that the procedure is important for preserving thyroid function and improving the quality of life for patients. In contrast to thyroidectomy, which requires patients to take lifelong hormone replacement medication, RFA allows patients to maintain natural thyroid hormone production.

The cost of thyroid RFA is a significant barrier to its adoption in the United States. While the procedure is cheaper in South Korea and other countries, insurance coverage is a major factor in the affordability of treatment for patients. Insurance companies need to recognize the value of RFA and begin covering the procedure in order for it to become more widely available to patients.

Overall, thyroid RFA is a promising treatment option that has the potential to improve the lives of many thyroid nodule patients. It is important for insurance companies to acknowledge the benefits of this procedure and work towards making it more widely accessible to patients.

MORE INFO
www.rfamd.com

During this video, the following topics are discussed:

✅ Finding treatments that are not over-aggressive and less-invasive.

✅ 70% of women and 50% of men have thyroid nodules

✅ Less than 10% of nodules are cancerous 

✅ Is radiofrequency ablation (RFA) an effective treatment?

✅ Is radiofrequency ablation (RFA) painful?

✅ How long does radiofrequency ablation (RFA) take to show results or shrinkage of the nodule?

✅ Ultrasound can categorize a nodule by low risk, intermediate, or high risk.

✅ Thyroidectomy comes with risks, including: vocal cord paralysis, bleeding, parathyroid damage, and nerve damage.

✅ Patients must educate themselves before seeing a doctor.

✅ About Dr. Larian

Babak Larian is a highly experienced, board certified Ear, Nose, & Throat Specialist and Head & Neck surgeon. Dr. Larian is the current Clinical Chief of the Division of Otolaryngology at Cedars-Sinai Hospital in Los Angeles (January 2012 – present).  He graduated with academic and humanitarian distinction, from UC Irvine School of Medicine. In 2002 after completing a 6-year residency program in Ear, Nose, & Throat (otolaryngology) and Head & Neck Surgery at UCLA, he began his professional career. He then went on to become a founding member and later the Medical Director of the Cedars-Sinai Head & Neck Center of Excellence (November 2009 – October 2011).

CONTACT

Email: info@larianmd.com

Phone: 310.461.0300

Website: https://https://www.parotidsurgerymd....

Hyperparathyroidism: 
https://www.hyperparathyroidmd.com/doctor-larian/ 

Facebook: https://www.facebook.com/parotidsurge...

Instagram: https://www.instagram.com/babaklarianmd/

✅ About Philip James

He is the host of the popular podcast: Doctor Thyroid

www.docthyroid.com

In 2013, his laryngeal nerve was severed, shoulder nerve damaged, parathyroids ruined, and residual cancer left behind — all for a 1 cm thyroid nodule.

Later, a vocal cord implant was inserted to help him speak.

All the above, the result of a bad thyroid surgery that dampened his quality of life — and left him wondering, what exactly happened — during what should be a low-risk surgery?

His attempts to follow up with UCLA and the UCLA surgeon were ignored.

He then turned to other doctors for answers — this was the beginning of the podcast:

"Doctor Thyroid with Philip James"

100+ episodes later, the Doctor Thyroid podcast is popular amongst patients; allowing them to access information from top doctors, without being limited by geography or economics.

The word he uses to describe his work as patient advocate is, 'tonglen'. Or, using his pain and hardship to help others.

When not producing podcast episodes or co-hosting live Q&As for patients with top doctors, he leads the creative team at Doctor Marketing and Philip James Media — a marketing agency dedicated to digital communications serving the sectors of healthcare, payments, and Greentech.

The Doctor Thyroid podcast is available in Spanish and English - and listened to in over 30 countries:

www.doctiroides.com (Spanish)

www.docthyroid.com (English)

✅Please email your requests to philip@philipjames.co

LinkedIn: www.linkedin.com/in/philip-james/

Facebook @docthyroid

YouTube @Doctor Thyroid

Twitter @docthyroid

Looking for a RFA doctor?

Search the RFA Directory:

www.rfamd.com

Hosted by Philip James.

Supported by www.rfamd.com.

Find an RFA doctor at www.rfamd.com 🔹🔹🔹

During this interview, the following topics are discussed:

→ Stanford University prioritizes anatomic structures, ultrasound, and how to best protect the laryngeal nerve

→ Pre- procedure ultrasound is instrumental in minimizing risk

→ Risk to the laryngeal nerve is minimal during RFA

→ Where to deliver heat is guided by ultrasound

→ If unintended consequences occurs during RFA, they are usually reversible

→ Most risk is affecting a patient's voice

→ Technique and space — away from structures — can be controlled with extra fluid

→ Dr. Noel has conducted 80+ RFA procedures at Stanford University

→ What should every practitioner know in regard to protecting the nerves?

→ Commitment to ultrasound anatomy is critical

→ Ultrasound guided procedures

→ The Stanford RFA team for conducting a procedure is one assistant MD or Fellow, medical assistant laying out equipment and vital signs

→ Patient due diligence when selecting an RFA doctor is key: it should include vetting providers for their experience with RFA → Ask if the doctor has done RFA procedures, what's the plan for follow up?

→ With RFA, are fewer thyroidectomies occurring?With RFA in clinic, patients now have more treatment options → "No hammers looking for nails"

→ Who is the ideal candidate for RFA?

→ Solitary, large, benign thyroid nodule is the ideal candidate → Cost is between $5000 - $10,000

→ Reduction in thyroid nodule size is up to 80%

→ RFA can be used for malignant nodules

→ Why did it take so long for the U.S. to adopt RFA?

FDA processes are laborious and time consuming

→ Is RFA painful? Generally "no"

→ RFA fills a void in treatment options for thyroid nodule

→ Preservation of thyroid function is key — the thyroid is preserved

→ Does insurance cover RFA treatment?

→ Sometimes the insurance company will cover the procedure through an appeal process

About Dr. Julia Noel

✅ TWITTER @JuliaNoelMD

✅ WEBSITE https://profiles.stanford.edu/julia-noel

✅ WEBSITE https://rfamd.com/julia-noel/

✅ Grand Rounds Video on YouTube https://www.youtube.com/watch?v=YeiOQ...

✅ About Philip James

✅ Instagram @philipjames360

✅ TWITTER @docthyroid

✅ LinkedIn @Philip James

✅ Website www.philipjames.co

✅ YouTube https://www.youtube.com/c/DoctorThyroid

 🔹🔹🔹

✅ ABOUT Philip James

I shared my story with many of you on my podcast: Doctor Thyroid www.docthyroid.com In 2013, my laryngeal nerve was severed, shoulder nerve damaged, parathyroids ruined, and residual cancer left behind — all for a 1 cm thyroid nodule.Later, a vocal cord implant was inserted to help me speak. The bad result of thyroid surgery dampened my quality of life → and left me wondering, what exactly happened → during what should be a low-risk surgery? My attempts to follow up with UCLA and the surgeon were ignored. So, I turned to other doctors for answers — this was the beginning of the podcast: "Doctor Thyroid with Philip James" 100+ episodes later, the Doctor Thyroid podcast is popular amongst patients; allowing them access to information from top doctors, without being limited by geography or economics. The word I use to describe my work as patient advocate is, 'tonglen'. Or, using my pain and hardship to help others. When not producing podcast episodes or co-hosting live Q&As for patients with top doctors, I lead the creative team at Philip James Media — we are a marketing agency dedicated to digital communications — serving the sectors of healthcare, payments, and Greentech. The Doctor Thyroid podcast is available in Spanish and English - and listened to in over 30 countries: www.doctiroides.com (Spanish) www.docthyroid.com (English) Please email your requests to philip@philipjames.co 🔹🔹🔹

During this episode the following topics are discussed:

✅we are treating malignant nodules with radiofrequency ablation therapy
✅We are using radiofrequency ablation therapy since 2006
✅it is something that we are really experiencing is the treatment of those malignant thyroid nodules with radiofrequency ablation
✅avoid the risk of thyroidectomy
✅surgeons must give patients all treatment options; including no surgery
✅there are some nodules malignant nodules, they are not amenable for radiofrequency due to position, size, or something like this
✅patient consultations take longer because there are more treatment options to consider
✅ the problem of taking the levothyroxine

✅About Dr. Leonardo Rangel
Staff da Universidade do Estado do Rio de Janeiro
Membro da Sociedade Brasileira de Cirurgia de Cabeça e Pescoço
Membro da Sociedade Americana de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço
Membro da Sociedade Latinoamericana de Tireoidologia

✅Facebook
Rangel MD - Cirurgia de Cabeça e Pescoço
@cabecaepescoco

✅Website
https://www.rfamd.com/leonardo-rangel/

✅ABOUT RFA MD
A guide for locating doctors of radiofrequency ablation. Find radiofrequency ablation doctors from across the world.
rfamd.com

✅
Facebook
@RFADOCTOR

✅
Instagram
@RFADOCTOR

✅
LinkedIn
@rfa-doctor-directory

✅
Twitter
@RFADOC

✅
Internet
www.rfamd.com

✅ ABOUT Philip James
He is the host of the popular podcast: Doctor Thyroid
www.docthyroid.com
🔹
In 2013, his laryngeal nerve was severed, shoulder nerve damaged, parathyroids ruined, and residual cancer left behind — all for a 1 cm thyroid nodule.
Later, a vocal cord implant was inserted to help him speak.
🔹
All the above, the result of a bad thyroid surgery that dampened his quality of life — and left him wondering, what exactly happened — during what should be a low-risk surgery?
🔹
His attempts to follow up with UCLA and the UCLA surgeon were ignored.
He then turned to other doctors for answers — this was the beginning of the podcast:
"Doctor Thyroid with Philip James"
🔹
100+ episodes later, the Doctor Thyroid podcast is popular amongst patients; allowing them to access information from top doctors, without being limited by geography or economics.
🔹
The word he uses to describe his work as patient advocate is, 'tonglen'. Or, using his pain and hardship to help others.
🔹
When not producing podcast episodes or co-hosting live Q&As for patients with top doctors, he leads the creative team at Doctor Marketing and Philip James Media — a marketing agency dedicated to digital communications serving the sectors of healthcare, payments, and Greentech.
🔹
The Doctor Thyroid podcast is available in Spanish and English - and listened to in over 30 countries:

www.doctiroides.com (Spanish)🔹
www.docthyroid.com (English)🔹

✅Please email your requests to philip@philipjames.co

✅Instagram
@PhilipJames360

✅
LinkedIn
www.linkedin.com/in/philip-james/

✅
Facebook
@docthyroid

✅
YouTube
@Doctor Thyroid

✅
Twitter
@docthyroid

✅
Are you looking for an RFA doctor?
Find one here:
www.rfamd.com

Radiofrequency Ablation 🛑 REMOVE Thyroid Nodules 🛑 NO SURGERY 🛑 Dr Ralph Tufano

During this podcast, the following topics are discussed:
✅advocate for patients to be as well informed as possible and consider all treatment options for thyroid problems, including avoiding surgery whenever possible and radiofrequency ablation.
✅ five thousand dollars out of pocket and save your thyroid with radiofrequency ablation or thyroidectomy and maybe nothing out of pocket with an insurance paid thyroidectomy?
✅if there are isn't if there are options available if there is an option available to avoid surgery and it gives you an equivalent outcome or maybe even better outcome why wouldn't you choose radiofrequency ablation?

✅with radiofrequency ablation now it's exciting because for thyroid nodules they can be removed without doing surgery
✅before radiofrequency ablation all you had was surgery really and obviously with surgery we talked about the possible risks of surgery and of course probably more concerning sometimes to a lot of people is if you take out half of the thyroid even if you're functioning normally with thyroid your thyroid levels you're having normal thyroid function 25% of those patients will still need thyroid hormone
✅the beauty of radiofrequency ablation is that first of all in most circumstances it's no general anesthesia you can do it in the office much like when you go to your dentist and maybe you're getting a cavity filled you get novocaine or lidocaine to numb up the neck area and then under guidance with an ultrasound you take a needle
✅the beauty of that is that the overwhelming majority of times radiofrequency ablation does not change your thyroid function so think about it we're talking about an invasive procedure surgery general anesthesia complication risk
✅ they have a thyroid problem goiter or a nodule that can be treated by radiofrequency ablation that they seriously consider radiofrequency ablation in preserving the thyroid as a treatment option versus a surgery or a thyroidectomy
✅radiofrequency ablation is very effective and more effective than surgery in fact in ablating and controlling papillary micro-cancer without any real complications
✅radiofrequency ablation seems to be a little more focused and maybe a little bit more able to control that destructive process in that area so you can protect those important structures

✅About Dr. Ralph Tufano

Dr. Ralph P. Tufano is the Director of the Division of Head and Neck Endocrine Surgery and conducts thyroid and parathyroid surgery with a focus on optimizing outcomes. He is a recognized world authority on the management of thyroid cancer, thyroid nodules, benign thyroid diseases and parathyroid disease. He has expertise in the management of thyroid cancer nodal metastases, advanced and invasive thyroid cancers as well as recurrent thyroid cancers. His work in molecular markers, improving surgical outcomes, nerve monitoring and exploring novel treatment techniques for thyroid and parathyroid diseases has helped the medical field tailor and personalize treatment for patients with these conditions.
Dr. Tufano has performed every type of minimally invasive endoscopic and robotic thyroid and parathyroid surgery over the years and was director of the initial team that developed the now internationally accepted approach for the scarless transoral thyroidectomy and parathyroid surgery.

Website
https://rfamd.com/doctors/dr-ralph-tufano/

✅ABOUT RFA MD
A guide for locating doctors of radiofrequency ablation. Find radiofrequency ablation doctors from across the world.
rfamd.com

✅
Facebook
@RFADOCTOR

✅
Instagram
@RFADOCTOR

✅
LinkedIn
@rfa-doctor-directory

✅
Twitter
@RFADOC

✅
Internet
www.rfamd.com

✅ ABOUT Philip James
He is the host of the popular podcast: Doctor Thyroid
www.docthyroid.com
🔹
In 2013, his laryngeal nerve was severed, shoulder nerve damaged, parathyroids ruined, and residual cancer left behind — all for a 1 cm thyroid nodule.
Later, a vocal cord implant was inserted to help him speak.
🔹
100+ episodes later, the Doctor Thyroid podcast is popular amongst patients; allowing them to access information from top doctors, without being limited by geography or economics.
🔹
The word he uses to describe his work as patient advocate is, 'tonglen'. Or, using his pain and hardship to help others.
🔹
The Doctor Thyroid podcast is available in Spanish and English - and listened to in over 30 countries:

www.doctiroides.com (Spanish)🔹
www.docthyroid.com (English)🔹

✅Please email your requests to philip@philipjames.co

✅Instagram
@PhilipJamesMedia

✅
LinkedIn
www.linkedin.com/in/philip-james/

✅
Facebook
@docthyroid

✅
YouTube
@Doctor Thyroid

✅
Twitter
@docthyroid

✅
¿Está buscando un médico RFA?
Encuentre un médico aquí:
www.rfamd.com

RFA for benign nodules, for cystic nodules, for hyper functioning nodules, benign nodules, and now for malignant micro-papillary tumors.

During this episode the following topics are discussed:

The six steps that go into the RFA

STEP 1: setup of the patient. The setup of the patient is in an operatory room -- the safety of a operatory room is by far greater than the setting of an ambulatory room so

STEP 2: prepare for anesthesia.

STEP 3: electrode needle insertion; it is done at the point exactly at the point transistorically...

Step 4: preparation in regard to the laryngeal nerve…. the laryngeal nerve is the most delicate point. The laryngeal nerve may be cooled.

Step 5: extraction; simply take out the needle and at the same time it must. Use compression; avoids bleeding both internal and external

Step 6: Final check.

✅ About Roberto Valcavi

20 years and 1800+ RFA procedures done; laser since 2000
and radiofrequency ablation starting in 2010.

