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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 philipjames@docthyroid.com
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Aug 18, 2017

Many centers from around the world want to know how Memorial Memorial Sloan Kettering Cancer Center treats thyroid cancer.  A key member of the MSKCC is Dr. Michael Tuttle. 

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

Aug 15, 2017

In this episode, topics include:

  • 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

Aug 10, 2017

Dr. Hernán Tala es endocrinólogo de la Clinica Alemana en Santiago, Chile. Su area especialidad incluye cáncer de tiroides avanzado, endocrinologia general, y enfermedades tiroides.

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

Facebook

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

 

Aug 6, 2017

This episode is recorded from Boston and the World Congress on Thyroid Cancer, where leading doctors and researchers have gathered to share the latest medical research and trends related to thyroid disease. 

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

 

 

Aug 1, 2017

This episode is recorded from Boston at the World Congress on Thyroid Cancer, where thyroid doctors and researchers gathered to share the latest medical research and medical improvements related to thyroid disease. 

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

Dr. Özer Makay

Contact

Facebook

Publications

World Congress on Thyroid Cancer

American Thyroid Association

Jul 27, 2017

La glándula tiroides es un órgano importante del sistema endocrino. Está ubicada en la parte anterior del cuello, justo por encima de donde se encuentran las clavículas. La tiroides produce hormonas que controlan la forma como cada célula en el cuerpo usa la energía. Este proceso se denomina metabolismo.

Hipotiroidismo es una afección en la cual la glándula tiroides no produce suficiente hormona tiroidea. Esta afección a menudo se llama tiroides hipoactiva.

Este episodio Dra. Gabriela Brenta discute sobre hipotiroidismo, las causas, los síntomas, pruebas y exámenes, el tratamiento, pronóstico, posibles complicaciones, y cuándo contactar a un médico.

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.

Jul 19, 2017

Doctor Califano es Endocrinóloga del Instituto de Oncología AH Roffo, Universidad de Buenos Aires.
Es miembro del Departamento de Tiroides de la Sociedad Argentina de Endocrinología y Metabolismo y de la Sociedad Latinoamericana de Tiroides.
Es coautora del Consenso Multisocietario Argenino para el Manejo del Cáncer de Tiroides Diferenciado.

En esta entrevista, discutimos lo siguiente:

  1. ¿Qué es un nódulo? 
  2. ¿Qué sucede durante ecografia?
  3. ¿Qué sucede durante la oja fina?
  4. Si es cáncer, ¿siempre hace la cirugía?
  5. Si no es cáncer, ¿algunas veces hace cirugía?
  6. ¿Qué sucede durante la cirugía? ¿Cuánto tiempo se tarda en recuperarse?
  7. ¿Es necesario radioactivo?  
  8. ¿Qué sucede durante la RAI? ¿Hay efectos secundarios? Dieta especial.
  9. Si se elimina mi tiroides, ¿cómo será mi vida después? T4
  10. ¿Cómo elijo al mejor cirujano?
  11. ¿Cuáles son los errores médicos que usted ve con más frecuencia y cómo pueden evitarse?
  12. ¿A qué hora del día debo tomar mi medicamento para la tiroides?
Jul 13, 2017

Not all thyroid cancer patients who receive a thyroidectomy require radioactive iodine, but for those whose cancer maybe more aggressive and spread beyond the thyroid area, often radioactive iodine (RAI) is protocol. 

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

Jul 5, 2017

This is an in depth discussion about the connection between flame retardants and plastics, and thyroid cancer.  These chemicals, also known as endocrine disruptors, have a clear connection to thyroid cancer occurrence.

The research is presented by Julie Ann Sosa, MD MA FACS is Chief of Endocrine Surgery at Duke University and leader of the endocrine neoplasia diseases group in the Duke Cancer Institute and the Duke Clinical Research Institute. She is Professor of Surgery and Medicine. Her clinical interest is in endocrine surgery, with a focus in thyroid cancer. She is widely published in outcomes analysis, as well as cost-effectiveness analysis, meta-analysis, and survey-based research, and she is director of health services research. 

NOTES:

Study Associates Flame Retardants with Papillary Thyroid Cancer

Flame retardants used in furniture may increase thyroid cancer risk

Trends in Thyroid Cancer Incidence and Mortality in the United States, 1974-2013

How to Buy a Sofa without Toxic Flame Retardants

Julie Ann Sosa, MD

Jun 29, 2017

One-third of all thyroid nodule fine needle aspirations come back indeterminate. When surgery is performed on these cases, pathology of the thyroid reveals that many times the nodule is benign.  Through molecular profiling, patients with indeterminate thyroid nodules, can now avoid unnecessary surgery and get more accurate pathology results from the fine needle aspiration.

