Info

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
RSS Feed Subscribe in Apple Podcasts
Doctor Thyroid
2018
September
June
May
March
January


2017
December
November
October
September
August
July
June
May
April
March
February
January


2016
December
November
October


Categories

All Episodes
Archives
Categories
Now displaying: Page 1
Sep 15, 2018

Dr. Jorge Calvo
Lugar de estudio:
U. de Panamà, Hospital de la Caja de Seguro Social, Fundaciòn Santa Fe (Colombia) U. Del Norte (Argentina), Sistema Integrado de Salud (Veraguas)
Otros estudios:
Laparoscopía, Curso de postgrado de Cirugía Gastrointestinal, Curso de postgrado de Cirugía de Cabeza y Cuello

 

En este episodio, se tratan los siguientes temas:

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

Más información:
www.doctiroides.com

Jun 26, 2018

The 5-year survival rate for invasive thyroid cancer is 97.9%, and the 10-year survival rate is more than 95%, according to the National Cancer Institute. This leads some people to refer to it as a "good cancer."

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

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

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

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

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

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

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

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

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

NOTES

Briseis Aschebrook-Kilfoy

Raymon Grogan, M.D., MS, FACS

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

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

Jun 26, 2018

Dr. Akira Miyauchi

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

During this episode, the following topics are discussed:

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

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

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

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

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

 

Listen to Doctor Thyroid here! 

Akira Miyauchi, MD

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

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

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

PAPERS and RESEARCH

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

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

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

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

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

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

 

Jun 26, 2018

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.

NOTES

Listen to Doctor Thyroid

American Thyroid Association

Dr. Michael Tuttle

RELATED EPISODES

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

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

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

Jun 26, 2018

Dr. Allen Ho 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.

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

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

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

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

Other active surveillance research

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

The team

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

NOTES

Allen Ho, MD

Active Surveillance of Thyroid Cancer Under Study

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

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

Jun 26, 2018

The past year has been fascinating and highly fruitful year for Dartmouth Institute Associate Professor Louise Davies, MD, MS. A 2017-2018 Fulbright Global Scholar, Davis spent several months in Japan at the Kuma Hospital in Kobe, Japan, studying the hospital's pioneering surveillance program for thyroid cancer. Davies, the chief of otolaryngology-head & neck surgery-at the Veterans Affairs Medical Center in White River Junction, Vermont, has researched U.S. patients' experiences of monitoring thyroid cancers they self-identify as overdiagnosed, and has found that such patients often feel unsupported, even ostracized. Following her stay in Japan, Davies, who also develops and teaches courses in qualitative research methods in Dartmouth Institute's MPH programs, spent several months in the U.K. at the Health Experiences Research Group (HERG) at Oxford University. There, she learned skills that will help her develop web-based materials to raise public awareness about surveillance, surveillance programs, and overdiagnosis in general.

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

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

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

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

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

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

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

NOTES

Louise Davies, MD, MS

Thyroid cancer and overdiagnosis

American Thyroid Association

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

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

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

May 28, 2018

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

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

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

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

Temas de este entrevista uncluye: 

  • Que tan común es el cancer de tiroides, de estos cual es el mas común?
  • Cuéntenos un poco sobre el tratamiento con Yodo radioactivo.
  • Como y porque decido escribir un libro sobre cancer de tiroides
  • Cuando se publicara este libro, donde se puede conseguir
  • Quien es  un buen cirujano de  tiroides, donde puedo buscar un cirujano con experiencia 
  • Nodulos de tiroides
May 28, 2018
Fabián Pitoia, MD, Ph D.
 
Jefe de la sección tiroides, División Endocrinología Hospital de Clinicas decla universidad de Buenos Aires
Sub director de la carrera de medicos especialistas en Endocrinología- hospital de clinicas
 
Docente adscripto de medicina interna.
 
Temas de este entrevista incluye:
 
El tema de hoy es la gestión de la vigilancia activa microcarcinoma
  • ¿qué es el microcarcinoma y qué es la vigilancia activa?
  • Para aquellos que siguen el podcast de Doc Thyroid, es posible que conozcan mi historia, tuve una tiroidectomía y cáncer de tiroides.
  • Cuando escuché la palabra cáncer de mi médico, creó miedo y ansiedad. Pero, ¿la palabra cáncer relacionada con el cáncer de tiroides es diferente? (papilar)
  • ¿Puede decirnos cómo y por qué esto es cierto? Por ejemplo, en comparación con el cáncer de cerebro o el cáncer de páncreas ...
  • ¿Cuántos pacientes con cáncer papilar de tiroides ves un año?
  • ¿Cuántos pacientes con cáncer papilar de tiroides han muerto bajo su cuidado? (La intención de esta pregunta es reducir el miedo en la audiencia sobre la palabra cáncer)
  • Cuéntanos más sobre la vigilancia activa ... es una nueva practica? ¿Y por qué estamos escuchando más sobre esto últimamente?
  • ¿Cómo sabe un paciente si es adecuado para ellos?
  • ¿Cuál es el tratamiento para los pacientes que eligen este tratamiento?
  • ¿Todos los hospitales en América Latina ofrecen vigilancia activa?
  • ¿Cómo puede un paciente encontrar doctores que lo ofrezcan?
  • La Dra. Davies dice que algunos pacientes en su programa dicen sentirse "estúpidos" por dejar el cáncer en su cuerpo. ¿Hay apoyo emocional para aquellos que eligen Vigilancia Activa Microcarcinoma?
May 27, 2018
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

NOTES:

American Thyroid Association

Bryan McIver, MD, PhD

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

Hossein Gharib, M.D.