✅ www.rfamd.com/roberto-valcavi/

✅ABOUT RFA MD
A guide for locating doctors of radiofrequency ablation. Find radiofrequency ablation doctors from across the world.
rfamd.com

✅
Facebook
@RFADOCTOR

✅
Instagram
@RFADOCTOR

✅
LinkedIn
@rfa-doctor-directory

✅
Twitter
@RFADOC

✅
Internet
www.rfamd.com

✅ ABOUT Philip James
He is the host of the popular podcast: Doctor Thyroid
www.docthyroid.com
🔹
In 2013, his laryngeal nerve was severed, shoulder nerve damaged, parathyroids ruined, and residual cancer left behind — all for a 1 cm thyroid nodule.
Later, a vocal cord implant was inserted to help him speak.
🔹
All the above, the result of a bad thyroid surgery that dampened his quality of life — and left him wondering, what exactly happened — during what should be a low-risk surgery?
🔹
His attempts to follow up with UCLA and the UCLA surgeon were ignored.
He then turned to other doctors for answers — this was the beginning of the podcast:
"Doctor Thyroid with Philip James"
🔹
100+ episodes later, the Doctor Thyroid podcast is popular amongst patients; allowing them to access information from top doctors, without being limited by geography or economics.
🔹
The word he uses to describe his work as patient advocate is, 'tonglen'. Or, using his pain and hardship to help others.
🔹
When not producing podcast episodes or co-hosting live Q&As for patients with top doctors, he leads the creative team at Doctor Marketing and Philip James Media — a marketing agency dedicated to digital communications serving the sectors of healthcare, payments, and Greentech.
🔹
The Doctor Thyroid podcast is available in Spanish and English - and listened to in over 30 countries:

www.doctiroides.com (Spanish)🔹
www.docthyroid.com (English)🔹

✅Please email your requests to philip@philipjames.co

✅Instagram
@PhilipJamesMedia

✅
LinkedIn
www.linkedin.com/in/philip-james/

✅
Facebook
@docthyroid

✅
YouTube
@Doctor Thyroid

✅
Twitter
@docthyroid

✅
Are you looking for an RFA doctor?
Find one here:
www.rfamd.com

Dr. Clayman has performed more than four hundred thyroid cancer operations per year for over twenty years among patients ranging from 6 months to 100+ years of age. Nearly half of Dr. Clayman's patients have undergone failed initial surgery for their thyroid cancer by another surgeon or have recurrent, persistent, or aggressive thyroid cancer. If it pertains to thyroid surgery or thyroid cancer, there is likely nothing that he hasn't seen.

Dr. Clayman left the M. D. Anderson Cancer Center in the fall of 2016 to form the Clayman Thyroid Cancer Center in Tampa, Florida

If someone is considering surgery, Dr. Clayman discusses important topics, including:

• Do not let a doctor operate on you unless the surgeon can prove to you that he/she has done a minimum of 150 annual thyroid surgeries, and for a minimum of ten years.  This means, do not see a surgeon unless he/she has completed a minimum of 1500 thyroid surgeries. 
• Damage to voice box nerves is preventable, when surgery is done right.
• 90% of thyroid surgeries done in the U.S. are by doctors doing fewer than fifteen thyroid surgeries per year
• There is a growing trend of patients being more informed compared to years past
• Do not rush into a surgery.  Vet your doctor and hospital.  Talk to people and make sure you have selected a skilled surgeon 
• Surgery is not franchisable, use caution when
• If a case is too complex, important that a less experienced surgeon seek help from a more experienced surgeon
• Incomplete surgery is completely unacceptable (persistence of disease)
• Advice to surgeons, especially less-experienced ones

Other Doctor Thyroid episodes referenced during this interview:

The Financial Burden of Thyroid Cancer with Dr. Jonas de Souza from The University of Chicago Medicine

The Parathyroid, and a Safer — Less-Scarring Thyroid Surgery with Dr. Babak Larian from Cedars-Sinai

A Must Listen Episode Before Getting Surgery – Do Not Do It Alone, with Douglas Van Nostrand from MedStar Washington Hospital

SHOW NOTES:

Dr. Gary Clayman

Thyroid Cancer Overview

Book: Atlas of Head and Neck Surgery

Health Grades

Zoc Doc

The American Thyroid Association

For their most recent research, Aschebrook-Kilfoy and Grogan recruited 1,174 thyroid cancer survivors – 89.9 percent female with an average age of 48

After treatment, thyroid cancer survivors face a lifetime of cancer surveillance and an anxiety-inducing high rate of recurrence, which could contribute to their findings.

"The goal of this study is to turn it into a long-term, longitudinal cohort," said Grogan, who hopes to develop a tool that physicians can use to assess the psychological wellbeing of thyroid cancer survivors. "But, there was no way to do that with thyroid cancer because no one had ever studied quality of life or psychology of thyroid cancer before."

In this episode, we will explore:

The spiritual, social, psychological, and physical impacts of thyroid cancer.  Some of the sometimes over-looked physical impacts include dry mouth, voice problems, dry eyes, dental problems, fatigue, dry skin,  and hypoglycemia.  

What happens to vocal cords after surgery?  Even when not paralyzed, quality of voice is effected. 

Often times, family members don't take treatment seriously.  Society, healthcare professionals, and the media have minimized thyroid cancer, and in return has made patients feel minimized.

Anxiety about reoccurrence, RAI treatment, and self-concept, influence quality of life for thyroid cancer patients.

A 2011 study by Aschebrook-Kilfoy and Grogan found that thyroid cancer, which is most common in women, will double in incidence by 2019.

Dr. Spencer's major areas of research interest are thyroid physiology and pathology, thyroglobulin and thyroid cancer, immunoassay techniques, thyroid hormone metabolism, and the cost-effective use of thyroid tests. Her current research includes clinical significance of Tg and TgAb in patients with thyroid cancers, parameters for optimizing thyroid hormone suppression of TSH for DTC. Studies on hypothalamic/pituitary mechanisms for regulating TSH, and testing for thyroid dysfunction during pregnancy.

Dr. Spencer earned her PhD from Glasgow University in Scotland. She then went on to complete two fellowships, one in Clinical Biochemistry at Glasgow, and the other at the National Academy of Clinical Biochemistry.  

resources:

www.thyroidlab.com/updates

Dr. Breen completed a residency with Dr. Gary Weiner at Pearl Natural Health and continues to see patients at this location.  Her training and expertise in the areas of IBD/IBS, thyroid health, bio-identical hormones, gynecology, IV therapy, herbal, nutritional and lifestyle changes offers people a holistic, integrative and comprehensive model of care.

Dr. Breen is a wife and mother of two children.  She enjoys living in the Pacific Northwest where she hikes, snow skis, and gardens.  She has a special love for animals, including her two cats, fermented foods and Tabata workouts.

In this episode, the following topics are discussed:

• Fatigue, hair loss, weight gain, anxiety, and depression.
• Sub-clinical hypothyroidism
• Standard range for TSH has changed over the years, .5 - 1.5 TSH is optimal
• Armour Thyroid vs Levothyroxine
• If antibodies are involved than it is most likely related to the gut
• Getting off thyroid medication
• Testing: TSH, free T3 T4, TPO antibodies, reverse T3
• Getting motivated and inspired by fixing thyroid
• Selenium
• Iodine
• Thyroid supplements
• Treating fertility
• Hair loss and levothyoxine
• Joint pain and levothyroxine 
• Nature vs Armour
• Magnesium interfering with T4
• Analysis of gut and assessment: bad breath, burping, etc.
• Stool testing for SIBO
• Progesterone and testosterone
• Testing for adrenal fatigue through saliva throughout the day
• Cortisol secretion related to grief or stress
• Desiccated bovine adrenal
• Graves' disease and testosterone fix
• Breath tests and pathogens
• Microflora
• Digestive and thyroid health are connected
• Bowel movement frequency and constipation
• Whole foods and unprocessed foods
• Sugar, inflammation, and heart disease
• Homemade yogurt and cow's milk and removing lactose, fixing bloating
• Food allergy testing
• Achy joints, painful feet, anemia, cramping, testosterone and estrogen, neuro-therapy, ozone therapy, acupuncture, blood flow, dizziness, hydration, lyme disease, and muscle spasms.

NOTES:

Mysymotoms.com

Susanne Breen, N.D.

Can adding adjusting your medication from T4 to slow release with T3 really make you feel better?  The answer is, yes!  And, could also be the key to losing weight.

We also discuss the following topics, painful feet, dizziness, fatigue, hair loss, iron deficiency, chronic pain, fibromylagia, adrenal connection to to inflammation, sleep problems, muscle spasms, caution with your morning smoothies, and why you should stand up when taking T3.

Want to find a compounding pharmacy that will make your slow release T3 and T4?  Start here:  http://www.pccarx.com/     

Dr. Milner has published several articles on new treatment protocols for hypothyroidism. Most recently, " Hypothyroidism: Optimizing Medication with Slow-Release Compounded Thyroid Replacement" was published in the peer review journal of compounding pharmacists, International Journal of Pharmaceutical Compounding (IJPC) Vol. 9 No. 4 July/August 2005. In 2006 and 2007 he lectured around the United States guiding physicians and compounding pharmacists in the management of hypothyroidism using his protocol of slow released compounded thyroid replacement. Also to his credit are "Wilson's Syndrome and T3 therapy – A Clinical Guide to Safe and Effective Patient Management" IJPC Vol. 3 No. 5, Sept/Oct 1999, p. 344-349 and Assessment and Management of Thermoregulation, IJPC Vol. 3 No. 5, Sept/Oct 1999, p. 350-351. Reprints of many of these and other Dr. Milner articles are available at CNMWellness.com, the medical education website of the Center for Natural Medicine. Dr. Milner co-authored chapter 14 in An Alternative Medicine Definitive Guide to Cancer by J. Diamond and W.L. Cowden, the most definitive text on alternative cancer therapies. He also served as the primary consulting physician for Judith Sach's book Natural Medicine for Heart Disease. The has authored many articles over the years in cardiology.

Dr. Milner is well published with texts, medical journal articles and studies in cardiology, endocrinology, pulmonology, oncology, and environmental medicine. Dr. Milner published in May 2005, Menopause Revolution: Smashing the HRT Myth- Alternatives to Manufactured Drug Therapy , Agora Health Books. He enjoys what he calls practicing "integrated endocrinology" balancing all the endocrine hormones using bio-identical hormone replacement and amino acid neurotransmitter precursors.

His specialty is nuclear medicine, and his primary area of interest and expertise is the nuclear medicine diagnosis and treatment of thyroid cancer. He has held numerous academic and medical society positions including Clinical Professor of Radiology and Nuclear Medicine, Uniformed Services University of Health Sciences; past President, Mid-Eastern Society of Nuclear Medicine, Director of Continuing Medical Education Department, and other elected positions of the Medical Staff of Good Samaritan Hospital. He has over 150 articles published and has been the co-editor of seven medical books including the medical textbook entitled Thyroid Cancer, A Comprehensive Guide to Clinical Management.

In this episode, get the critical questions to ask prior to committing to a surgeon.  And, other useful strategies to make sure a patient gets the best outcome possible.  

Are you a patient and your doctor has said your thyroid nodule is indeterminate and is recommending surgery as an option?  The key is, to confirm that molecular profiling was performed.   

Jennifer Kuo, MD is Director of the Thyroid Biopsy Program, Director of the Endocrine Surgery Research Program, and Instructor in Surgery, at the Columbia University Medical Center. Dr. Kuo received her medical degree from the College of Physicians and Surgeons at Columbia University and completed surgical training at the University of California, Davis Medical Center, in Sacramento.  Her new position follows completion of her clinical fellowship in the Department of Surgery, Division of Endocrine Surgery. Dr. Kuo has clinical expertise in minimally invasive endocrine surgery and fine-needle thyroid biopsy and is dedicated to the advancement of the field of endocrine surgery.

NOTES:

Dr. Jennifer Kuo

Afirma - Veracyte

RELATED DOCTOR THYROID EPISODES

23: You Have a Thyroid Nodule, What Happens Next? with Dr. Regina Castro from The Mayo Clinic

• Hypothyroidism symptoms — including physical, mental, and emotional.
• How to find the right health professional.
• Hypothyroidism treatment with T3.
• The importance of iron and ferritin. 
• The emotional toll of hypothyroidism. 
• Nutrition strategies. 
• Basal body temperature method for testing hypothyroidism.

Elle Russ is a writer, health/life coach, and host of the Primal Blueprint Podcast. She is becoming the leading voice of thyroid health in the burgeoning Evolutionary Health Movement (also referred to as Paleo, Primal, or Ancestral Health). Elle has a B.A in Philosophy from The University of California at Santa Cruz and is a certified Primal Health Coach. She sits on the advisory board of The Primal Health Coach Program created by Mark Sisson, bestselling author of The Primal Blueprint.  Exasperated and desperate, Elle took control of her own health and resolved two severe bouts of hypothyroidism on her own – including an acute Reverse T3 problem. Through a devoted paleo/primal lifestyle, intensive personal experimentation, and a radically modified approach to thyroid hormone replacement therapy…Elle went from fat, foggy, and fatigued – to fit, focused, and full of life!

NOTES:
Elle Russ web site

http://www.elleruss.com/

Primal Blueprint Podcast

http://blog.primalblueprint.com/

Yahoo Natural Thyroid Support Group

https://beta.groups.yahoo.com/neo/groups/NaturalThyroidHormones/info

Thyroidectomy often leads to hypothyroidism-like symptoms.  This includes brain fog, sluggishness, weight gain, unmotivated, and water accumulation. 

Dr. Bianco's research has revealed the connection between thyroidectomy, hypothyroidism symptoms, and T4 only therapy.  Although T4 only therapy works for the majority, others report serious symptoms.  Listen to this segment to hear greater detail in regard to the following topics:

Combination therapy of adding T3 to T4

85% of patients on Synthroid feel fine.

Nearly 5% of the U.S. population takes T4, as revealed by the NHANE survey

Residual symptoms of thyroidectomy include depression, difficulty losing weight, poor motivation, sluggishness, and lack of motivation.  For some, there is no remedy to these symptoms. 

The importance of physical activity and its benefit in treating depression

If we normalize T3 does it get rid of hypothyroid symptoms?

Overlap between menopause and hypothyroidism symptoms

Dr. Antonio Bianco, Rush University Medical Center as professor of medicine, senior vice chair in the Department of Internal Medicine and division chief of endocrinology at Rush University Medical Center.  He has more than 30 years of experience in thyroid research.

Bianco's research interests have been in the cellular and molecular physiology of the enzymes that control thyroid hormone action in which he contributed more than 200 papers, book chapters and review articles, and lectured extensively both nationally and internationally.

Recently, he has focused on the aspects of the deiodination pathway that interfere with treatment of hypothyroid patients, a disease that affects more than 10 million Americans. He is Director of Bianco Labs.

Notes:

Bianco Lab

http://deiodinase.org/

Bianco Lab on Facebook

https://www.facebook.com/biancolab/

NHANES Survey

The National Health and Nutrition Examination Survey (NHANES) is a program of studies designed to assess the health and nutritional status of adults and children in the United States. The survey is unique in that it combines interviews and physical examinations.

https://www.cdc.gov/nchs/nhanes/

In this episode, we visit with Dr. hypothyroidism, a pioneer in prescribing active surveillance in place of immediate surgery.    

Dr. Miyauchi is President and COO of Kuma Hospital, Center for Excellence in Thyroid Care, Kobe, Japan. He is an endocrine surgeon, especially interested in thyroid and parathyroid diseases. He earned his MD and PhD at Osaka University Medical School in 1970 and 1978, respectively. He was Associate Professor of Department of Surgery, Kagawa Medical University until he was appointed to Vice President of Kuma Hospital in 1998. Since 2001, he is at his present position. About 2,000 operations, including about 1,300 thyroid cancer cases, are done every year at Kuma Hospital. He is currently serving as Chairman of the Asian Association of Endocrine Surgeons. He also served as Council of the International Association of Endocrine Surgeons until August 2015.

Topics covered, include:

• Incidence versus mortality
• Worldwide trends related to thyroid cancer
• Papillary Microcarcinoma of the Thyroid (PMCT)
• Unfavorable events following immediate surgery
• Results of research which began in 1993
• The current trend in the incidence of thyroid cancer is expected to create an added cost of $3.5 billion by 2030, to the individual and as a society.

NOTES

Akira Miyauchi, MD, PhD (Kuma Hospital)

• the emotional burden of being diagnosed with cancer and the haste that sometimes follows
• the unnecessary damage of thyroid surgery, including the cutting of the laryngeal nerve resulting in vocal cord paralysis, low calcium levels and a need to supplement calcium and Vitamin D for life, and leaving residual disease behind
• knowing your risk factor and finding the right medical team to address it

Dr. Ralph P. Tufano is the Director of the Division of Head and Neck Endocrine Surgery at The Johns Hopkins School of Medicine, and conducts thyroid and parathyroid surgery with a focus on optimizing outcomes.  He is a recognized world authority on the management of thyroid cancer, thyroid nodules, benign thyroid diseases and parathyroid disease.  He has expertise in the management of thyroid cancer nodal metastases, advanced and invasive thyroid cancers as well as recurrent thyroid cancers.  His work in molecular markers, improving surgical outcomes, nerve monitoring and exploring novel treatment techniques for thyroid and parathyroid diseases has helped the medical field tailor and personalize treatment for patients with these conditions.  He is a Charles W. Cummings Professor, sits on the American Thyroid Association Board of Directors, is Director of the Division of Head and Neck Endocrine Surgery, and is a part of the Department of Otolaryngology-Head and Neck Surgery.  He conducts approximately 450 thyroid surgeries annually.  