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

Jun 26, 2017

I sometimes get asked, why am I doing this podcast? 

What started out as a pet project is now being listened to in over 30 countries and with as many as 20000 downloads per episode.  So far, thyroid patients are embracing the opportunity to hear from the world’s leading thyroid doctors, and gaining the information needed to make better decisions related to health.

So why did I start Doctor Thyroid?

My motivation for doing this podcast is to help patients avoid bad experiences related to thyroid cancer and thyroid disease, including bad surgery.   And, provide resources to help make better health decisions and improve quality of life.

My thyroid surgery resulted in errors, which have downgraded my quality of life significantly.  Knowing what I know now, I would have picked a different surgeon, or chosen no surgery at all.  Because, as this interview will discuss, although perceived as safe, thyroid surgery is not without risks. 

To be published next month, new research reveals thyroid surgery errors are five times more likely than previously reported. 

The study was conducted by Dr. Maria Papaleontiou.  She is an Assistant Professor of Internal Medicine with an appointment in the Division of Metabolism, Endocrinology and Diabetes. She graduated medical school from the prestigious Charles University in the Czech Republic and subsequently spent several years conducting research at the Geriatrics Division at Weill Cornell Medical College. She then completed her internal medicine residency at Saint Peter’s University Hospital in New Jersey and her endocrinology fellowship at the University of Michigan. She joined the faculty at the University of Michigan in 2013. She is a recipient of Fulbright and Howard Hughes Medical Institute scholarships.  Dr. Papaleontiou’s practice focuses on thyroid disorders and thyroid cancer. She is especially interested in the treatment of endocrine disorders in older adults. She also conducts health services research in the field of thyroidology and aging.

NOTES

Dr. Maria Papaleontiou

Complications from thyroid cancer surgery more common than believed, study finds

National Cancer Institute (NCI)

RELATED DOCTOR THYROID INTERVIEWS

Dr. Ralph Tufano: Be Careful, Not All Surgeons Are Equal and Here is Why 

Dr. Gary Clayman: The Single Most Important Question to Ask Your Surgeon

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

Jun 22, 2017

Dr. Rashika Bansal is a PGY-2 resident in Internal Medicine at St. Joseph's Regional Medical Center in Paterson, NJ.  Her major research has been with diabetes prevalence and awareness in rural India, with special interest in thyroid disease. 

In this episode Dr. Bansal shares the research she presented at AACE 2017 and ENDO 2017, regarding the poor readability scores for thyroid cancer web sites.

The challenge for these web sites and health institutions is to translate thyroid education from complex to simple and easy to understand.  Currently, many patients are not following with treatment, citing confusion after being exposed to the various thyroid cancer education resources.  

NOTES

Thyroid Education Scores Low for Readability

Thyroid patient education materials not adequately targeted to patient reading level

 

Jun 13, 2017

In this interview, items discussed include:

  • 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

Jun 1, 2017

Antonio Bianco, MD, PhD, is head of the division of Endocrinology and Metabolism at Rush University Medical Center.   Dr. Bianco also co-chaired an American Thyroid Association task force that updated the guidelines for treating hypothyroidism.

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.

May 29, 2017

The USPSTF upholds its 1996 recommendation against screening for thyroid cancer among asymptomatic adults.

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

May 20, 2017

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.

 

About Dr. Allen Ho

Allen Ho, MD, is a fellowship-trained head and neck surgeon who focuses on head and neck tumors, including HPV(+) throat cancers and thyroid malignancies. As director of the Head and Neck Cancer Program and co-director of the Thyroid Cancer Program, he leads the multidisciplinary Cedars-Sinai Head and Neck Tumor Board, which provides consensus management options for complex, advanced cases. Ho's research interests are highly integrated into his clinical practice. His current efforts lie in cancer proteomics, HPV(+) oropharyngeal cancer pathogenesis, and thyroid cancer molecular assays. He has presented his research at AACR, ASCO, AHNS, and ATA, and has published extensively as lead author in journals that include Nature Genetics, Journal of Clinical Oncology, Cancer, and Thyroid. Ho serves on national committees within the ATA and AHNS, and is principal investigator of a national trial on micropapillary thyroid cancer active surveillance (ClinicalTrials.gov ID: NCT02609685). He maintains expertise in transoral robotic surgery (TORS), minimally invasive thyroidectomy approaches, and nerve preservation techniques. Ho’s overarching mission is to partner with patients to optimize treatment and provide compassionate, exceptional care.

