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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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Now displaying: 2017
Sep 25, 2017

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

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

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

In the episode, we discuss:

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


NOTES
The American Gut

Michael Pollan ‘Some of My Best Friends Are Germs’

An Epidemic of Absence

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

Sep 24, 2017

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

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

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

In this episode, the following topics are discussed:

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

NOTES:

Mysymotoms.com

Susanne Breen, N.D.

Sep 20, 2017

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

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

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

In this episode, the following topics are discussed:

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

NOTES:

American Association of Endocrine Surgeons

American Thyroid Association

Sep 18, 2017

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

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

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

In this interview, we discuss the following topics:

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

NOTES

Dr. Antonio Bianco

Dr. Jacqueline Jonklaas

American Thyroid Association

Sep 10, 2017

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

In this episode, Dr. Wartofsky discusses the following:

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

Related episodes:

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

NOTES

Leonard Wartofsky

American Thyroid Association

 

Aug 29, 2017

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

En este entrevista, hablamos sobre:

  • No todos los cánceres de tiroides deben ser operados.
  • No todos los nódulos tiroideos deben ser biopsiados.
  • La mitad de la población tiene nódulos tiroideos. El 10% de esos nódulos tienen cáncer. En Colombia, 2,5 millones de personas tienen cáncer de tiroides. 15 millones de personas tienen cáncer de tiroides en los Estados Unidos, y lo más probable es que no lo sepan.
  • Los estudios muestran que el 30% de los cadáveres tienen nódulos tiroideos con cáncer.
  • Comprender las repercusiones de hacer una biopsia. Si se trata de un nódulo que no requiere cirugía, incluso si es cáncer, decirle a un paciente esto a veces hace más daño en la forma de estrés emocional que lo que es necesario.
  • No sacrificar una tiroides debido a la fobia.
  • La carga es en el médico para no desencadenar paranoia y estrés en el paciente diciéndoles que "podría" tener cáncer, en el caso de llevar a cabo una biopsia en un nódulo cuando no es necesario.
  • Una tiroidectomía cambia una vida, incluyendo la piel seca, aumento de peso, calcio, pérdida de voz o cambio de voz - estos pueden ser peores que vivir con cáncer de tiroides papilar.
  • ¿Qué necesita ocurrir en la comunidad médica para cambiar el paradigma que no necesitamos para operar en todo el cáncer de tiroides?
  • La patología es la clave para cambiar el paradigma.
  • El cáncer no es igual en todos los casos. Piense en el cáncer de tiroides similar a la vista sobre el cáncer de próstata en los hombres.
Aug 25, 2017

Dr. Shaha specializes in head and neck surgery, with a particular interest in thyroid and parathyroid surgery. He uses an algorithm of selective thyroid tumor criteria (the size, location, stage and type of cancer, along with the patient’s age), to tailor therapy to each individual’s circumstances. This can help thyroid cancer patients avoid unnecessary and potentially damaging over-treatment, while still providing the best option for control of their cancer and better quality of life after treatment. Dr. Shaha works very closely with Memorial Sloan Ketterings’ endocrinologists to monitor the careful post-treatment hormone balancing necessary for thyroid cancer patients. Many academic hospitals and medical societies worldwide have invited Dr. Shaha to speak on the principles of targeted thyroid surgery and to share his expertise in the treatment of head and neck cancers.

 

In this interview, topics include:

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

NOTES:

Dr. Ashok R. Shaha

 

RELATED EPISODES:

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

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

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

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

 

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

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

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

 

American Thyroid Association

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

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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

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