NOTES:

American Thyroid Association

Dr. Ralph P. Tufano

Doctor Thyroid past episodes

• Better treatment options for thyroid disease
• Better testing for thyroid disease
• Mental challenges
• Juggling career and Hashimoto's
• The word insignificant
• The role of T3 and biological connections
• Diagnosed at twelve years old
• Disappearing eyebrows
• You can't have thyroid disease because you're not overweight
• Always cold
• Depression and anxiety
• Integrative medicine
• High TSH levels
• The myth of fork to mouth disease
• Armour Thyroid
• Cold intolerance
• Saliva testing and cortisol levels
• Lyme disease
• The problem of testing TSH levels only

NOTES

Thyroid Change Resources

Website:  www.ThyroidChange.org
Facebook:  www.facebook.com/ThyroidChange
Twitter:   www.twitter.com/ThyroidChange

• 60% of the U.S. population has thyroid nodules

• Discovered when evaluating other neck issues such as an unrelated pain

• What happens when you are told you have a thyroid nodule?

• How to know if your thyroid nodule is cancerous?

• When is surgery done despite the nodule being benign?

• Decreasing patient anxiety with quick biopsy results

• The American Thyroid Association as a resource for patients and physicians

• A word of caution about sourcing medical information from online resources

Dr. M Regina Castro is an endocrinologist in Rochester, Minnesota and is affiliated with Mayo Clinic. She received her medical degree from Central University of Venezuela and has been in practice for more than 20 years. Dr. Castro accepts several types of health insurance, listed below. She is one of 78 doctors at Mayo Clinic who specialize in Endocrinology, Diabetes & Metabolism. She also speaks multiple languages, including Spanish and French.

NOTES:

M. Regina Castro, M.D.

THYROID NODULES —  Thyroid nodule size larger than 4 cm does not increase the risk of false negative biopsy results or the risk of cancer

American Thyroid Association 

In this episode, Dr. Wartofsky discusses the following:

• Hypothyroidism causes
• When is replacement thyroid hormone necessary?
• The history of replacement thyroid hormone going back to 1891
• The early treatment included a chopped up sheep thyroid and served as a 'tartar', often resulting in vomiting
• Myxedema coma
• The danger of taking generic T4; are cheaper, larger profit margin, but the content varies.
• Synthroid versus generic
• Manufacturing plants in Italy, India, Puerto Rico are known to produce generics
• Content versus absorption when taking generic T4
• An explanation of TSH
• 1.39 is a healthy TSH level for women in the U.S.
• Symptoms of hypothyroidism, such as a slow mind, poor memory, dry skin, brittle hair, slow heart rate, problems with pregnancy, miscarriage, and hypertension.
• Screening TSH levels if contemplating pregnancy
• T4 is the most prescribed drug in the U.S.
• Hypothyroidism is common when there is a family history
• Auto-immune disease is often associated with hypothyroidism
• An explanation of T3
• An explanation of desiccated thyroid
• The T3 'buzz'
• Muhammed Ali's overdose of T3
• Dangers of too much T3
• When to take T4 medication, and caution toward taking mediations that interfere with absorption
• Coffee and thyroid hormone absorption
• Losing muscle and bone by taking too much thyroid hormone
• Taking ownership of your disease

Related episodes:

37: Adding T3 to T4 Will Make You Feel Better? For Some the Answer is 'Yes' with Dr. Antonio Bianco from Rush University

NOTES

Leonard Wartofsky

American Thyroid Association

In this episode Dr. Bauer shares the complexities of managing children with thyroid nodules, and differentiated thyroid cancer.  This is a must listen interview for parents whose child has a thyroid nodule or thyroid cancer diagnosis. 

There are a several important differences in how pediatric thyroid nodules and differentiated thyroid cancer (DTC) present and respond to therapy. Kids are less frequently diagnosed with a thyroid nodule; however, the risk for malignancy is four- to fivefold higher compared with an adult thyroid nodule. For DTC (specifically papillary thyroid cancer), more than 50% of pediatric-aged patients will have metastases to cervical lymph nodes at the time of diagnosis, but because the tumors typically retain the ability to absorb iodine (retain differentiation), disease-specific mortality is very low, with > 95% of pediatric patients surviving from the disease. This is true even for children with pulmonary metastases, which occur in approximately 15% of patients who present with lateral neck disease.

With the high risk for malignancy and the invasive potential of the cancer, there has been a stronger tendency to take kids with thyroid nodules to the operating room (OR) and to administer RAI to those found to have DTC. With a greater realization of the increased risk for surgical complications as well as the short- and long-term complications of RAI treatment, the guidelines emphasize the need for appropriate preoperative assessment of nodules, and the approach to surgical resection, and they provide a stratification system and guidance for surveillance to identify which patients may benefit from RAI. The stratification system, called the "ATA pediatric risk classification," is not designed to identify patients at risk of dying of disease; it is designed to identify patients at increased likelihood of having persistent disease.

We have known about these differences for years, but the approach to evaluation and care has never been summarized into a pediatric-specific guideline. The adult guidelines aren't organized to address the differences in presentation, and the adult staging systems are targeted to identify patients at increased risk for disease-specific mortality. So, the adult guidelines are not transferable to the pediatric population.

NOTES:

Dr. Andrew Bauer

American Thyroid Association

RAI treatment may vary depending on the hospital.   For example, in this interview you hear protocol for RAI at Cedars Sinai. 

In this interviews, Dr. Alan Waxman explains what occurs leading up to, during, and after RAI.   Topics discussed include:

• If staying at the hospital after taking RAI, how long is the stay required?
• Should you go home after RAI?
• What is the benefit of staying overnight at the hospital when receiving RAI?
• Worldwide trends toward prescribing lower doses of RAI.
• Is there risk in RAI causing leukemia?
• The importance of ultrasound prior to administering RAI of done.
• The need to stimulate TSH prior to administering RAI.
• Withdrawal versus injections in raising TSH levels.
• Damage to salivary glands. 

Alan D. Waxman, MD is Director of Nuclear Medicine at the S. Mark Taper Foundation Imaging Center at Cedars Sinai. He is also a member of the Saul and Joyce Brandman Breast Center – A Project of Women's Guild and the Thyroid Cancer Center at Cedars-Sinai Medical Center. He is a clinical professor of radiology at Los Angeles County + University of Southern California (USC) Medical Center. Dr. Waxman's participation in research has led to the development of many new imaging techniques and equipment adaptations. A leading expert in nuclear medicine imaging, Dr. Waxman has directed efforts to develop innovations in whole-body tumor imaging using new and existing radiolable compounds. Dr. Waxman is an active member and officer of the Society of Nuclear Medicine. He has authored numerous publications and lectured extensively throughout the world. Dr. Waxman is a graduate of the USC Medical School, where he completed his postgraduate training. He also completed a clinical research fellowship at the National Institutes of Health.

NOTES:

Dr. Alan Waxman

Salivary gland toxicity after radioiodine therapy for thyroid cancer.

Blog by Philip James

American Thyroid Association

RELATED EPISODES

34: What Happens When Thyroid Cancer Travels to the Lungs? with Dr. Fabian Pitoia from the Hospital of University of Buenos Aires

30: Thyroid Cancer and Children with Dr. Andrew Bauer from the Perelman School of Medicine, U of Pennsylvania

After, completing her Ph.D. in Cancer Biology, she became a thyroid cancer research fellow at Memorial Sloan-Kettering Cancer Center in the Human Oncology and Pathogenesis Program.

Dr. Franco is a survivor of thyroid cancer, and balances her research as a mom and competitive triathlete. 

in this interview we explore the following:

Does thyroid cancer have a good prognosis compared to other cancers because its different or because we are aggressive with surgery and radiation therapy?

What were some personal insecurities when facing thyroid cancer surgery?

What are the questions in regard to TSH that the medical community is overlooking?
Which prescription medication works best?

How often and when should thyroid blood markers be tested?

You may find Dr. Franco here, http://physiology.uams.edu/faculty/aime-franco/

• Self-discovered thyroid nodule
• Diagnosed thyroid nodule
• FNA and biopsy
• 5 cm nodule
• Juice cleanse and no more red meat
• 3 hour surgery
• Regret about a Friday afternoon surgery
• Outpatient surgery
• Vocal cord paralysis
• Impact of vocal cord paralysis
• RAI six weeks post surgery - 176 mc
• RAI diet
• A positive and optimistic approach to the disease
• Surgeon did not present consequences of thyroid surgery
• Ran cross-country in high school

In this episode, the following topics are discussed:

• Broadway musical and tour
• Voice used during work as a performer, singing and acting
• Diagnosed with thyroid cancer while going to the doctor for a minor back strain
• MRI on back lead to discovery of thyroid nodules
• A scare, at one point being told cancer could be medullary
• BETHESDA scale
• Book by Dr. Gilbert Welch
• Incidental findings
• Watch and wait or active surveillance as an option to removing your thyroid
• Conflicting and inconsistent information from healthcare professionals to the patient
• Maximilaist or minimalist
• Cultivating a wherewithal to ask questions, even when being told something by a healthcare professional
• Dr. Atul Gawande
• Dr. Henry Marsh
• Choosing active surveillance and then feeling isolated or alienated
• Sharing selectively
• The importance of Google and Twitter and searching 'papillary thyroid cancer'

NOTES

Regarding Thyroid Cancer, Are You a Minimalist or a Maximalist? with Dr. Michael Tuttle from Sloan Kettering

Diagnosed with Thyroid Cancer and You Say No to Surgery with Dr. Louise Davies

Avoiding Thyroid Cancer Surgery, Depending on the Size with Dr. Miyauchi from Kuma Hospital in Kobe, Japan

1 in 3 People Die With Thyroid Cancer — Not From with Dr. Seth Landefeld from UAB

Rethinking Thyroid Cancer – When Saying No to Surgery Maybe Best for You with Dr. Allen Ho from Cedars-Sinai in Los Angeles

American Thyroid Association

Overdiagnosed: Making People Sick in the Pursuit of Health

Best Time of Day to Take Your Thyroid Medication and Other Questions for the Endocrinologist with Wendy Sacks, M.D. from Cedars Sinai

Jody Gelb

blog

Twitter

In addition to his extensive academic and clinical activities, Dr. Farwell has been extremely active and served in multiple capacities in the ATA, including as Chair of the Education Committee and the Patient Education and Advocacy Committee, and as a member of the Program Committee and the Website Task Force Publications Committee. He has served two terms on the ATA Board of Directors, is the founding and current Chair of the ATA Alliance for Patient Education. 

Dr. Farwell has been an Associate Editor and member of the Editorial Board of Thyroid, and since 2009 has been Editor-in-Chief of Clinical Thyroidology for the Public.

In this interview, we discuss the following topics:

• Thyroid surgery and RAI sometimes results in hypothyroidism
• Most common cause is Hashimoto's disease
• Explanation of overactive and underactive thyroid
• Weight gain, dry skin, constipation
• Very few symptoms unique to hypothyroidism
• Sleep apnea and being tired all of the time and weight gain.
• Brain fog and difficulty concentrating
• Blood tests diagnose hypothyroidism based on TSH levels, when elevated means it is not working too well.
• Explaining TSH in laymen's terms
• Normal TSH in the U.S. is .3 to 3.5
• Treating for feel rather than a number
• People with elevated TSH have many of the hypothyroid symptoms, but people with normal TSH levels may also have hypothyroid symptoms
• Sleep disturbances such as apnea and anemia can be disguised as hypothyroidism
• Historical explanation of hypothyroidism treatment
• About 10% of patients do not respond to Levothyroxin
• Explanation of desiccated thyroid, including pig and cow
• Dr. Jacqueline Jonklaas, PCORI Grant will look at a study, head to head, Levothyroxin versus desiccated
• Adding T3 to T4 treatment
• Discussing Dr. Bianco's research and deiodinases enzyme
• A discussion of celiac disease and gluten
• Explanation of auto-immune disorders, where the thyroid is attacked by the bodies own antibodies
• Physical symptoms of hypothyroidism are goiters, sluggishness, fatigue, dry skin, lateral eyebrows to disappear, the tongue can get thick, puffiness, swelling in legs, face, and around eyes.  With proper treatment, these are reversible.

NOTES

Dr. Antonio Bianco

Dr. Jacqueline Jonklaas

American Thyroid Association

Dr. Brady was named director of endocrine surgery for the new medical school in Austin. She was also recently chosen to teach general surgeons seeking additional training in endocrine surgery. Dr. Brady instructs these endocrine surgeons from the Baylor Scott and White fellowship program.

In this episode the following topics are discussed:

• Austin Thyroid Surgeons sees 30 patients per week with thyroid nodules
• Up to 80% of US population could have a thyroid nodule(s)
• less than 5% of Dr Brady's thyroid nodule patients test positive for cancer
• How relevant is what I don't know won't hurt me in thyroid cancer and biopsies of nodules?
• BETHESDA system or the middle category, also known as indeterminate
• For thyroid nodules that are indeterminate, historically a surgery would be performed 
• With molecular testing, surgery can be decreased by up to 50%
• Afirma molecular testing uses messenger RNA
• If Afirma comes back suspicious it does NOT necessarily mean it is cancer
• Insurance covers molecular testing
• Nest steps for a doctor who would like to incorporate molecular testing
• Suspicious results with molecular testing can still be benign on final pathology
• How do you calmly tell a patient they have cancer?

NOTES

Dr. Bridget Brady

Veracyte

American Thyroid Association

After pursuing her undergraduate studies at Occidental College, Dr. Leung completed her internal medicine residency and endocrinology fellowship training at Boston University School of Medicine. She also studied at the Boston University School of Public Health and obtained a master's degree in Epidemiology.

Dr. Leung has particular clinical and research interests in thyroid disorders, and she also sees patients regarding parathyroid and adrenal disorders.  She has published widely and lectures frequently on thyroid disease, including hyperthyroidism, hypothyroidism, thyroid nodules, thyroid cancer, and thyroid disease during pregnancy.

In this episode, the following topics are explained:

• Optimizing thyroid health prior to conception
• Thyroid issues that affect pregnancy
• Hypothyroid as result of surgery or Hashimotos
• Hyperthyroidism and pregnancy
• Adjusting current thyroid treatment, meaning optimizing thyroid levels by adjusting dosage of thyroid medication
• TSH levels in light of pregnancy
• Planned pregnancy usually means a dose increase
• What happens if someone does not get treatment during pregnancy?
• Hypothyroidism and the fetus
• Brain development for the fetus
• Lower IQ scores and hypothyroid in pregnancy
• CATS study from UK and Italy
• Iodine and pregnancy
• Iodine intake prior to pregnancy
• Armour thyroid and pregnancy
• Concerns regarding animal derived thyroid replacement
  TSH levels

NOTES

Dr. Angela Leung

CATS study

American Thyroid Association

49: Thyroid and Pregnancy⎥Why It Matters, with Dr. Elizabeth Pearce from Boston University

In this interview, Dr. Laird reflects on a decade of treating papillary thyroid cancer patients and reports none have died.  In this interview we also explore these questions:

1. Prognosis and what will happen in the long run and quality of life.
2. Surgery complications.
3. Levothyroxine side-effects, including weight gain. 
4. Life after surgery and RAI.
5. What causes thyroid cancer.
6. What time of day to take thyroid replacement medication.
7. What blood tests should be ordered and is fasting necessary prior to thyroid lab work.

