Doctor Thyroid

Welcome to Doctor Thyroid with your host, Philip James. This is a meeting place for you to hear from top thyroid doctors and healthcare professionals. Information here is intended to help those wanting to 'thrive' regardless of setbacks related to thyroid cancer. Seeking good health information can be a challenge, hopefully this resource provides you with better treatment alternatives as related to endocrinology, surgery, hypothyroidism, thyroid cancer, functional medicine, pathology, and radiation treatment. Not seeing an episode that addresses your particular concern? Please send me an email with your interest, and I will request an interview with a leading expert to help address your questions. Philip James
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Doctor Thyroid




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Mar 15, 2018

James L. Netterville, M.D.
Mark C. Smith Professor of Head and Neck Surgery, Professor of Otolaryngology
Director, Head & Neck Oncologic Surgery
Associate Director, Bill Wilkerson Center for Otolaryngology and Communication Sciences

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


Vanderbilt Health

Vanderbilt-Ingram Cancer Center

Thyroid research

Funding surgical educational camps in Africa


Index Medicus

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

American Thyroid Association

Mar 10, 2018

Antonio Bianco, MD, is the Charles Arthur Weaver Professor of Cancer Research in the Department of Internal Medicine. He is the president of Rush University Medical Group and vice dean for clinical affairs in Rush Medical College.

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.


American Thyroid Association

Bianco Lab

A Controversy Continues: Combination Treatment for Hypothyroidism


Mar 6, 2018

18 years ago Lorrie was diagnosed with Graves’ disease.  Then, in 2017 she received a diagnosis of thyroid cancer. 

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


American Thyroid Association


Mar 3, 2018

Dr. Amanda Laird, MD is an endocrine surgeon and Chief of Endocrine Surgery at the Rutgers Cancer Institute of New Jersey in New Brunswick, New Jersey. She is currently licensed to practice medicine in New Jersey and New York. She is affiliated with Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Hospital.

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.


Amanda Laird, MD

American Thyroid Association 


Mar 1, 2018

H. Gilbert Welch, MD, MPH

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 TimesThe 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


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 


Jan 31, 2018

Dra. Gabriela Brenta, M.D., Ph.D.

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


Asociación Americana de Tiroides

Jan 30, 2018

In this episode we hear from Doug, and 37 year old, male patient of Hashimoto's.  Discussed, are the following topics:

  • 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


American Thyroid Association

NP Thyroid

ACTH stimulation test


Deiodinase polymorphism testing


All hormone deficiencies

Hypothyroid Men

Jan 23, 2018

In this interview, the following topics are discussed:

  • 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


Thyroid Change Resources



Jan 16, 2018

In this episode, we visit with Carla. She had thyroid cancer surgery.  During the interview, we discuss:

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


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


Jan 10, 2018

Dr. Eduardo Faure

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?


American Thyroid Association (en Español)

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

Dec 29, 2017

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. 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. 


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


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.

Dec 8, 2017

Ezra Cohen, MD, is a board-certified oncologist and cancer researcher. He cares for patients with all types of head and neck cancers, including esophageal, thyroid and salivary gland cancers.

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


Ezra Cohen, MD

American Thyroid Association


Nov 9, 2017

Kimberly Vanderveen, MD is a Colorado native and graduate of Bear Creek High School in Lakewood, CO. She received her bachelor’s degree with honors from Muhlenberg College in Allentown, PA. She then earned her medical degree from Northwestern University in Chicago, IL in 2001. Dr. Vanderveen completed her surgical residency at UC-Davis in Sacramento, CA. During her residency, she also obtained a master's degree in Clinical Research and was actively involved in cancer research and education. After her surgical training, Dr. Vanderveen completed a fellowship in Endocrine Surgery at the Mayo Clinic in Rochester, MN. She is knowledgeable in both medical and surgical aspects of endocrine diseases. She specializes in surgery for diseases of the thyroid, parathyroid, adrenal glands and is a high volume neck and adrenal surgeon.

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


Kimberly Vanderveen, MD

American Thyroid Association


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


Nov 6, 2017

Bryan McIver, MD, PhD

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


American Thyroid Association

Bryan McIver, MD, PhD

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

Hossein Gharib, M.D.


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

Oct 21, 2017

A native of Saskatchewan, Canada, Dr. Kaptein began teaching at the Keck School of Medicine in the Endocrinology Division in 1977. She became a tenured Professor of Medicine in 1990, a position she currently holds. Dr. Kaptein is a distinguished member of the Western Society for Clinical Investigation, American Society of Nephrology, the Endocrine Society and the American Thyroid Association. An accomplished researcher and lecturer, Dr. Kaptein has been invited to speak on the topics of Endocrinology and Nephrology in such cities as Montreal, Milan, Tel Aviv, Jerusalem, Vienna and Rotterdam, to name a few.

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. 


American Thyroid Association

Dr. Elaine Kaptein



Oct 19, 2017

Carmelo Nucera, M.D., Ph.D., is currently an Assistant Professor at Harvard Medical School, Boston, in the Division of Cancer Biology and Angiogenesis (Department of Pathology), Beth Israel Deaconess Medical Center. Dr. Nucera received his M.D. and Ph.D. in Experimental Endocrinology and Metabolism from Italy.
Dr. Nucera is highly driven by an intense desire to make important contributions that will directly benefit patients. Dr. Nucera is strongly committed to make discovery aimed to immediately cure patients that are suffering with aggressive tumors and rare/orphan cancer disease.
Dr. Nucera has a clinical background and intensely served patients with fatal human diseases.