NOTES

American Thyroid Association

Cedars-Sinai clinical trial

MSKCC thyroid cancer active surveillance

THYCA Support Group

 

Active Surveillance of Thyroid Cancer Under Study

 

May 12, 2017

What Happens When Thyroid Cancer Travels to the Lungs?

Fabian Pitoia, M.D., serves as the Head of the Thyroid Section of the Division of Endocrinology and Investigation Area Coordinator at the Hospital de Clinicas of the University of Buenos Aires (UBA). He works also as an Proffessor of internal medicine at the Faculty of Medicine (UBA).

Dr Pitoia serves as a Full Member of the Argentine Society of Endocrinology and Metabolism, of the Latin American Thyroid Society, the Endocrine Society and he is a Correspondent Member of the American Thyroid Association.

In this episode Dr. Pitoia addresses the following topics:

  • 10% of thyroid cancer patients will have distant metastatic disease
  • The disease will travel to lungs, bones, or both
  • Treatment with RAI is most effective for those under 40 years old
  • Evaluation of metastatic thyroid cancer in the lungs is a CT scan
  • In 2006, there was a change in the treatment of the disease
  • Adverse events of medication
  • The coordination between the endocrinologist and the oncologist 

RESOURCES

ResearchGate

Dr. Pitoia - Facebook

Dr. Pitoia - web site

Dr. Pitoia - Twitter

Thyroid Cancer Alliance

American Thyroid Association

Hospital de Clínicas de la Universidad de Buenos Aires - Ciudad Autónoma de Buenos Aires.  Consultorio privado: Pte. J.E. Uriburu 754 - Piso 2. Teléfonos: 49545488/49525496  fpitoia@glandulatiroides.com.ar

 

May 12, 2017

Bienvenido al episodio 33 de Doctor Thyroid con Philip James.   

El invitado de hoy es Dr. Fabian Pitoia.  El Dr. Pitoia es un experto endocrino mundial, que aparece en muchas publicaciones y conferencias mundiales, donde habla de cáncer de tiroides. El Dr Pitoia es médico endocrinólogo, está encargado de la Sección Tiroides de la División Endocrinología del Hospital de Clínicas de la Universidad de Buenos Aires.

En este episodio, el Dr. Pitoia responde las siguientes preguntas:

  • ¿Qué es la enfermedad metastásica en relación con el cáncer de tiroides?  
  • Hay una tendencia de este enfermedad?
  • ¿cómo se descubre la enfermedad metastásica?
  • cuando se trata de cáncer de tiroides es un procedimiento típico para los médicos para detectar la enfermedad metastásica?
  • si un paciente no responde a RAI (radioactiva), ¿qué es una opción de tratamiento? ¿Podemos hacer vigilancia activa
  • cuando hay metástasis en los pulmones, ¿es lo mismo que el cáncer de pulmón?
  • 600 milicurios de RAI .... ¿Hay peligro para este alto de una dosis?
  • ¿hay efectos secundarios o peligros a los medicamentos usados ​​para tratar la enfermedad metastásica que no responde a la radiación?
  • se le informa a un paciente de la enfermedad metastásica, y este es un área de estrés para los pacientes con cáncer de tiroides, ¿puede decirle a un paciente algo para reducir la ansiedad relacionada con la enfermedad metastásica?
  • si un paciente tiene enfermedad metastásica, ¿es necesario un médico especial para el tratamiento?
  • ¿cómo sabemos si un médico se especializa en la enfermedad metastásica?
  • ¿hay una página web o recursos adicionales para aprender más sobre la enfermedad metastásica?

Recursos:

Dr. Pitoia - Facebook

Dr. Pitoia - pagina web

Dr. Pitoia - Twitter

ResearchGate

Thyroid Cancer Alliance

American Thyroid Association - Español

Hospital de Clínicas de la Universidad de Buenos Aires - Ciudad Autónoma de Buenos Aires.  Consultorio privado: Pte. J.E. Uriburu 754 - Piso 2. Teléfonos: 49545488/49525496  fpitoia@glandulatiroides.com.ar

May 8, 2017

This is a candid interview with Dr. Gary Clayman about thyroid cancer surgery and making sure a patient receives the best available care. 