NOTES

Amanda Laird, MD

American Thyroid Association 

In this episode:

• Medical error is the third leading cause of death?
  After heart disease and cancer.
• Intended audience for the book? A general audience; lay-public and medical professionals.
• It is difficult to define a medial error. Starting medication at wrong dose? What errors cause death? This can be vague.
• Hospitalized patients are different than the general public
• All sorts of patient harm should be brought to light — shift the medical field to "more safe" should be our goal.
• Once you are in the patient chair, one loses their strength and power.
• System flaws: more common error is a qualified professional who is burdened by design flaws — including false alarms.
• Collaboration and intellectual humility — recognizing we don't know.
• Patients are sicker and more chronic conditions, mean collaboration helps reduce error.
• Denmark as an example to error response: acknowledge and apologize.
• The U.S. malpractice system as part of the problem.
• Qualifiers of malpractice: harm occurred, doctor was the cause, and consequence was big enough to make the case worthwhile.
• Who is making the laws about malpractice? Could be an underlining agenda.
• Recourse for patients: 1. Talk with doctor or nurse. 2. The hospital's patient advocate. 3. Insurance patient advocates. 4. Local Board of Health. 5. Keep notes, and have a paper trail.
• The system is not designed to get information easy — take advantage of CARES Act.
• When transparency backfires; if a doctor is treating high risk patients, then their error will be higher.
• Doctors penalized for spending more time with a patient.
• The need for silence or time to think.
• The problem with the "reimbursement" model.
• Medical error, adverse events, and unintended consequences.
• Over-treating and over-diagnosis in regard to prostate or thyroid.
• Statute of limitations.
• Errors that don't cause harm.
• Wash your hands and stop and think.

Dr. Ofri's Links:

Bellevue Literary Review

www.danielleofri.com

"When We Do Harm: A Doctor Confronts Medical Error"

New Yorker Covid Diary

Recent events - Dr. Ofri:

tinyurl.com/BLRViral  Covid Writing Goes Viral: How Literary and Social Media Writing Became a Lifeline during the Pandemic

tinyurl.com/ReadingTheBody Reading the Body: Poetry, Dance & Disability

Notes

CARES Act

Hardeep Singh, M.D., M.P.H.

Doctor Thyroid Facebook

Doctor Thyroid with Philip James

Twitter

philipjames@docthyroid.com

• Hypothyroidism and hyperthyroidism during pregnancy
• Pregnant and without a thyroid
• Avoiding T3 during pregnancy, including concerns with desiccated thyroid
• If being treated for hypothyroidism already, the importance of upping dose while pregnant
• Pregnant with auto-immunity
• Pregnant with Graves' disease
• The dangers of pregnancy and overt hypothyroidism or hyperthyroidism
• Three-percent of pregnancies are affected
• The importance of iodine during pregnancy

Dr. Pearce received her undergraduate and medical degrees from Harvard and a masters' degree in epidemiology from the Boston University School of Public Health. She completed her residency in internal medicine at Beth Israel Deaconess Medical Center, and her fellowship in endocrinology at the Boston University Medical Center. She is currently an Associate Professor of Medicine at Boston University School of Medicine. She has served as a member of the board of directors of the American Thyroid Association and is currently on the management council of the Iodine Global Network.  She recently co-chaired the ATA's Thyroid in Pregnancy Guidelines Task Force. She was the 2011 recipient of the ATA's Van Meter Award for outstanding contributions to research on the thyroid gland.

NOTES

Elizabeth Pearce

American Thyroid Association

In this interview, topics include:

• The first question a surgeon should ask and why.
• When talking active surveillance or observation, changing the language to deferred intervention,  'we are going to defer'.
• Understanding the biology of the cancer
• The biology of thyroid cancer is a friendly cancer.
• Anxiety when diagnosed with cancer.
• Medical legalities — spend a lot of time with patient — and empower patient.
• Let the treatment not be worse than the disease.
• Large tumors, more than 4 cm,  bulky nodes,  voice hoarseness,  vocal cord is paralyzed.  All circumstances where surgery maybe advocated.
• If a tumor is benign but there is presence of compressive goiters, or deviation of trachea or swallowing difficulty.
• Considering the condition of the patient, age, cardiac issues.
• When voice is critical to the patients livelihood, such as teachers, politicians, and singers.
• Main three complications of surgery include bleeding, change of voice, calcium problems.
• Non-academic surgeons.
• Cancer treatment requires a team: surgeons, anesthesiologist, pre-op, radiologist, pathologist, endocrinologists, oncologists.
• When wind pipe is involved with tumor.
• When in surgical business a long time, you become humble no matter how good you are.
• Family present during consultation.
• God gave you an organ — you took it away — now you are on a pill — since the surgery its 'just' not the same.
• When treatment is out of the box — many will not agree with you.
• How to develop a scale to measure quality of life.
• To avoid scarring, surgery maybe conducted through the armpit in Korea and Japan.
• Fibrosis
• Progress in understanding biology of thyroid cancer only cancer, that there is 98% survival.

NOTES:

Dr. Ashok R. Shaha

RELATED EPISODES:

50: Regarding Thyroid Cancer, Are You a Minimalist or a Maximalist? with Dr. Michael Tuttle from Sloan Kettering

40: New Research Reveals Thyroid Surgery Errors 5x More Frequent Than Reported with Dr. Maria Papaleontiou from Michigan Medicine

42: Flame Retardants Connected to Thyroid Cancer, with Dr. Julie Ann Sosa from Duke University

35: Rethinking Thyroid Cancer – When Saying No to Surgery Maybe Best for You with Dr. Allen Ho from Cedars-Sinai in Los Angeles

21: Diagnosed with Thyroid Cancer and You Say No to Surgery with Dr. Louise Davies

09: Thyroid Cancer Patients Experience Quality of Life Downgrade with Dr. Raymon Grogan and Dr. Briseis Aschebrook from the University of Chicago Medicine

36: 1 in 3 People Die With Thyroid Cancer — Not From with Dr. Seth Landefeld from UAB

American Thyroid Association

• Challenges of managing thyroid cancer as outlined by the guidelines
• Scaling back care for insurance-challenged patients, and adopting a plan that gets the same result without needing the expensive tests
• Desired outcome is survival and no recurrence, a third is for no harm that would be caused by an unnecessary surgery
• Unwanted side affects of thyroid cancer include nerve damage, parathyroid damage, and infections
• RAI sometimes has unwanted side affects
• With technology, ultrasounds and biopsies, we know some cancers do not need to be treated, as they are now being found very early
• Change in ATA guidelines, low risk cancers can be considered for observation
• Two different kinds of patient profiles: Minimalist and Maximalist
• 1cm or 1.5cm?
• Patient characteristic, ultra sound characteristics, and the medical team characteristics weighs who is the most appropriate for observation
• 400 active surveillance patients currently at MSKCC
• Certain parts of the world are harder to offer observation as a treatment due to practicality, examples include Latina America where multi-nodular goiters are common, and Germany still is iodine deficient

About Dr. Tuttle, in his words:

I am a board-certified endocrinologist who specializes in caring for patients with advanced thyroid cancer. I work as part of a multidisciplinary team including surgeons, pathologists, radiologists, nuclear medicine specialists, and radiation oncologists that provides individualized care to patients treated at Memorial Sloan Kettering for thyroid cancer.

In addition to treating patients I am also actively researching new treatments for advanced thyroid cancer. I am a professor of medicine at the Joan and Sanford I. Weill Medical College of Cornell University and travel extensively both in the US and abroad, lecturing on the difficult issues that sometimes arise in the management of patients with thyroid cancer. My research projects in radiation-induced thyroid cancer have taken me from Kwajalein Atoll in the Marshall Islands to the Hanford Nuclear power-plant in Washington State to regions in Russia that were exposed to fallout from the Chernobyl accident.

I am an active member of the American Thyroid Association (ATA) and the Endocrine Society. In addition to serving on the ATA committee that produced the current guidelines for the management of benign and malignant nodules, I am also a Chairman of the National Comprehensive Cancer Network Thyroid Cancer Panel, a consultant to the Endocrinologic and Metabolic Drugs Advisory Committee of the FDA, and a consultant to the Chernobyl Tissue Bank.

NOTES

Listen to Doctor Thyroid

American Thyroid Association

Dr. Michael Tuttle

RELATED EPISODES

35: Rethinking Thyroid Cancer – When Saying No to Surgery Maybe Best for You with Dr. Allen Ho from Cedars-Sinai in Los Angeles

22: Avoiding Thyroid Cancer Surgery, Depending on the Size with Dr. Miyauchi from Kuma Hospital in Kobe, Japan

21: Diagnosed with Thyroid Cancer and You Say No to Surgery with Dr. Louise Davies

The USPSTF commissioned the systematic review due to the rising incidence of thyroid cancers against a background of stable mortality, which is suggestive of over-treatment. And in view of the results, the task force concluded with "moderate certainty" that the harms outweigh the benefits of screening.

The USPSTF emphasizes, however, that this recommendation pertains only to the general asymptomatic adult population, and not to individuals who present with throat symptoms, lumps or swelling, or those at high risk for thyroid cancer.

A global problem

The over-diagnosis of thyroid cancer is worldwide.  

South Korean doctors treated these newly diagnosed thyroid cancers by completely removing the thyroid—a thyroidectomy. People who undergo these surgeries require thyroid replacement hormones for the rest of their lives. And adjusting the dose can be difficult. Patients suffer from too much thyroid replacement hormone (sweating, heart palpitations, and weight loss) or too little (sleepiness, depression, constipation, and weight gain). Worse, because of nerves that travel close to the thyroid, some patients suffer vocal-cord paralysis, which affects speech.

Over-diagnosis and over-treatment of thyroid cancer hasn't been limited to South Korea. In France, Italy, Croatia, Israel, China, Australia, Canada, and the Czech Republic, the rates of thyroid cancer have more than doubled. In the United States, they've tripled. In all of these countries, as had been the case in South Korea, the incidence of death from thyroid cancer has remained the same.

1 in 3 people die with thyroid cancer, not of.

NOTES

As heard on NPR

Dr. Seth Landefeld

American Thyroid Association

RELATED DOCTOR THYROID INTERVIEWS

35: Rethinking Thyroid Cancer – When Saying No to Surgery Maybe Best for You with Dr. Allen Ho from Cedars-Sinai in Los Angeles

22: Avoiding Thyroid Cancer Surgery, Depending on the Size with Dr. Miyauchi from Kuma Hospital in Kobe, Japan

21: Diagnosed with Thyroid Cancer and You Say No to Surgery with Dr. Louise Davies

www.docthyroid.com

Dr. Bianco's research has revealed the connection between thyroidectomy, hypothyroidism symptoms, and T4-only therapy.  Although T4-only therapy works for the majority, others report serious symptoms.  Listen to this segment to hear greater detail in regard to the following topics:

• Combination therapy of adding T3 to T4
• 85% of patients on Synthroid feel fine.
• Nearly 5% of the U.S. population takes T4 or Levothyroxine, as revealed by the NHANE survey.  This means 10 - 15 million Americans. 
• Residual symptoms of thyroidectomy include depression, difficulty losing weight, poor motivation, sluggishness, and lack of motivation.  For some, there is no remedy to these symptoms.  For others, adding T3 to T4 shows immediate improvement. 
• The importance of physical activity and its benefit in treating depression
• If we normalize T3 does it get rid of hypothyroid symptoms?
• Overlap between menopause and hypothyroid symptoms

Notes:

American Thyroid Association

Bianco Lab

Bianco Lab on Facebook

NHANES Survey

The National Health and Nutrition Examination Survey (NHANES) is a program of studies designed to assess the health and nutritional status of adults and children in the United States. The survey is unique in that it combines interviews and physical examinations.

During this interview, Dr. Tuttle discusses the following points:

• Challenges of managing thyroid cancer as outlined by the guidelines
• Scaling back care for insurance-challenged patients, and adopting a plan that gets the same result without needing the expensive tests
• Desired outcome is survival and no recurrence, a third is for no harm that would be caused by an unnecessary surgery
• Unwanted side affects of thyroid cancer include nerve damage, parathyroid damage, and infections
• RAI sometimes has unwanted side affects
• With technology, ultrasounds and biopsies, we know some cancers do not need to be treated, as they are now being found very early
• Change in ATA guidelines, low risk cancers can be considered for observation
• Two different kinds of patient profiles: Minimalist and Maximalist
• 1cm or 1.5cm?
• Patient characteristic, ultra sound characteristics, and the medical team characteristics weighs who is the most appropriate for observation
• 400 active surveillance patients currently at MSKCC
• Certain parts of the world are harder to offer observation as a treatment due to practicality, examples include Latina America where multi-nodular goiters are common, and Germany still is iodine deficient

About Dr. Tuttle, in his words:

I am a board-certified endocrinologist who specializes in caring for patients with advanced thyroid cancer. I work as part of a multidisciplinary team including surgeons, pathologists, radiologists, nuclear medicine specialists, and radiation oncologists that provides individualized care to patients treated at Memorial Sloan Kettering for thyroid cancer.

In addition to treating patients I am also actively researching new treatments for advanced thyroid cancer. I am a professor of medicine at the Joan and Sanford I. Weill Medical College of Cornell University and travel extensively both in the US and abroad, lecturing on the difficult issues that sometimes arise in the management of patients with thyroid cancer. My research projects in radiation-induced thyroid cancer have taken me from Kwajalein Atoll in the Marshall Islands to the Hanford Nuclear power-plant in Washington State to regions in Russia that were exposed to fallout from the Chernobyl accident.

I am an active member of the American Thyroid Association (ATA) and the Endocrine Society. In addition to serving on the ATA committee that produced the current guidelines for the management of benign and malignant nodules, I am also a Chairman of the National Comprehensive Cancer Network Thyroid Cancer Panel, a consultant to the Endocrinologic and Metabolic Drugs Advisory Committee of the FDA, and a consultant to the Chernobyl Tissue Bank.

• Clinical Expertise: Thyroid Cancer
• Languages Spoken: English
• Education: MD, University of Louisville School of Medicine
• Residencies: Dwight David Eisenhower Army Medical Center
• Fellowships: Madigan Army Medical Center
• Board Certifications: Endocrinology and Metabolism

NOTES

22: Avoiding Thyroid Cancer Surgery, Depending on the Size with Dr. Miyauchi from Kuma Hospital in Kobe, Japan

21: Diagnosed with Thyroid Cancer and You Say No to Surgery with Dr. Louise Davies

35: Rethinking Thyroid Cancer – When Saying No to Surgery Maybe Best for You with Dr. Allen Ho from Cedars-Sinai in Los Angeles

The American Thyroid Association

Dr. Doherty was trained in Surgical Oncology, and has practiced the breadth of that specialty, including as founder and co-director of the Breast Health Center at Barnes-Jewish Hospital.  His clinical and administrative work was integral in the establishment of the Siteman Cancer Center at Washington University.  Since joining the University of Michigan in 2002, he has focused mainly on surgical diseases of the thyroid, parathyroid, endocrine pancreas and adrenal glands as well as the surgical management of Multiple Endocrine Neoplasia syndromes. He has devoted substantial effort to medical student and resident education policy.  His bibliography includes over 300 peer-reviewed articles, reviews and book chapters, and several edited books.  

He currently serves as President of the International Association of Endocrine Surgeons, Past-President of the American Association of Endocrine Surgeons, Editor-in-Chief of VideoEndocrinology and Reviews Editor of JAMA Surgery.  He is a director of the Surgical Oncology Board of the American Board of Surgery.

In this episode, the following topics are discussed:

• Imaging has increased thyroid nodule discovery.
• Following patients with small thyroid cancer — analogous to prostate cancer.  Better followed than treated.
• Tiny thyroid cancers can be defined by those nodules less than 1/4 inch in size. 
• Less RAI is being used as a part of thyroid cancer treatment. This means, less need to do total thyroidectomy or thyroid lobectomy.   
• Dry mouth and dry eyes are risks to doing RAI.  Also, there is risk to developing a second malignancy.   Most of the secondary cancers are leukemia.
• Risks to operation include changes to voice and calcium levels.  Thyroid surgery is a safe operation but not risk free.
• Best question for a patient to ask is, who is my treatment team?
• The quarterback of treatment team is often the endocrinologist .
• Cluster of issues can happen after RAI, such as the need to carry water and eye drops for life.
• For some patients taking thyroid hormone replacement, their blood levels are correct, but still does not feel well on standard treatment protocol.
• By the end of two weeks, most people go back to what they were doing before surgery with a relatively normal state.
• Scarring reduction; massage, aloe, Vitamin E.