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). 

Carmelo Nucera

Researchers identify novel therapeutic strategy for drug-resistant thyroid cancers

Publication: Thyroid Cancer and resistance to BRAFV600E inhibitors

American Thyroid Association


Oct 19, 2017

Dr. Angela M. Leung is an Assistant Professor of Medicine at the UCLA David Geffen School of Medicine and an endocrinologist at both UCLA and the VA Greater Los Angeles Healthcare System.

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


Dr. Angela Leung

CATS study

American Thyroid Association

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

Sep 29, 2017

Dr. Paul Y. Casanova-Romero, M.D., M.P.H., F.A.C.P., F.A.C.E, E.C.N.U, que se unió a Palm Beach Diabetes y Endocrine Specialists en 2012, recibió su grado médico con honores (Summa Cum Laude) y Doctor en Ciencias Médicas (DMSc), de la Universidad de Zulia, la Escuela de Medicina en Venezuela. Posteriormente se unió a la facultad de su Alma Mater y en 1998, el Grupo de Investigación del Programa de Prevención de la Diabetes (D.P.P.) en el Instituto de Investigación de la Diabetes-Universidad de Miami. Completó su posgrado en Medicina Interna y Endocrinología (Jackson Memorial Hospital) y estudios de postgrado en Salud Pública (M.P.H.) con el Premio de Mérito Académico en la Universidad de Miami.

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


Dr. Paul Casanova

American Thyroid Association (español)

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


Sep 28, 2017

Dr. Bridget Brady is Austin’s first fellowship trained endocrine surgeon. She has a passion for and expertise in disease of the thyroid, parathyroid, and adrenal glands. Since completing her endocrine surgery fellowship in 2006 under Matthias Rothmund, MD, an internationally acclaimed endocrine surgeon, she has performed thousands of thyroidectomies and parathyroidectomies here in Austin. Dr. Brady focuses on a variety of minimally invasive techniques to optimize patients’ medical and cosmetic outcomes. Her fellowship training in Germany and experience in Austin have enabled her to specialize in patients with recurrent or persistent disease of the thyroid and parathyroid, including thyroid cancer. She offers complete diagnostic workups including in-office ultrasounds and FNA biopsies of thyroid nodules and lymph nodes.

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?


Dr. Bridget Brady


American Thyroid Association


Sep 25, 2017

Dr. Lisa Sardinia is an associate professor in the Pacific University Biology Department. She received a B.S. in Biology from Whitworth College, a Ph.D. in Microbiology from Montana State University and a J.D. from the University of California, Hastings College of the Law.  

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

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)

Sep 24, 2017

Dr. Susanne Breen is a board certified naturopathic physician. She completed her medical training at the National University of Natural Medicine (NUNM) after initial medical studies at the Oregon Health Sciences University in conventional medicine.  Healing, she discovered, required more than medication or even natural remedies. Her inspiration came from her advanced studies at NUNM in gastroenterology, including Small Intestinal Bacterial Overgrowth (SIBO), where she learned about the root causes of her personal health challenges. She read Breaking the Vicious Cycle, changed her diet, found direction from practitioners and started her path to health. She brings her personal experience and training to help others do the same.

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.


Susanne Breen, N.D.

Sep 20, 2017

Dr. Gerard Doherty, an acclaimed endocrine surgeon, is a graduate of Holy Cross and the Yale School of Medicine. He completed residency training at UCSF, including Medical Staff Fellowship at the National Cancer Institute.  Dr. Doherty joined Washington University School of Medicine in 1993, and became Professor of Surgery in 2001. In 2002 he became Head of General Surgery and the Norman W. Thompson Professor of Surgery at the University of Michigan, where he also served as the General Surgery Program Director and Vice Chair of the Department of Surgery. From 2012 to 2016, Dr. Doherty was the Utley Professor and Chair of Surgery at Boston University and Surgeon-in-Chief at Boston Medical Center before becoming Moseley Professor of Surgery at Harvard Medical School, and Surgeon-in-Chief at Brigham and Women’s Hospital and Dana-Farber Cancer Institute. 

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.


American Association of Endocrine Surgeons

American Thyroid Association

Sep 18, 2017

Dr. Alan Farwell is an endocrinologist, Director of the Endocrine Clinics at Boston Medical Center, and Associate Professor of Medicine at Boston University School of Medicine, in Massachusetts.

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.


Dr. Antonio Bianco

Dr. Jacqueline Jonklaas

American Thyroid Association

Sep 10, 2017

Dr. Wartofsky is Professor of Medicine, Georgetown University School of Medicine and Chairman Emeritus, Department of Medicine, MedStar Washington Hospital Center.  He trained in internal medicine at Barnes Hospital, Washington University and in endocrinology with Dr. Sidney Ingbar, Harvard University Service, Thorndike Memorial Laboratory, Boston.   Dr. Wartofsky is past President of both the American Thyroid Association and The Endocrine Society.  He is the editor of books on thyroid cancer for both physicians and for patients, and thyroid cancer is his primary clinical focus.   He is the author or coauthor of over 350 articles and book chapters in the medical literature, is recent past Editor-in-Chief of the Journal of Clinical Endocrinology & Metabolism, and is the current Editor-in-Chief of Endocrine Reviews.

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


Leonard Wartofsky

American Thyroid Association


Aug 29, 2017

Dr. José A. Hakim realiza más de 400 cirugías al año. Es cirujano general. Especialista en cirugía de cabeza y cuello en relación con el cáncer.

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.
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