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

May 4, 2017

El término nódulo tiroideo se refiere a cualquier crecimiento anormal de las células tiroideas formando un tumor dentro de la tiroides. Aunque la gran mayoría de los nódulos tiroideos son benignos (no cancerosos), una pequeña proporción de estos nódulos sí contienen cáncer de tiroides. Es por esta posibilidad que la evaluación de un nódulo tiroideo está dirigida a descubrir un potencial cáncer de tiroides.

En esta entrevista, el Dr. Castro explica los siguientes temas:

  • ¿Qué es un nódulo tiroideo?
  • ¿Cuáles son los síntomas de un nódulo tiroideo?
  • ¿Cómo se diagnostica el nódulo tiroideo?
  • Punción de la tiroides con aguja fina
  • Ecografía de la tiroides
  • ¿Cómo se tratan los nódulos de la tiroides?
  • Cuando la observación activa es la opción de tratamiento en lugar de una tiroidectomía
  • Niños con nódulos tiroideos

M. Regina Castro, MD es consultante en la División de Endocrinología de la Clínica Mayo de Rochester, MN. Es Profesora Asociada de Medicina. Es Directora Asociada del Programa de entrenamiento en la especialidad de Endocrinología, y Directora de la rotación de Endocrinología para la Residencia de Medicina Interna. También es miembro del Grupo de Tiroides de la Clínica Mayo. Ella sirvió de 2009 a 2015 como Editor de Sección de la Tiroides para el Programa de Autoevaluación de AACE y ha sido autora de varios capítulos sobre Hipertiroidismo, Nódulos de Tiroides y cáncer

Notas

Nódulos Tiroideos

Regina Castro Publications

American Thyroid Association en Español 

 

 

Apr 25, 2017

Andrew J. Bauer, MD is an Associate Professor of Pediatrics at the Perelman School of Medicine, University of Pennsylvania and serves as the Director of the Thyroid Center in the Division of Endocrinology and Diabetes at The Children’s Hospital of Philadelphia. Dr. Bauer maintains active membership as a fellow in the American Academy of Pediatrics (FAAP), the Endocrine Society, the Pediatric Endocrine Society, and the American Thyroid Association. He also volunteers as a consultant for the Thyroid Cancer Survivors Association and the Graves’ Disease and Thyroid Foundation. In the American Thyroid Association Dr. Bauer has recently served as a member of the pre-operative staging committee, the thyroid hormone replacement committee, and as a co-chair for the task force charged to author guidelines on the evaluation and treatment of pediatric thyroid nodules and differentiated thyroid cancer. His clinical and research areas of interest are focused on the study of pediatric thyroid disease, to include hyperthyroidism, thyroid nodular disease, thyroid cancer, and inherited syndromes associated with an increased risk of developing thyroid nodules and thyroid cancer.

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

Apr 22, 2017

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.

Victor J. Bernet, MD, is Chair of the Endocrinology Division at the Mayo Clinic in Jacksonville, Florida and is an Associate Professor in the Mayo Clinic College of Medicine. Dr. Bernet served 21+ years in the Army Medical Corps retiring as a Colonel. He served as Consultant in Endocrinology to the Army Surgeon General, Program Director for the National Capitol Consortium Endocrinology Fellowship and as an Associate Professor of Medicine at the Uniformed Services University of Health Sciences. Dr. Bernet has received numerous military awards, was awarded the “A” Proficiency Designator for professional excellence by the Army Surgeon General and the Peter Forsham Award for Academic Excellence by the Tri-Service Endocrine Society. Dr. Bernet graduated from the Virginia Military Institute and the University of Virginia School of Medicine. Dr. Bernet completed residency at Tripler Army Medical Center and his endocrinology fellowship at Walter Reed Army Medical Center. Dr. Bernet’s research interests include: improved diagnostics for thyroid cancer, thyroidectomy related hypocalcemia, thyroid hormone content within supplements as well as management of patient’s with thyroid cancer. He is the current Secretary and CEO of the American Thyroid Association.

Apr 22, 2017

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.