NOTES:

American Association of Endocrine Surgeons

American Thyroid Association

Dr. McIver contributes to Moffitt Cancer Center almost 20 years of clinical experience in the care of patients with endocrine diseases, specializing in the evaluation of patients with thyroid nodules and thyroid cancer. He has a particular interest in the management of patients with advanced and aggressive forms of cancer and the role of genetic and molecular techniques to improve the accuracy of diagnosis; to tailor appropriate treatment to a patientdisease. Dr. McIver has a long-standing basic research interest in the genetic regulation of growth, invasion and spread of thyroid tumors of all types. His primary research focus is the use of molecular and genetic information to more accurately diagnose thyroid cancer and to predict outcomes in the disease. Dr. McIver received his MB ChB degree from the University of Edinburgh Medical School in Scotland. He completed an Internal Medicine residency at the Royal Infirmary of Edinburgh, followed by a clinical fellowship and clinical investigator fellowship in Endocrinology at the School of Graduate Medical Education at Mayo Clinic in Rochester, MN. Prior to joining Moffitt, he was employed as Professor and Consultant at the Mayo Clinic and Foundation in the Division of Endocrinology & Metabolism. Amongst his most proud accomplishments, Dr. McIver counts his two commitment to education of medical students, residents and fellows; his involvement as a founding member of the World Congress on Thyroid Cancer, an international conference held every four years; and his appointment as a member of the Endowed and Master Clinician Program at the Mayo Clinic, recognizing excellence in patient care.  

In this episode, the follwoiung 

• By sixty years old, more common to have nodule than not
• Most nodules are benign
• When to do a biopsy
• How to interpret the results of biopsy
• Advances in thyroid cancer
• Ultrasound technology advancements
• Molecular markers
• Cytopathology categorizations
• Molecular marker technologies
• Gene expression classifier
• Afirma
• Identifying aggressive cancer
• Types and sub-types of thyroid cancers
• Invasive and aggressive thyroid cancers
• Papillary versus anapestic thyroid cancer
• Biopsy results in 2 - 3 hours
• Clinical studies that have transformed thyroid treatment
• Less aggressive surgery and less radioactive iodine
• Targeted chemotherapies
• Immunotherapy
• The importance of clinical trial environments, or thoughtful philosophy
• The minimum necessary surgery
• Do not rush into thyroid cancer surgery

NOTES:

American Thyroid Association

Bryan McIver, MD, PhD

Ian D. Hay, M.D., Ph.D.

Hossein Gharib, M.D.

PAST EPISODES

32: Thyroid Cancer Surgery? The Single Most Important Question to Ask Your Surgeon with Dr. Gary Clayman

Dr. Netterville is the Director of Head and Neck Surgery at Vanderbilt and is an international leading authority of treating head and neck cancer. He is one of the world's experts in the treatment of skull base tumors and has a vast clinical experience.

Todays topic's include:

• Reoccurrence thyroid disease patients in paratracheal, thyroid bed, and cervical lymph nodes
• Papillary thyroid cancer and subtypes: tall cell, columnar, oncocytic, clear cell, hobnail
• The extreme importance of the pathologist
• Facebook is one of the number one sources of referrals
• The changing landscape of researching physicians
• PubMed and Index Medicus have replaced the library and medical literature
• In past 5 years patients are seeking advice from peers and experiences from others
• Patients have become the bets marketers for physicians versus the institution
• performing thyroid surgery on professional singers
• Patients are attached to a doctor and care team, which is often driven by social media
• Paratracheal region, and difficulty in ultrasound
• Selective neck dissection
• The evil remnant: when a surgeon inadvertently leaves thyroid cancer behind
• Three areas where thyroid cancer reoccurs: where remnant is left behind, hidden paratracheal lymph nodes,
• Lymph nodes in levels II, III, IV
• Some surgeons' misperceptions about the effectiveness of RAI as a means to cleaning up poor surgery
• Doing a thyroid surgery is easy.  Doing it right is hard.  The importance of finding a surgeon who knows how to do it right
• Damage to RLN and leaving cancer behind or remnant, is due to inexperience
• Working around larynx and voice box during thyroid surgery
• Challenges with the trachea during thyroid surgery
• Grafting the RLN
• Grafting the RLN, in line graft, ends of motor nerves and sewing them back to the RLN
• Thyroid marketing and the term minimally invasive 
• Superior RLN protection
• Preserving the cricothyroid muscle, especially singers
• The importance of being a good listener
• Vetting a surgeon by searching social media or reputation, publications, and volume
• Is thyroid cancer a cancer or just a nuisance.  Chances are it is not going to kill you.
• Doctors managing their reputation online
• RAI and killing gross disease fallacy
• A surgeon's personal brand versus institution branding
• Online eduction

NOTES

Vanderbilt Health

Vanderbilt-Ingram Cancer Center

Thyroid research

Funding surgical educational camps in Africa

PubMed

Index Medicus

Aggressive Variants of Papillary Thyroid Carcinoma: Hobnail, Tall Cell, Columnar, and Solid

American Thyroid Association

Bianco came to Rush from the University of Miami Health System, where he served as professor of medicine and chief of the Division of Endocrinology, Diabetes and Metabolism.

He has more than 30 years of experience in the thyroid field. He has been recognized with a number of national and international awards and membership in prestigious medical societies. A well-rounded investigator in the field of thyroid disease, Bianco led two American Thyroid Association task forces: one charged with drafting guidelines for thyroid research (as chair) and another responsible for developing guidelines for the treatment of hypothyroidism (co-chair).

Bianco's research interests include the cellular and molecular physiology of the enzymes that control thyroid hormone action (the iodothyronine deiodinases). He has contributed approximately 250 papers, book chapters and review articles in this field, and has lectured extensively both nationally and internationally. Recently, he has focused on aspects of the deiodination pathway that interfere with treatment of hypothyroid patients, a disease that affects more than 10 million Americans. He directs an NIH-funded research laboratory where he has mentored almost 40 graduate students and postdoctoral fellows.

This episode includes the following topics:

• Thyroid produces thyroxin of T4. 
• T4 is not the biologically active, rather it is T3
• T3 is biologically active
• Transformation of T4 to T3 happens throughs the body
• Levothyroxine has become the standard of care for treating hypothyroid patients
• T3 is the biologically active hormone, it could be by giving T4 only we are falling short
• Evidence based medicine wants to only treat with proven and documented therapy; T3 combination therapy is still not scientifically proven
• If patient takes T3 in the morning, it peaks about three hours later
• We have not developed a delivery system to maintain stable T3 levels
• The most important that we can challenge the pharmacy community is to deliver T3 in a way that it mimics the way it behaves in the human body
• Surveyed 12,000 patients and the ones on desiccated thyroid have higher QoL compared to those on Levothyroxine
• I was okay, I had a job, and then I had TT, and from that day forward my life is not the same.  Brain fog, and lack motivation
• We do not yet have evidence proving that combination therapy works, but some patients report improvement to QoL
• Mood disorders, depression, brain fog, memory loss, and lack of motivation are reported by TT patients
• T3 combination therapy does not
• Many symptoms of hypothyroidism is similar to menopause
• Depression like symptoms, difficult for weight loss, low motivation, less desire for physical activity, brain fog, memory loss are all symptoms patients report post TT
• Cannot yet yet distinguish between positive effects of T3 and placebo effects
• Side effects of T3 may include palpitation or sweating
• Improvement with combination T3 can be immediate, as reported by patients
• Patients on Levothyroxine most likely to be on statins, beta-blockers, and anti depressants
• Blood tests for TT patients, taking T3 and not
• Time of day to take blood tests
• Time blood sample depending on when patient takes lab work.  Ideally 3 or 4 hours after taking the T3 tablet
• Hypothyroid-like symptoms could be depression
• There is greater likelihood of depression symptoms for those taking
• Nearly 5% of the U.S. population takes T4 or Levothyroxine, as revealed by the NHANE survey.  This means 10 – 15 million Americans. 
• Levothyroxine is the most prescribed drug in the U.S.

NOTES

American Thyroid Association

Bianco Lab

A Controversy Continues: Combination Treatment for Hypothyroidism

Professor Akira Miyauchi (Figure 1) is President and COO of Kuma Hospital, Center of Excellence in Thyroid Care, Kobe, Japan. He is a Japanese endocrine surgeon, and a pioneer in active surveillance, and visionary in regard to treatment of thyroid cancer.  World renowned researcher, and lecturer. As the associate professor of the Department of Surgery, Kagawa Medical University, he proposed and initiated a clinical trial of active surveillance for low-risk papillary micro cancer in collaboration with Kuma Hospital in 1993. In 2001, he was appointed the President of Kuma Hospital. Since then, he has been keen on the study of evaluating treatments for papillary micro cancer, observation versus surgery.

During this episode, the following topics are discussed:

1. Financial burden of surgery versus total cost of active surveillance over ten years.
2. Stretching Exercises for Neck
   Setting patient expectations prior to FNA to manage anxiety
3. When the laryngeal nerve is severed during thyroid surgery, it can and should be repaired, with proper surgeon skill and training.
4. Rather than being stationery and immobile, patients should practice neck stretching exercise within 24 hours proceeding surgery.  There should be no fear about separating the incision.
5. Total cost of surgery is 4.1x the cost compared to the cost of active surveillance.  In the U.S., the cost is higher.
6. Incidence versus mortality
7. Worldwide trends related to thyroid cancer
8. Papillary Microcarcinoma of the Thyroid (PMCT)
9. Unfavorable events following immediate surgery
10. Results of research which began in 1993
11. The current trend in the incidence of thyroid cancer is expected to create an added cost of $3.5 billion by 2030, to the individual and as a society.

By providing patient an active surveillance brochure prior to FNA, they are more open to not proceeding with surgery for small thyroid cancer management.

Patient voice restores to near normal when repair of laryngeal nerve is done correctly.  All surgeons should be executing this to perfection.

When doing next stretches one-day post surgery, patients report feeling much better and less pain, even one year after surgery.

Protocol for delaying surgery depends on the patient's age.  Older patients are less likely to require surgery.  75% of patients will not require surgery for their lifetime.

Listen to Doctor Thyroid here! 

Akira Miyauchi, MD

35: Rethinking Thyroid Cancer ? When Saying No to Surgery Maybe Best for You with Dr. Allen Ho from Cedars-Sinai in Los Angeles

21: Diagnosed with Thyroid Cancer and You Say No to Surgery with Dr. Louise Davies

50: Regarding Thyroid Cancer, Are You a Minimalist or a Maximalist? with Dr. Michael Tuttle from Sloan Kettering

PAPERS and RESEARCH

 Estimation of the lifetime probability of disease progression of papillary microcarcinoma of the thyroid during active surveillance

Comparison of the costs of active surveillance and immediate surgery in the management of low-risk papillary microcarcinoma of the thyroid.

Incidences of Unfavorable Events in the Management of Low-Risk Papillary Microcarcinoma of the Thyroid by Active Surveillance Versus Immediate Surgery

TSH-suppressive doses of levothyroxine are required to achieve preoperative native serum triiodothyronine levels in patients who have undergone total thyroidectomy.

Stretching exercises to reduce symptoms of postoperative neck discomfort after thyroid surgery: prospective randomized study.

Improvement in phonation after reconstruction of the recurrent laryngeal nerve in patients with thyroid cancer invading the nerve. Listen to Doctor Thyroid here!

En este episodio, se tratan los siguientes temas:

• ¿Cómo será la vida después de la cirugía?
• Embarazo después del cáncer de tiroides
• Parálisis de las cuerdas vocales
• Las complicaciones incluyen voz e hipo-calcio
• Sangrado durante la cirugía
• Tratamiento para hypo-calcium
• Vitamina D
• Embarazo y radiación
• TSH elevada después de la cirugía
• Problemas de TSH suprimido
• Número uno de miedo del paciente cuando se le diagnostica cáncer de tiroides y antes de la cirugía
• 32 años como cirujano tiroideo - cáncer papilar de tiroides
• Vigilancia activa
• Tasas de mortalidad del cáncer papilar de tiroides
• Recurrencia
• La mejor hora del día para tomar un reemplazo de tiroides

Más información:
www.doctiroides.com

Topics discussed in this episode include:

• How to interpret my thyroid results?
• Why did I get this? Is it something I did?
• Thyroid controls nearly all body systems: heart, weight, brain, bowel.
• Testing and diagnosis: beyond blood-work
• TSH is the most common check
• TSH is like the reading of your electric meter: it tells you big picture for a month, not daily — it is not a fluid system, it changes by the hour
• TSH is not the cure all for reading thyroid health
• Full thyroid panel: Free T4 and Free T3 is important — highest in morning, lowest around 2p or 3p in the afternoon
• There is no one size fits all to Hashimoto's — there are different types
• Blood tests: preparing for lab tests
• 'Normal' TSH but a patient does not feel normal
• Normal TSH range is controversial — .5 to 3 TSH is normal — if on thyroid replacement target 1.5
• Suppressed TSH
• Dangers of suppressed TSH for thyroid cancer replacement or those on too much on thyroid replacement — heart failure, osteoporosis
• T3 symptoms of TSH is kept too low for too long
• The T4 — T3 relationship
• T4 is money in savings account — but you cant use it now — T3 is money in your pocket and available now
• Preferred thyroid replacement — but, issues with synthetic and desiccated
• The goal — T4 and T3 as stable as possible throughout the day — in light of absorption and interfering food
• Compounded medications
• A doctor must listen to the patient
• Generic levothyroxine and fillers — who is the manufacturer
• What is better, Nature or Armour?
• Why do some people do better on various thyroid replacement formulations?
• Gut biome
• The environment and thyroid disease
• Defining leaky gut
• Avoid foods that gut inflammation thereby worsening auto-immune disease
• Three food foes: processed foods, sugar, and iodine disruptors
• Is adrenal fatigue real?
• Supplements: vitamins and Hashimoto's
• Nutrients needed to produce thyroid hormone, such as optimizing iron and selenium
• Anti-inflammatory vitamins and Vitamin A and Vitamin D
• Anti-oxidant vitamins — Vitamin B1, Vitamin C, and Glutathione
• What time of day to take to thyroid replacement medication
• What happens if you miss a day of thyroid replacement hormone?
• What does an endocrinologist feel about a patient seeing a Naturopath or an integrative medicine specialist?

NOTES

57: The Gut⎥Antibiotics Danger, Fixing Inflammation, and Thyroid Health, with Dr. Lisa Sardinia

42: Flame Retardants Connected to Thyroid Cancer, with Dr. Julie Ann Sosa from Duke University

Exposure to flame retardant chemicals and occurrence and severity of papillary thyroid cancer: A case-control study. 

LGR5 is associated with tumor aggressiveness in papillary thyroid cancer.

Hedgehog signaling in medullary thyroid cancer: a novel signaling pathway. 

Dr. Brittany Henderson

Facebook, Instagram, and Twitter: @DrHendersonMD, @charlestonthyroid, @hashimotosbook

Websites: www.charlestonthyroid.com and www.drhendersonmd.com

In this episode Dr. Bernet describes that Hashimoto's thyroiditis is an autoimmune condition that usually progresses slowly and often leads to low thyroid hormone levels — a condition called hypothyroidism. The best therapy for Hashimoto's thyroiditis is to normalize thyroid hormone levels with medication. A balanced diet and other healthy lifestyle choices may help when you have Hashimoto's, but a specific diet alone is unlikely to reverse the changes caused by the disease.

Hashimoto's thyroiditis develops when your body's immune system mistakenly attacks your thyroid. It's not clear why this happens. Some research seems to indicate that a virus or bacterium might trigger the immune response. It's possible that a genetic predisposition also may be involved in the development of this autoimmune disorder.

A chronic condition that develops over time, Hashimoto's thyroiditis damages the thyroid and eventually can cause hypothyroidism. That means your thyroid no longer produces enough of the hormones it usually makes. If that happens, it can lead to symptoms such as fatigue, sluggishness, constipation, unexplained weight gain, increased sensitivity to cold, joint pain or stiffness, and muscle weakness.

If you have symptoms of hypothyroidism, the most effective way to control them is to take a hormone replacement. That typically involves daily use of a synthetic thyroid hormone called levothyroxine that you take as an oral medication. It is identical to thyroxine, the natural version of a hormone made by your thyroid gland. The medication restores your hormone levels to normal and eliminates hypothyroidism symptoms.

You may hear about products that contain a form of thyroid hormones derived from animals. They often are marketed as being natural. Because they are from animals, however, they aren't natural to the human body, and they potentially can cause health problems. The American Thyroid Association's hypothyroidism guidelines recommend against using these products as a first-line treatment for hypothyroidism.

Although hormone replacement therapy is effective at controlling symptoms of Hashimoto's thyroiditis, it is not a cure. You need to keep taking the medication to keep symptoms at bay. Treatment is usually lifelong. To make sure you get the right amount of hormone replacement for your body, you must have your hormone levels checked with a blood test once or twice a year.

If symptoms linger despite hormone replacement therapy, you may need to have the dose of medication you take each day adjusted. If symptoms persist despite evidence of adequate hormone replacement therapy, it's possible those symptoms could be a result of something other than Hashimoto's thyroiditis. Talk to your health care provider about any bothersome symptoms you have while taking hormone replacement therapy.