PAST EPISODES

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

May 27, 2018
Jonas de Souza participates in both clinical and outcomes research studies on malignancies of the upper aerodigestive tract, especially head and neck cancers. His research focuses on the use of novel therapeutic agents along with measurements of financial burden, patients’ preferences, and the trade-offs between the risks and benefits of cancer therapies. His research has sought to integrate outcomes research, patient preferences, health policy, and economics into clinical practice. His ultimate goal is to increase access to essential cancer therapies by providing policy makers and scientific communities with the required information on patient preferences and on barriers that lie between cancer patients and access to care.
 
De Souza has authored and presented papers and given lectures on head and neck malignancies, reimbursement methods in oncology, and evidence-based care. He is the principal investigator for a trial examining the role of SPECT-CT in the follow-up of patients with locally advanced head and neck cancers.
 
De Souza earned his MD from the University of Rio de Janeiro State. He completed his residency specializing in internal medicine at the University of Texas Health Science Center in 2008 and a fellowship focusing on hematology/oncology at the University of Chicago in 2011.
 
During this episode the following topics are discussed:
“Financial toxicity,” or the financial burdens that some patients suffer as a result of the cost of their treatments can cause damage to their physical and emotional well-being. 
Financial impact of thyroid cancer
Lost income or high out-of-pocket costs for treatment, medication or related care.
Like any other side effect, financial toxicity should be disclosed and discussed with the patients.
Patients with thyroid cancer had a 41% increased risk for unemployment at 2 years 
 
 
 
 
May 27, 2018

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.

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

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

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

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

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

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

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

NOTES and REFERENCES

Request an Appointment

Victor Bernet, M.D.

 

Mar 26, 2018

Doctor Carlos Simón Duque Fisher

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

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

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

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

Información Adicional

American Thyroid Association en español

Doctor Tiroides pagina web

Doctor Tiroides en Facebook

Doctor Tiroides Grupo de apoyo

Facebook Doctor Carlos Duque

Carlos Simón Duque Fisher

Libro ¡Uuuyyy, TENGO CÁNCER DE TIROIDES! 

Mar 23, 2018

In this interview, some of the key points include:

  • Self-discovered thyroid nodule
  • Diagnosed thyroid nodule
  • FNA and biopsy
  • 5 cm nodule
  • Juice cleanse and no more red meat
  • 3 hour surgery
  • Regret about a Friday afternoon surgery
  • Outpatient surgery
  • Vocal cord paralysis
  • Impact of vocal cord paralysis
  • RAI six weeks post surgery - 176 mc
  • RAI diet
  • A positive and optimistic approach to the disease
  • Surgeon did not present consequences of thyroid surgery
  • Ran cross-country in high school
Mar 22, 2018

Dr. Jeremy Freeman was born in Hamilton, Ontario and grew up in Toronto. He attended medical school at the University of Toronto, graduating with highest honours. He completed his otolaryngology residency at the University of Toronto.

After receiving his Fellowship from the Royal College of Surgeons of Canada in 1978, he spent two further years of advanced training, one as a Gordon Richards Fellow at the Princess Margaret Hospital in Toronto in Radiation and Medical Oncology and a second year as a McLaughlin Fellow, training in Head and Neck Oncology at the Royal Marsden Hospital in London, UK. He was the first fellow of the Advanced Training Council sponsored by the two head and neck societies.

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

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

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

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

In this episode the following topics are discussed:

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

NOTES

Dr. Jeremy Freeman

Jeremy Freeman's scientific contributions

LinkedIn

 

Mar 21, 2018

En esta entrevista hablamos sobre:

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

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

Dr. Antonio Hakim

Mar 20, 2018

Jody Gelb is a Broadway singer and actress.   Six months ago she was diagnosed with papillary thyroid cancer, during a doctor's visit for an unrelated issue.  This news sparked immediate research and discovering an alternate path that does not include surgery.

In this episode, the following topics are discussed:

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

 

NOTES

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

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

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

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

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

American Thyroid Association

Overdiagnosed: Making People Sick in the Pursuit of Health

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

Jody Gelb

blog

Twitter

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

NOTES

Vanderbilt Health

Vanderbilt-Ingram Cancer Center

Thyroid research

Funding surgical educational camps in Africa

PubMed

Index Medicus

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

American Thyroid Association

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.

NOTES

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

PATIENT RESOURCES

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.

NOTES

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

NOTES

H. Gilbert Welch, MD, MPH

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

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

Should I Be Tested for Cancer? (2006)

Patient Resources

American Thyroid Association 

 

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

Recursos

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

NOTES:

American Thyroid Association

NP Thyroid

ACTH stimulation test

PubMed

Deiodinase polymorphism testing

FACEBOOK GROUPS

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

NOTES

Thyroid Change Resources

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

 

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

NOTES

American Thyroid Association

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

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

 

1 2 3 4 Next »