Victor J. Bernet, MD, is Chair of the Endocrinology Division at the Mayo Clinic in Jacksonville, Florida and is an Associate Professor in the Mayo Clinic College of Medicine. Dr. Bernet served 21+ years in the Army Medical Corps retiring as a Colonel. He served as Consultant in Endocrinology to the Army Surgeon General, Program Director for the National Capitol Consortium Endocrinology Fellowship and as an Associate Professor of Medicine at the Uniformed Services University of Health Sciences. Dr. Bernet has received numerous military awards, was awarded the “A” Proficiency Designator for professional excellence by the Army Surgeon General and the Peter Forsham Award for Academic Excellence by the Tri-Service Endocrine Society. Dr. Bernet graduated from the Virginia Military Institute and the University of Virginia School of Medicine. Dr. Bernet completed residency at Tripler Army Medical Center and his endocrinology fellowship at Walter Reed Army Medical Center. Dr. Bernet’s research interests include: improved diagnostics for thyroid cancer, thyroidectomy related hypocalcemia, thyroid hormone content within supplements as well as management of patient’s with thyroid cancer. He is the current Secretary and CEO of the American Thyroid Association.

Apr 18, 2017

This episode is a thorough presentation of Graves' Disease from Kimberly Dorris, an educator and expert, and also a patient.  In this episode, listeners will gain a thorough understanding of a disease that is often confused with other diagnosis.  

Kimberly Dorris is the Executive Director and CEO of the Graves' Disease and Thyroid Foundation, a small nonprofit organization based in Rancho Santa Fe, CA.
She began working with the GDATF as a volunteer in 2010, and took over day-to-day management of the Foundation in 2011.  

​Her responsibilities include organizing patient education events in various locations throughout the U.S.A., managing the Foundation's social media sites, producing print and electronic communications, seeking grant funding, and providing support for patients via phone, e-mail, and an online support forum.  ​
​She also leads a monthly patient support group meeting in Phoenix, AZ.
 
​Ms. Dorris has a unique perspective on thyroid dysfunction, having lived with both hyperthyroidism and hypothyroidism.  She was diagnosed with Graves' disease in 2007 and took methimazole for seven years.  
​A​pproximately 18 months after stopping the methimazole, she became hypothyroid and is currently taking replacement hormone.  ​
 
Ms. Dorris received a B.A. from the University of Arizona in 1990 and an M.B.A. from Belmont University in Nashville in 1990. 
​P​rior to joining the GDATF, she spent 
​8 years with Mercury Nashville Records, a year with KPMG Consulting, and ​
10 years with a community bank, including a two-year term as chairman of the company’s Charitable Giving Committee.
 
NOTES & RESOURCES:
GDATFWebsite:  http://gdatf.org/
GDATF Online Support Forum: http://gdatf.org/forum/
GDATF YouTube Site (includes free videos on Graves' disease, autoimmunity, and thyroid eye disease): https://www.youtube.com/user/GravesAndThyroid
 
 
Twitter: @GDATF
 
Patients and family members can also e-mail the Graves' Disease Foundation at info@gdatf.org or call toll-free 877-643-3123.  
Apr 18, 2017

En este episodio explora los siguientes temas:

  • Opciones de tratamiento para la enfermedad de Graves.
  • Opciones de tratamiento para el hipertiroidismo.
  • Peligros de la medicación del hyperthyroidism.
  • Síntomas del hipertiroidismo.

Dr. Alejandro Ayala obtuvo su doctorado de la Universidad Federal Fluminense en Río de Janeiro, Brasil, en 1992, y completó su residencia en medicina interna en la Universidad Federal de Sao Paulo. Posteriormente se unió al Programa de Medicina Interna de la Universidad de Georgetown en el Centro Hospitalario de Washington, donde recibió el Premio Saul Zukerman, MD, Humanitarianism in Medicine. El Dr. Ayala obtuvo su formación clínica en Endocrinología en el Hospital Universitario Johns Hopkins, seguido de una beca de investigación en los Institutos Nacionales de Salud (NIH) en Bethesda, Maryland, donde continuó durante los siguientes cinco años como clínico del personal, investigador clínico y facultad de El programa de entrenamiento de endocrinología NIH.

Durante este tiempo, los intereses de investigación del Dr. Ayala están relacionados con los trastornos de la Neruendocrinología, la pituitaria y la adrenal. Sus intereses de investigación incluyen hiperaldosteronismo, síndrome de Cushing y feocromocitoma, áreas en las que ha sido autor de más de dos docenas de artículos revisados ​​por pares y ha escrito varios capítulos de libros.

NOTAS:

The Hormone Foundation

Dr. Alejandro Ayala

GDATFWebsite:  http://gdatf.org/
 
GDATF Online Support Forum: http://gdatf.org/forum/
 
 
 
GDATF YouTube Site (includes free videos on Graves' disease, autoimmunity, and thyroid eye disease): https://www.youtube.com/user/GravesAndThyroid
 
 
Twitter: @GDATF
 
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