NOTES and REFERENCES

Request an Appointment

Victor Bernet, M.D.

In this interview — a discussion about Dr. Ho's research; Parallels Between Low-Risk Prostate Cancer and Thyroid Cancer: A Review. Topics include:

• prostate and thyroid cancer parallels
• prostate cancer and practical acceptance of active surveillance
• randomized and followed patients through true active surveillance
• overall survival, comparing thyroid and prostrate cancer
• tolerance of risk
• Older versus younger patient priorities
• Younger patient  thought process
• Weighing quality of life and risk
• Hypothyroidism, parathyroidism, laryngeal nerve risk in thyroidectomy… asymptomatic patients being made symptomatic due to treatment
• Physicians have embraced active surveillance for prostate cancer more than thyroid
• The patient leans on physician for guidance
• The Finland study: 17M in U.S. have thyroid cancer
• Extrapolation — Patients who die of other conditions, in autopsies very small thyroid cancers found in 36% of patients
• A lot of small cancers that need not be diagnosed
• The physicians perspective and influencing the active surveillance decision
• Shared decision making process
• Terminology… some people choose active surveillance even when nodule is greater than 2cm
• Jury is still out on what is considered safe size
• Size and lymph node spread is still being defined
• Moving away from Gleason system
• Some cancers are aggressive
• Some cancers are slow and not lethal
• Incidental cancers
• The word cancer or the c word… and shifting away from fear
• Radiology guidelines
• The Cedars Sinai active surveillance program
• 50% of patients who are offered surveillance accept it… which mirrors Japan
• Alienation of active surveillance patients
• Anxious, calm, and risk and prioritize risks of surgery 
• Thyroid cancer tends to strike younger patients.  Prostrate cancer tends to be older.
• Prostrate cancer may not improve survival
• Surgery in thyroid versus prostate is safer
• Radiation ad toxicity

NOTES

Parallels Between Low-Risk Prostate Cancer and Thyroid Cancer: A Review

50: Regarding Thyroid Cancer, Are You a Minimalist or a Maximalist? with Dr. Michael Tuttle from Sloan Kettering

89: Your Patient 'Type' May Determine Your Thyroid Cancer Treatment → Dr. Michael Tuttle from Sloan Kettering

77: Broadway Performer Says No to Thyroid Cancer Surgery → Surveillance Instead

87: Is There a Stigma to Choosing Active Surveillance? → Dr. Louise Davies from The Dartmouth Institute

Vigilancia activa en el tratamiento del microcarcinoma de tiroides.

Dr. Allen Ho

During this interview, the following topics are addressed:

• What is a thyroid nodule?  A lump that could be benign or cancerous
• The prevalence depends on how you search for them
• 60% of people in the U.S. will have nodules
• 90% are benign
• Sometimes done during routine physical exam
• Sometimes the patient discovers it
• Usually is discovered when imaging is done for other reasons — during CT scan
• Medical history of radiation to head or neck as a child, family history of thyroid cancer, size of nodule, abnormal lymph nodes in the neck
• Usually patients with a nodule are asymptomatic
• Best test to look at the nodule is an ultrasound of the nodule
• Features in the ultra sound determines how suspicious a nodule is
• A biopsy is ordered based on appearance, if nodules are clearly defined are more likely to suggest they are benign
• If nodule looks dark or borders are irregular, or increased blood flow within the nodule may cause concern
• Quality and resolution of thyroid ultra sound is high resolution and provides a clear look
• Coaching patients through the anxiety through a possible biopsy
• The majority of nodules can be observed
• ATA guidelines suggest observation based on the result of the biopsy
• Suspicious nodules that are less than 1cm are sometimes determined to best observe and not remove
• Cancer will be in only 5% of biopsies
• A smaller, low risk cancer should warrant a lesser surgery — and reduce the chance of surgical complications
• When to remove a nodule even if no cancer? 
• If other structures are being obstructed, such as breathing or swallowing, sometimes surgery relieves symptoms regardless if cancer or not
• Observation — and follow up recommendations
• 15% are labeled indeterminate
• If surgery, surgeon needs to be experienced — many surgeons conducting thyroid surgery are low in experience
• The Mayo Clinic thyroid cancer team
• Biopsy results in two hours versus two weeks

NOTES

The American Thyroid Association

Dr. Regina Castro

64: Managing Indeterminate Thyroid Nodules, with Dr. Kimberly Vanderveen from Denver Center for Endocrine Surgery

 Dr. Milner's articles include treatment protocols for hypothyroidism, "Hypothyroidism: Optimizing Medication with Slow-Release Compounded Thyroid Replacement" was published in the peer review journal of compounding pharmacists, International Journal of Pharmaceutical Compounding. 

In this interview, the following topics are discussed:

• Starving in the midst of plenty
• Slow release T3 and T4
• Hypothyroidism
• Hyperthyroidism or Graves Disease
• Often RAI leads to hypothyroidism
• Visiting a naturopath while being treated by traditional endocrinologist
• TSH suppression for thyroid cancer patients
• Ordering blood tests of TSH, Free T4, Free T4, and reverse T3
• Converting T4 into T3
• Slow released T3
• Manufactured T3 is not slow release
• 2005 article was published
• 150,000 pharmacist in U.S., and about 5,000 are compounding
• Slow release blends are the same T4 from Synthroid and T3 from Cytomel
• Slow release agent is hydroxypropyl melanose
• Side effects of too much T3 or T4
• The risk is compounder error or inconsistency
• Binder sensitivity is another reason for compounding
• Desiccated thyroid hormone compared to slow release
• Auto-immune disease and desiccated treatment
• Overwhelming response to slow release is when patients symptoms of hypothyroidism alleviate
• A small percentage of people do not do better on slow release
• Basel body temperatures
• 96.5 temperature in the morning, and hypothyroid symptoms is a concern in regard to treatment
• Testing temperature in the morning, ideally done using mercury thermometer
• How to use temperature testing as an indicator of hypothyroidism
• Body temp should be over 97.8 first thing in the morning
• Hypothyroidism will be overweight and difficult to lose weight, and brain fog, sluggish, dry skin, hair loss,
• Eating well, active, and weight gain
• Hypoglycemic or adrenal overload and low body temperature
• High cortisol levels
• Standard of care of Cytomel in contrast with conventional endocrinologist
• T3 has a short half life
• Half life — How long does it take a drug to bring blood levels to normal levels? 
• Half life of T3 is up to 70 days
• Starving in the midst of plenty with T4
• Insurance coverage of slow release T3 — T4
• Cost of slow release T3 — T4 is approximately $40 monthly
• Most important testing for TT patient is checking parathyroid gland status — and their role in calcium function
• Important to measure calcium for TT patients
• Caution about soy, broccoli, brussel sprouts, cauliflower, and calcium and thyroid hormone
• When to thyroid replacement hormone — first thing in the morning, 1 hour before eating,
• T4 replacement before bed — advantages to more stable levels
• Slow release, combination therapy, should be taken in the morning
• Estrogen deficiency
• Brief summaries of the following symptoms: painful feet, dizziness, fatigue, hair loss, iron deficiency, chronic pain, tyrosine turning into dopamine and then adrenaline, sleep problems and anxiety and hypothyroidism, insomnia and cortisone and adrenaline at nigh and DHEA, cortisol measured throughout the day, muscle spasms,
• Avoid refined sugar and high amounts of alcohol
• Drink more water
• Caution: food and its importance: smoothies and soluble fiber — fiber interacts with nutrients.    Avoid this, as it effects absorption of medications
• Emotional attachment to disease — fixation and complaining without making changes. 

NOTES

International Academy of Compounding Pharmacists

75: Fat, Foggy, and Depressed After Thyroidectomy? You May Benefit From T3, with Dr. Antonio Bianco from Rush University

19: Hypothyroidism – Moving From Fat, Foggy & Fatigued to Feeling Fit & Focused with Elle Russ

Hypothyroidism: Optimizing Therapy with Slow-Release Compounded Thyroid Replacement

• El nombre del cáncer ha cambiado
• La tasa de supervivencia con cáncer ha cambiado para mejor
• La mitad tiene nódulos, muchos de ellos tendrán cáncer
• 10% de esos tienen cáncer
• No es necesario operar con todo el cáncer de tiroides
• 2.5 millones de personas en Colombia tienen cáncer de tiroides
• No biopsia todos los nódulos
• ¿Qué es la fobia al cáncer?
• Lo que no sabemos no nos perjudicará
• No biopsiar pequeños nódulos tiroideos
• BETHESDA IV en inconcluso
• La vida sin tu tiroides cambia tu vida, para peor en la mayoría de los casos
• A veces ocurre piel seca y peso
• Problemas de calcio
• Cambio de voz después de la cirugía de tiroides
• No todo el cáncer es fatal

Dr José A. Hakim -- Manejo quirúrgico actual del cáncer de cabeza y cuello

Dr. Antonio Hakim

"The idea behind that 'good cancer' statement is a positive one," said study co-author Raymon Grogan, MD, Assistant Professor of Surgery at the University of Chicago Medicine, in Chicago, IL. "It is physicians trying to make people feel better. But, I think it's had the opposite effect over time."

The number of thyroid cancer survivors is rising rapidly due to the combination of an increasing incidence, high survival rates, and a young age at diagnosis, according to Dr. Grogan and co-author Briseis Aschebrook-Kilfoy, PhD, Assistant Research Professor in Epidemiology at the University of Chicago Medicine, who lead the North American Thyroid Cancer Survivorship Study (NATCSS).

The incidence of thyroid cancer will double by 2019 and thyroid cancer survivors could soon represent up to 10% of all cancer survivors in the United States, the researchers predicted.

But there's a difference between surviving and living happily ever after. Once treatment is over, thyroid cancer survivors then face a high rate of recurrence and an anxiety-filled lifetime of cancer surveillance. When the researchers heard clinic patients express these survival concerns firsthand, they sought to study this poorly investigated area.

The investigators recruited 1,174 thyroid cancer survivors whose mean time from diagnosis was 5 years (89.9% were female, average age was 48), and evaluated their quality of life using a questionnaire that assessed physical, psychological, social, and spiritual wellbeing on a 0-10 scale, with 0 being the worst.

Survivors of thyroid cancer reported worse quality of life—with an average overall score of 5.56 out of 10—than the mean quality of life score of 6.75 reported by survivors of other cancer types (including colorectal and breast) that have poorer prognoses and more invasive treatments.

"I think we all have this fear of cancer that has been ingrained in our society," Dr. Grogan said. "So, no matter what the prognosis is, we're just terrified that we have a cancer. And, I think this [finding] shows that."

Thyroid cancer survivors who were younger, female, less educated, and those who participated in survivorship groups all reported even worse quality of life than other study participants. However, after 5 years of survival, quality of life gradually began to increase over time in both women and men, the researchers found.

In order to further understand the psychological wellbeing of the growing number of thyroid cancer survivors, the researchers plan to continue to follow this cohort for the long term.

NOTES

Briseis Aschebrook-Kilfoy

Raymon Grogan, M.D., MS, FACS

Thyroid cancer patients report poor quality of life despite 'good' diagnosis

Why do thyroid cancer patients report poor quality of life despite a high survival rate?

An internationally recognized expert on the effects of medical screening and over-diagnosis

Dr. Gilbert Welch's work is leading many patients and physicians think carefully about what leads to good health. For Welch, the answer is often "less testing" and "less medicine" with more emphasis on non-medical factors, such as diet, exercise, and finding purpose in life.

Welch's research examines the problems created by medicine's efforts to detect disease early: physicians test too often, treat too aggressively, and tell too many people that they are sick. Most of his work has focused on overdiagnosis in cancer screening: in particular, screening for melanoma, thyroid, breast, and prostate cancer. He is the author of three books: Less Medicine, More Health: 7 Assumptions That Drive Too Much Health Care (2015), Overdiagnosed: Making People Sick in the Pursuit of Health(2012), and Should I Be Tested for Cancer? (2006). His op-eds on health care have appeared in numerous national media outlets, including the Los Angeles Times, The New York Times, the Washington Post, and the Wall Street Journal.

Welch is a professor of medicine at the Geisel School of Medicine, an adjunct professor of business administration at the Tuck School of Business, and an adjunct professor of public policy at Dartmouth College. He has initiated and taught courses on health policy, biostatistics, and the science of inference.

In this episode, the following topics are discussed:

• overdiagnosis is about how its found, and is a side effect of screening
• when screening for early forms of cancer
• some cancer is never going to cause the patient problems
• some cancer never becomes clinically evident
• we are looking so hard for cancer, that there is more than is possible
• birds, rabbits, turtles
• can't fence in birds or aggressive cancers
• rabbits you can catch if you build enough fences
• turtles aren't going anywhere anyway
• certain organs have a lot of turtles, prostate, lung, thyroid, breast
• ovedrdiagniosis only occurs when we are trying to look for early forms
• screening can benefit, but also cause harm
• breasts, prostate, and thyroid carry a lot of cancers. 
• overcoming cancer phobia, and reducing patient anxiety. 
• the best test is not the one that finds the most cancers, the best test is to find the ones that matter
• paradigm shift is happening in regard to cancer. 
• liquid biopsies, looking at biomarkers
• CA125

NOTES

H. Gilbert Welch, MD, MPH

Less Medicine, More Health: 7 Assumptions That Drive Too Much Health Care (2015)

Overdiagnosed: Making People Sick in the Pursuit of Health(2012)

Should I Be Tested for Cancer? (2006)

Patient Resources

American Thyroid Association 

In this episode, Dr. Wartofsky discusses the following:

• Bioavailability versus content of a thyroid replacement tablet, and how it is absorbed.
• Hypothyroidism causes
• When is replacement thyroid replacement hormone necessary?
• The history of replacement thyroid hormone going back to 1891
• The early treatment included a chopped up sheep thyroid and served as a 'tartar', often resulting in vomiting
• Myxedema coma
• The danger of taking generic T4; are cheaper, larger profit margin, but the content varies.
• Synthroid versus generic
• Manufacturing plants in Italy, India, Puerto Rico are known to produce generics
• Content versus absorption when taking generic T4
• An explanation of TSH
• 1.39 is a healthy TSH level for women in the U.S.
• Symptoms of hypothyroidism, such as a slow mind, poor memory, dry skin, brittle hair, slow heart rate, problems with pregnancy, miscarriage, and hypertension.
• Screening TSH levels if contemplating pregnancy
  T4 is the most prescribed drug in the U.S.
• Hypothyroidism is common when there is a family history
• Auto-immune disease is often associated with hypothyroidism
• An explanation of T3
• An explanation of desiccated thyroid
• The T3 'buzz'
• Muhammed Ali's overdose of T3
• Dangers of too much T3
• When to take T4 medication, and caution toward taking mediations that interfere with absorption
• Coffee and thyroid hormone absorption
• Losing muscle and bone by taking too much thyroid hormone
• Taking ownership of your disease

NOTES

Listen to Doctor Thyroid Related Episode : 37: Adding T3 to T4 Will Make You Feel Better? For Some the Answer is 'Yes' with Dr. Antonio Bianco from Rush University

American Thyroid Association

Leonard Wartofsky

Weighing treatment options for thyroid cancer, with deep consideration for the patient's lifestyle, could become the new norm in assessing whether surgery is the best path. 

Dr. Allen Ho states, "if a patient is a ballerina or an opera singer, or any other profession that could be jeopardized due to undesired consequences of thyroid cancer surgery, then the best treatment path maybe active surveillance."  Undesired consequences of thyroid cancer surgery could be vocal cord paralysis, damage to the parathyroid glands resulting in calcium deficiencies, excessive bleeding or formation of a major blood clot in the neck, shoulder nerve damage, numbness, wound infection, and mental impairment due to hypothyroid-like symptoms.  Or in the case of a ballerina, undesired scarring could jeopardize a career.   

The above risks occur in approximately 10% of thyroid cancer surgeries.  Although, some thyroid cancer treatment centers have a much more reduced incidence of undesired consequences, while others much higher. 

In order to address the above and remove the risk of thyroid cancer surgery, Cedars-Sinai has become the first west coast hospital to launch an active surveillance study as optional treatment for thyroid cancer.  The study includes 200 patients from across the country who have chosen the wait and see approach rather than hurry into a surgery that could result in undesired, major life changes.   By waiting, this means these patients will dodge the need to take daily hormone replacement medication for the rest of their lives as the result of a thyroidectomy. 

Other active surveillance research

Although this is the first study for active surveillance on the west coast, other studies are ongoing, including Sloan Kettering as directed by Dr. Tuttle, Kuma Hospital in Kobe as directed by Dr. Miyauchi, and the Dartmouth Institute as directed by Dr. Louise Davies.

The team

Dr. Ho says the "de-escalating" of treatment for thyroid cancer will become the new trend.  The active surveillance thyroid cancer team at Cedars-Sinai is orchestrated to the patient's needs, and includes the pathologist, endocrinologist, and surgeon.

NOTES

Allen Ho, MD

Active Surveillance of Thyroid Cancer Under Study

22: Avoiding Thyroid Cancer Surgery, Depending on the Size with Dr. Miyauchi from Kuma Hospital in Kobe, Japan

21: Diagnosed with Thyroid Cancer and You Say No to Surgery with Dr. Louise Davies

As if the year wasn't packed enough, Davies also visited the site of the Fukushima Daiichi nuclear power plant, site of the 2011 nuclear accident in Japan. Unrelated to her Fulbright work, Davies is a member of an international task force organized through the International Agency for Research on Cancer, a branch of the World Health Organization. The task force will make recommendations on the monitoring of the thyroid gland after nuclear accidents. Learn more about her incredible year and what's next for her research in overdiagnosis!

Q: As a practicing physician, how did your interest in overdiagnosis develop?

A: My interest in over diagnosis grew from my work with Dr. Gil Welch, dating back to 2004. He was and is a mentor to me, and we developed the work on thyroid cancer together. I have always had an interest in making sure that patients receive care that aligned with their values. The problem of overdiagnosis is particularly intriguing because if people do not understand the concept, they may undergo treatment that, had they understood more about their risks, they might not have elected. Finding ways to solve that problem has been a fascinating focus for me.

Q: Is overdiagnosis and/or overtreatment in thyroid cancer on the rise, if so what accounts for this increase?

A: Thyroid cancer incidence has more than tripled in the U.S. over the past 30 years. The majority of the increase has been due to the detection of small cancers, which we know exist as a subclinical reservoir in otherwise asymptomatic people. As more attention has been drawn to the problem of overdiagnosis, the rate of increase has slowed, which has been gratifying to see; although it has not stopped completely or reversed. In the most recent national guidelines on the treatment of thyroid cancer (from the American Thyroid Association), there has been a clear suggestion that treatment should be more conservative for the small cancers that are so commonly detected now. It is not yet clear how much of an impact these new guidelines have had on practice patterns.

Q: You've studied the experiences of patients who are diagnosed with thyroid cancer but choose not to intervene. What are some of the commonalities you've found?
A: The patients who were the first to understand that their small, asymptomatic thyroid cancers picked up incidentally might not need immediate intervention, but instead could be monitored through regular checkups and active surveillance did not receive a lot of support from the medical community. Many managed their cancer by keeping it a secret, which can be stressful in itself, and several stopped getting follow ups-the recommended care if surveillance rather than interventions chosen for a small thyroid cancer. This was a unique group of patients who represented the first people to undertake what is a new and incompletely understood treatment option in the U.S. As such, they are probably more representative of people going against medical convention than thyroid cancer patients who elect to undertake surveillance, per se.
Q: What will/have you been looking for when evaluating the surveillance program at Kuma Hospital? How will you combine this with your own U.S. pilot data?
My goal in going to Kuma Hospital last fall was to understand more about the active surveillance program they have there. They were the first in the world to run such program and collect data on it, and have been doing so since 1993. I wanted to understand their data on active surveillance in more detail. I wanted to understand the patient experience of being on surveillance, and how the program worked operationally. I was able to do all those things and gathered patient experience data through a survey as well as interviews. I also was lucky to get to spend a fair amount of time in the operating room, where I learned a number of new surgical techniques that will advance my own practice in thyroid surgery. My goal is to report what I learned at Kuma Hospital as broadly as possible, so that people in the U.S. begin to feel comfortable adopting active surveillance as a method of managing the early thyroid cancers that are appropriate candidates for surveillance.

What's next for you in overdiagnosis research?
My work on the task force about thyroid monitoring after nuclear power plant accidents has given me a new appreciation for the complexity of public health communication about risk, emergency preparedness, and the problem of over diagnosis when it comes to policy setting. I hope to be able to continue to contribute in other ways to the broader public health discussion about over diagnosis. In my next steps looking at the epidemiology of thyroid cancer, I plan to focus on understanding more about why we see such variation in thyroid cancer incidence across geography, age groups, and gender.

NOTES

Louise Davies, MD, MS

Thyroid cancer and overdiagnosis

American Thyroid Association

35: Rethinking Thyroid Cancer – When Saying No to Surgery Maybe Best for You with Dr. Allen Ho from Cedars-Sinai in Los Angeles

21: Diagnosed with Thyroid Cancer and You Say No to Surgery with Dr. Louise Davies

50: Regarding Thyroid Cancer, Are You a Minimalist or a Maximalist? with Dr. Michael Tuttle from Sloan Kettering

El Dr. Duque es un Cirujano de Cabeza y Cuello, formado en la Universidad de Miami, actualmente  trabaja en el Hospital Pablo Tobon Uribe de Medellin.

Al años opera unos 220 pacientes con problemas  de tiroides, de estos la mayoría con  cancer de tiroides.

El Dr. Duque ha escrito un libro titulado !Uuuyy. TENGO CANCER DE TIROIDES¡ 

 (Antes de inciar esta entrevista , me gustaria  dejar claro que  el fin de esta entrevista es informativo. Muy respetuosamente le solicitaria todos los que se unen a esta entrevista, No hacer preguntas  sobre casos personales, o mencionar nombres de personas o medicos tratantes , el fin de estas y otras entrevistas que hago es informar.)

Temas de este entrevista uncluye: 

• Que tan común es el cancer de tiroides, de estos cual es el mas común?
• Cuéntenos un poco sobre el tratamiento con Yodo radioactivo.
• Como y porque decido escribir un libro sobre cancer de tiroides
• Cuando se publicara este libro, donde se puede conseguir
• Quien es  un buen cirujano de  tiroides, donde puedo buscar un cirujano con experiencia 
• Nodulos de tiroides

Médico de la Universidad Pontificia Bolivariana y Otorrinolaringólogo de la Universidad de Antioquia en Medellín, Colombia. Residencia en Otorrinolaringología en la Universidad de Antioquia.

Fellowship , Entrenamiento exclusivo en Cirugía de Cabeza y Cuello (1996 a 1998) y posteriormente un Fellowship en Rinología y Cirugía Endoscópica de Senos para nasales (2004 a 2005) ambos en el Departamento de Otorrinolaringología de la Universidad de Miami, USA.

En esta entrevista escuchamos del autor y cirujano, Dr. Carlos Duque, que explica los siguientes temas sobre el cáncer de tiroides:

• Tendencias con cáncer de tiroides
• La aparición más frecuente de cáncer de tiroides.
• 150 - 200 cirugías tiroideas cada año.
• Lo que un paciente con cáncer de tiroides debe esperar si es diagnosticado.
• Antes de la cirugía, el paciente debe conocer los riesgos, incluida la voz y el calcio
• Aumento de peso y cirugía de tiroides
• Después de la cirugía, un paciente a veces tiene síntomas hipotiroideos
• La mejor hora del día para tomar medicamentos para la tiroides
• Espere una hora antes de comer después de tomar
• Levothyroxine
• Precaución al consumir calcio después de tomar la hormona de reemplazo tiroidal
• Cómo detectar a un cirujano
• Cómo recuperarse mejor después de una cirugía de tiroides
• Radiación después de la cirugía de tiroides
• Diferencias de tratamiento de un país a otro
• Cambios en el tratamiento en los últimos años con respecto a la radiación y la cirugía
• Cómo localizar un buen cirujano de tiroides

Información Adicional

American Thyroid Association en español

Doctor Tiroides pagina web

Doctor Tiroides en Facebook

Doctor Tiroides Grupo de apoyo

Facebook Doctor Carlos Duque

Carlos Simón Duque Fisher

Libro ¡Uuuyyy, TENGO CÁNCER DE TIROIDES! 

In this episode we hear Lorrie describe the following:

• Papillary thyroid cancer
• Long delayed pathology results
• Graves' disease
• Balancing Graves' disease and a thyroid cancer diagnosis
• Emotional roller coaster of feeling optimistic and other days of sadness.
• The feelings and emotions of related to a cancer diagnosis
• Being careful about the information shared on the Internet and potential negativity
• Support network and family
• Nodule size was 1.1 cm, but with history of Graves' disease, she decided to forego active surveillance

PATIENT RESOURCES

American Thyroid Association

Docente de post grado de la Universidad Favaloro y de las carreras de Especialista en Endocrinología así como de Bioquímica Clínica dependientes de Universidad de Buenos Aires.  Médica adscripta en el Servicio de Endocrinología y Metabolismo de la Unidad Asistencial Dr. César Milstein de Buenos Aires, Sector Tiroides.  Presidente del Comité Científico de la Sociedad Latinoamericana de Tiroides.  Miembro del Dpto. de Tiroides de la Sociedad Argentina de Endocrinología y Metabolismo.   Su área de investigación clínica abarca el efecto cardiovascular y metabólico de las hormonas tiroides.

En esta entrevista, discutimos los siguientes temas:

• Menos función cardiovascular
• Hipertensión
• La conexión entre el funcionamiento del corazón menos y el hipotiroidismo
• El riesgo cardiovascular
• Resistencia cardiovascular
• Mayor colesterol LDL e hipotiroidismo
• Hipotiroidismo subclínico y riesgo
• Niveles de TSH
• Niveles de TSH por encima de 10
• Colesterol e hipotiroidismo
• Riesgo residual y estatinas
• Mejorando la absorción de T4
• Levotiroxina y buen cumplimiento
• Osteoporosis
• Niveles altos de colesterol, tomar estatinas y dolores musculares
• Mujeres que toman estatinas y un mayor riesgo cardiovascular y altos niveles de TSH
• Altos niveles de TSH, uso de estatinas e inflamación
• Colesterol y nivel de conexión tiroidea
• Conexión de diabetes e hipotiroidismo
• Niveles normales de TSH en pacientes mayores
• Riesgos con pacientes mayores

Recursos

Asociación Americana de Tiroides

• Panic attacks
• Nervous
• Sweating
• Can't get out of bed
• Putting on weight
• Feeling coldness
• NP Thyroid®
• L-Tyrosine
• Synthroid
• WP Thyroid
• WP Thyroid and L-Tyrosine combination therapy
• High heart rate on T3
• ACTH stimulation test
• TSH as high as 60
• T3 suppressing pituitary
• Experience as a male with Hashimoto's
• Brain fog
• Body aches
• Food and diet

NOTES:

American Thyroid Association

NP Thyroid

ACTH stimulation test

PubMed

Deiodinase polymorphism testing

FACEBOOK GROUPS

All hormone deficiencies

Hypothyroid Men

• 50 biopsies of the first nodule
• 5 cm nodule
• Biopsies
• RAI
• Weight gain
• Support from family

NOTES

American Thyroid Association

23: You Have a Thyroid Nodule, What Happens Next? with Dr. Regina Castro from The Mayo Clinic

64: Managing Indeterminate Thyroid Nodules, with Dr. Kimberly Vanderveen from Denver Center for Endocrine Surgery

Especialista en Endocrinología. UBA

Médico egresado de la Facultad de Medicina de la Universidad Nacional de Rosario.  Especialista en Endocrinología egresado de la Facultad de Medicina de la Universidad de Buenos Aires.  Especialista recertificado por AMA (Asociación Médica Argentina) / SAEM (Sociedad Argentina de Endocrinología y Metabolismo) años 2003 y 2009. Realizó su formación como Endocrinólogo en el Servicio de Endocrinología del Complejo Médico PFA Churruca-Visca. Buenos Aires. Argentina.   Se sub-especializó en el área de Tiroides.  Actualmente se desempeña como Médico de Planta del Servicio de Endocrinología del Complejo Médico PFA Churruca-Visca.  Es Jefe de la Sección Tiroides de dicho Servicio.   Sus trabajos de investigación se basan fundamentalmente en Tiroides. 
Fue docente de Fisiología de la Cátedra de Fisiología Humana de la Facultad de Medicina de la Universidad Nacional de Rosario.  Es docente de la Carrera de Médicos Especialistas en Endocrinología de la Universidad de Buenos Aires.   Es colaborador Docente de la Unidad Docente Hospitalaria "Churruca-Visca" dependiente de la Facultad de Medicina de la Universidad Nacional de Buenos Aires.   Fue docente estable de la Carrera de Especialización en Endocrinología Ginecológica y de la Reproducción en la Universidad Favaloro.   Es Miembro Activo de las siguientes sociedades: Sociedad Argentina de Endocrinología y Metabolismo y de la Sociedad Latinoamericana de Tiroides.   Forma parte del Departamento de Tiroides de la Sociedad Argentina de Endocrinología y Metabolismo.  Es invitado por Sociedades Nacionales e Internacionales como disertante en temas relacionados con Tiroides.  Ex Director de la Sociedad Latinoamericana de Tiroides (LATS).   Chair de la Educational Task Force de la Sociedad Latinoamericana de Tiroides (LATS).

Durante este episodio, escuchamos más detalles sobre lo siguiente:

1. Calidad de vida después de la cirugía
2. Complicaciones
3. Riesgo de obesidad
4. ¿Necesitaré quimioterapia?
5. Otros tratamientos relacionados con el cáncer de tiroides que se necesitan?

NOTES

American Thyroid Association (en Español)

14: When Your Medical Professional Gets Thyroid Cancer with Dr. Aime Franco from University of Arkansas

During this episode, the following topics are discussed:

1. Financial burden of surgery versus total cost of active surveillance over ten years. 
2. Setting patient expectations prior to FNA to manage anxiety
3. When the laryngeal nerve is severed during thyroid surgery, it can and should be repaired, with proper surgeon skill and training. 
4. Rather than being stationery and immobile, patients should practice neck stretching exercise within 24 hours proceeding surgery.  There should be no fear about separating the incision. 
5. The most common question asked to Dr. Miyauchi by surgeons from around the world. 

Total cost of surgery is 4.1x the cost compared to the cost of active surveillance.  In the U.S., the cost is higher. 

By providing patient an active surveillance brochure prior to FNA, they are more open to not proceeding with surgery for small thyroid cancer management. 

Patient voice restores to near normal when repair of laryngeal nerve is done correctly.  All surgeons should be executing this to perfection.

When doing next stretches one-day post surgery, patients report feeling much better and less pain, even one year after surgery.

Protocol for delaying surgery depends on the patient's age.  Older patients are less likely to require surgery.  75% of patients will not require surgery for their lifetime. 

NOTES

Akira Miyauchi, MD

American Thyroid Association

35: Rethinking Thyroid Cancer – When Saying No to Surgery Maybe Best for You with Dr. Allen Ho from Cedars-Sinai in Los Angeles

21: Diagnosed with Thyroid Cancer and You Say No to Surgery with Dr. Louise Davies

50: Regarding Thyroid Cancer, Are You a Minimalist or a Maximalist? with Dr. Michael Tuttle from Sloan Kettering

PAPERS and RESEARCH

Estimation of the lifetime probability of disease progression of papillary microcarcinoma of the thyroid during active surveillance

Comparison of the costs of active surveillance and immediate surgery in the management of low-risk papillary microcarcinoma of the thyroid.

Incidences of Unfavorable Events in the Management of Low-Risk Papillary Microcarcinoma of the Thyroid by Active Surveillance Versus Immediate Surgery

TSH-suppressive doses of levothyroxine are required to achieve preoperative native serum triiodothyronine levels in patients who have undergone total thyroidectomy.

Stretching exercises to reduce symptoms of postoperative neck discomfort after thyroid surgery: prospective randomized study.

Improvement in phonation after reconstruction of the recurrent laryngeal nerve in patients with thyroid cancer invading the nerve.

Dr. Cohen is also an internationally recognized expert on novel cancer therapies and heads the Solid Tumor Therapeutics program at Moores Cancer Center. Much of his work has focused on squamous cell carcinomas and cancers of the thyroid, salivary gland, and HPV-related oropharyngeal cancers. As a physician-scientist, he is especially interested in developing novel therapies and understanding mechanisms of sensitivity or resistance; cancer screening; and using medication and other agents to delay or prevent cancer (chemoprevention). He was recently appointed chair of the National Cancer Institute Head and Neck Cancer Steering Committee, which oversees NCI-funded clinical research in this disease.

Dr. Cohen is editor-in-chief of Oral Oncology, the most respected specialty journal in head and neck cancer. A frequent speaker at national and international meetings, he has authored more than 120 peer-reviewed papers and has been the principal investigator of multiple clinical trials of new drugs in all phases of development. 

In this episode, topics include:

• Drug therapy for patients that fail standard therapy; including surgery and RAI
• Not all patients have same behavior for their cancer
• Some cancers are aggressive
• Not many thyroid cancer patients are affected by this; maybe a few thousand in the U.S., but not tens of thousands
• What is the treatment protocol for therapy?
• Lenvatinib or Sorafenib is the treatment for refectory thyroid cancer
• Lenvatinib tends to be more effective
• Sorafenib is tolerated by the patient better
• Other options to consider include, molecular profiling or some thyroid cancers carry mutation that is targetable, or BRAF
• BRAF inhibitors used with thyroid cancer patients
• Molecular profiling
• DNA sequencing
• Side effects include, what patient will feel and those that appear in blood tests
• Side effects include fatigue in 60% patients, hand or foot blisters, nausea and vomiting
• Side effects in blood tests include high blood pressure, increase in liver enzymes, and a reduction in blood counts
• VEGF receptor
• CT scans and ultra sounds or thyroglobulin as an indicator that thyroid cancer not responsive to traditional therapy
• We don't want to make the patient feel worse; the question is when to treat the patient with drug therapy
• Drug treatment does no cure the disease
• Holidays from the drug and be rid of side effects
• When restarting drug, disease responds again
• Pediatric care
• Immunotherapy

NOTES

Ezra Cohen, MD

American Thyroid Association

In this episode, the following topics are discussed:

• Two roads of tests: rule out and malignant markers
• Rule-out tests picks up innocent behavior pattern.  Most common is Afirma
• Malignant markers, or rule-in tests, are useful at determining extent of surgery, and help avoid a second or third surgery.  ThyroSeq, ThyraMIR, Rosetta
• Do patients get both tests?  Rule out and behavior?
• Approximately 15% of FNA's come back indeterminate.  Some  centers as high as 30%
• Managing indeterminate nodules when a patient chooses no surgery.
• Taking into account emotional, financial, and lifestyle goals of the patient.
• Addressing priorities and goals of the patients should come first.
• Additional molecular testing, surgery, or active surveillance.
• Profiling a patient who choose to remove thyroid even if indeterminate — is usually due to fear and the C word.
• Price of molecular test is $3000 - $6000

NOTES

Kimberly Vanderveen, MD

American Thyroid Association

PAST EPISODES

50: Regarding Thyroid Cancer, Are You a Minimalist or a Maximalist? with Dr. Michael Tuttle from Sloan Kettering

35: Rethinking Thyroid Cancer – When Saying No to Surgery Maybe Best for You with Dr. Allen Ho from Cedars-Sinai in Los Angeles

22: Avoiding Thyroid Cancer Surgery, Depending on the Size with Dr. Miyauchi from Kuma Hospital in Kobe, Japan

09: Thyroid Cancer Patients Experience Quality of Life Downgrade with Dr. Raymon Grogan and Dr. Briseis Aschebrook from the University of Chicago Medicine

08: The Financial Burden of Thyroid Cancer with Dr. Jonas de Souza from The University of Chicago Medicine

In this interview, Dr. Kaptein discusses the need to consider each patient before making treatment decisions.  In some cases, this may mean foregoing the removal of cancerous lymph nodes. 

NOTES

American Thyroid Association

Dr. Elaine Kaptein

In this episode, Dr. Nucera discusses a combination drug therapy using vemurafenib and palbociclib represents a novel therapeutic strategy to treat papillary thyroid carcinoma (PTC). 

NOTES
Carmelo Nucera

Researchers identify novel therapeutic strategy for drug-resistant thyroid cancers

Publication: Thyroid Cancer and resistance to BRAFV600E inhibitors

American Thyroid Association

Un consultor privado endocrinólogo y orador nacional desde 2006, el Dr. Paul Y. Casanova-Romero de investigación extensa sobre la prevención de la diabetes, trastornos de la tiroides, síndrome metabólico y otros trastornos endocrinos han sido ampliamente publicadas. Sigue colaborando en estudios de investigación en Estados Unidos y Latinoamérica, el más reciente en pruebas moleculares de tiroides. El Dr. Casanova-Romero está certificado por la Junta en Medicina Interna, así como en Endocrinología, Diabetes y Metabolismo. Es miembro del Colegio Americano de Endocrinología (F.A.C.E.) y miembro del Colegio Americano de Médicos (F.A.C.P.). Actualmente es profesor voluntario de medicina en la Universidad de Miami.

Dr. Paul Y. Casanova-Romero se especializa en el tratamiento de la enfermedad de la tiroides incluyendo nódulos tiroideos, hipotiroidismo, hipertiroidismo y cáncer de tiroides, enfermedad paratiroidea, diabetes, pre-diabetes, trastornos lipídicos y otros trastornos endocrinos. Él ha estado usando la prueba molecular para la caracterización de los nódulos de la tiroides desde 2010. Él ha satisfecho con éxito los requisitos para la certificación endocrina en el ultrasonido del cuello (ECNU) para realizar la biopsia internamente guiada por ultrasonido de la aspiración de la aguja fina de nódulos de tiroides, de la paratiroides, nodos.

Es miembro del panel de membresía de la American Thyroid Association, miembro activo de la Endocrine Society, la Asociación Americana de Endocrinólogos Clínicos, la American Diabetes Association, el American College of Physicians y la National Lipid Association.

En esta entrevista hablamos sobre esta temas:

• ¿Cómo se identifican los nódulos y por qué ocurren? autoexamen o en la oficina del médico
• La mayoría de los nódulos son benignos pero ocurren porque en mas de 70% de la población
• ¿Qué tests puede realizar un médico para evaluar el nódulo?
• Ninguna test es 100%
• Ultrasonido - qué están buscando en general
• Que es ojo fina y el proceso general
• Tests moleculares
• ¿Qué tipos de resultados se pueden obtener de la citología y qué significan?
• La mayoria de ojo finas son benigno
• Maligno o sospechoso de malignidad, todavía tiene la posibilidad de no ser cáncer
• Los arco iris - 3,4,5 - indeterminate categoria 
• Systema BETHESDA
• ¿Qué tests adicionales se pueden realizar para resolver los nódulos indeterminados? - Tests moleculares
• Que son todas los tests moleculares?  Y son las mismas?
• Dr. Casanova prefiere usar test de Afirma, este es por que

MAS INFORMACIÓN

Dr. Paul Casanova

American Thyroid Association (español)

La prueba de la expresión génica de Afirma puede reducir cirugías innecesarias del cáncer de tiroides

Afirma

Following graduate school, she was awarded a National Cancer Institute research fellowship at the University of California, San Francisco studying molecular genetics.

At Pacific University, she teaches Molecular Biology, Microbiology, Basic Science for Optometry and Human Genetics for Physician Assistants. She has been the recipient of the Thomas J. and Joyce Holce Endowed Professorship in Science and the S.S. Johnson Foundation Award for Excellence in Teaching at Pacific University.

In the episode, we discuss:

• Microbiome
• Microbes inside the gut
• Gut microbe biota
• 95% of serotonin manufactured in gut
• Dark chocolate and bacteria in your gut
• Probiotics
• Prebiotics are food that we eat that has food for good bacteria
• Soluble fiber
• Eat food that feeds your gut bacteria
• Whole grains, black beans, cruciferous vegetables
• Dark chocolate benefit – the darker the better
• Most disruptive to gut biome is antibiotics
• Danger: antibiotics with children
• Majority of antibiotics given to children under three are for upper respiratory issues, fact is antibiotics do not work for such issues
• 85% of antibiotics used are given to food sources, and released into the environment including soil and water
• Danger of consuming emulsifiers
• Cow's milk
• US has low gut diversity — more diversity means more resilience
• Autism and gut connection
• Resetting your gut microbiota by changing diet
• The importance of starting kids out with the right food
• Inflammatory disease is seen less in underdeveloped countries
• Avoid emulsifiers, additives, and artificial sweeteners

NOTES
The American Gut

Michael Pollan 'Some of My Best Friends Are Germs'

An Epidemic of Absence

How Emulsifiers Are Messing with Our Guts (and Making Us Fat)

En este entrevista, hablamos sobre:

• No todos los cánceres de tiroides deben ser operados.
• No todos los nódulos tiroideos deben ser biopsiados.
• La mitad de la población tiene nódulos tiroideos. El 10% de esos nódulos tienen cáncer. En Colombia, 2,5 millones de personas tienen cáncer de tiroides. 15 millones de personas tienen cáncer de tiroides en los Estados Unidos, y lo más probable es que no lo sepan.
• Los estudios muestran que el 30% de los cadáveres tienen nódulos tiroideos con cáncer.
• Comprender las repercusiones de hacer una biopsia. Si se trata de un nódulo que no requiere cirugía, incluso si es cáncer, decirle a un paciente esto a veces hace más daño en la forma de estrés emocional que lo que es necesario.
• No sacrificar una tiroides debido a la fobia.
• La carga es en el médico para no desencadenar paranoia y estrés en el paciente diciéndoles que "podría" tener cáncer, en el caso de llevar a cabo una biopsia en un nódulo cuando no es necesario.
• Una tiroidectomía cambia una vida, incluyendo la piel seca, aumento de peso, calcio, pérdida de voz o cambio de voz - estos pueden ser peores que vivir con cáncer de tiroides papilar.
• ¿Qué necesita ocurrir en la comunidad médica para cambiar el paradigma que no necesitamos para operar en todo el cáncer de tiroides?
• La patología es la clave para cambiar el paradigma.
• El cáncer no es igual en todos los casos. Piense en el cáncer de tiroides similar a la vista sobre el cáncer de próstata en los hombres.

Los temas presentados incluyen:

• Una mejor comprensión de la biología del cáncer de tiroides, y que no todo el cáncer de tiroides es igual. La enfermedad es única en cada paciente.
• La importancia de entender el perfil del cáncer en cada paciente.
• Diagnóstico del nódulo.
• Perfil molecular del nódulo tiroideo.
• Una pausa en la exploración universal del cáncer de tiroides.
• Vigilancia activa
• Menos radiación, o ningún tratamiento de radiación en los casos que anteriormente recibirían radiación
• La importancia para los médicos de compartir una comprensión universal de la vigilancia activa, por lo que los pacientes obtener una recomendación coherente.
• Hipotiroidismo en pacientes con tiroidectomía total.
• El cáncer de tiroides es lento en comparación con otros tipos de cáncer.
• Qué se requiere para la adopción adicional de la innovación del tratamiento del cáncer de tiroides.
• Los riesgos de la cirugía de la tiroides.

REFERENCIA:

Clinica Aleman

Dr. Hernán Tala

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American Thyroid Association (español)

35: Rethinking Thyroid Cancer – When Saying No to Surgery Maybe Best for You with Dr. Allen Ho

21: Diagnosed with Thyroid Cancer and You Say No to Surgery with Dr. Louise Davies

41: Molecular Profiling and Unnecessary Thyroid Surgeries with Jennifer Kuo from Columbia University

At the Congress, Dr. Okamoto presented on Thyroid Cancer Guidelines Around the World

He helped write the Japanese guidelines on thyroid cancer.  He is Professor & Chair of the Department of Surgery at Tokyo Women's Medical University. 

Key points from this episode include:

• Most Western countries carry out total thyroidectomies, whereas in Japan, the approach is more conservative with a fundamental practice of hemithyroidectomy whenever possible.
• By not doing a total thyroidectomy, this allows the patient to not avoid taking thyroid replacement medication.
• Complete thyroidectomy is conducted when 80-90% of lymph nodes have metastasis.
• I-131 treatment is decreasing despite cases of cancer increasing
• For I-131 treatment, patients wait more than 6 months post surgery.
• When receving I-131 treatment, patients be admitted to hospital for several days.
• TSH suppression therapy is common in Western countries, whereas in Japan, measures are taken to avoid TSH suppression by not removing all of the thyroid.
• Normal TSH in Japan is 4.3 or less.
• Culturally, Japanese patients are typically conservative compared to Western countries.  Even high risk patients opt for no TT.
• In Japan people are less aggressive and more patient as a culture, and this is reflected in their approach to treating thyroid cancer.
• For medullary thyroid cancer, treatment management differs in japan.  In Westerm countries, they receive TT.  But, in Japan, if its not familial it is treated with hemithyrodectmy.  Only when familial, is it treated with TT.
• Calcitonin
• Follicular diagnosis is difficult, benign and malignant is a big issue. 
• Active surveillance is spreading now, the question is why?  We must consider the patient's view.  Research from Japan focuses on the size of tumor, but must consider patient's view. 

NOTES

Book: Treatment of Thyroid Tumor: Japanese Clinical Guidelines

American Thyroid Association

RELATED EPISODES

38: Thyroid Surgery? Be Careful, Not All Surgeons Are Equal and Here is Why

35: Rethinking Thyroid Cancer – When Saying No to Surgery Maybe Best for You

6: A Must Listen Episode Before Getting Surgery – Do Not Do It Alone

Dr. Özer Makay is an expert in nerve monitoring during thyroid surgery, and has been a guest faculty member in South Korea, Italy, France, the Netherlands, Germany, Belgium and Bulgaria. 

He has received 17 awards and honors for his scientific studies.  He has authored a 300-page book on nerve monitoring during thyroid surgery. 

This episode covers the following topics:

• Protecting the recurrent laryngeal nerve (RLN) and superior laryngeal nerve during thyroid surgery.
• Outcomes of damaging these nerves during surgery include no voice, hoarseness, shortness of breath, problem with drinking water or aspiration, impaired physical exertion with something as simple as climbing a flight of stairs.
• Why some centers have a higher occurrence of damage during thyroid surgery and include an error rate as high as 10%
• The cause of the damaged nerve include stretching or traction, and cutting or stitching.
• How to reduce risk.
• Is it possible to reattach a cut nerve?
• Surgeons who are opponents of using a nerve monitor.
• Pitfalls of using nerve monitoring. 

Also discussed are thyroid cancer trends in Turkey including:

• Incidence being in the top 5 in the world.
• Now the number one cancer for women.
• Proximity to Chernobyl.
• Screening and awareness as a reason for the increase.
• 50% of population has a thyroid nodule.In the words of Dr. Özer Makay

Biography:  In the words of Dr. Özer Makay

I was born in 1974 in the Netherlands. After finishing the primary school there, I completed my secondary and high school educations at Bornova Anatolian High School in Izmir/Turkey. I graduated from Ege University, School of Medicine and started my residency at the General Surgery Department of Ege University, School of Medicine. During my studentship, I did my surgical internship at London King's College Hospital. During my surgical residency, in 2002, I received education regarding "Laparoscopic Surgery" at Free University Hospital, Amsterdam from Prof. Miguel Cuesta and carried out scientific studies there. I had the opportunity to meet with the robotic surgery system here and did use this system at the experimental investigation laboratory.

After being a specialist registrar in May 2005, I started to work at the division of "Endocrine Surgery" of the General Surgery Department of Ege University. During my fellowship, I worked under the supervision of Prof. Enis Yetkin, Prof. Mahir Akyıldız and Prof. Gökhan İçöz. During this period, I became the first Turkish surgeon to have the right to get the title "Fellow of European Board of Surgery – div. Endocine Surgery" by passing the "UEMS Board Examination for Endocrine Surgery". At the Ege University, we started the "Laparoscopic Adrenalectomy Programme' in 2008, together with Prof. Dr. Mahir Akyıldız. Besides, the "Robotic Surgery Programme' was launched in 2012. I promoted to "Associate Professor of Surgery" in 2012. I have been invited to become a member of the European Board of Endocrine Surgery Committee. This makes me the first Turkish member of this committee. Besides, I was chosen as "the national representative" of a "European Union Health Project" concerning this area.

To date, I own more than 80 national and international publications. Furthermore, I participated in more than 30 national and international scientific meetings as speaker, instructor and guest surgeon. I served as president, scientific secretary or organization/scientific committee member for national and international congresses and meetings. I had been in South Korea, Italy, France, the Netherlands, Germany, Belgium and Bulgaria as guest faculty member. I received 17 awards and honors because of my scientific studies presented during national and international scientific congresses. I speak English, Dutch and German fluently and Spanish at elementary level.

My essential areas of interests are "endocrine surgery" and "robotic surgery". As Ege University, we are the most experienced center of our country regarding "robotic adrenalectomy".

NOTES