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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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May 20, 2017

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

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

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

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

Other active surveillance research

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

The team

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

 

About Dr. Allen Ho

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

NOTES

American Thyroid Association

Cedars-Sinai clinical trial

MSKCC thyroid cancer active surveillance

THYCA Support Group

 

Active Surveillance of Thyroid Cancer Under Study

 

May 12, 2017

What Happens When Thyroid Cancer Travels to the Lungs?

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

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

In this episode Dr. Pitoia addresses the following topics:

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

RESOURCES

ResearchGate

Dr. Pitoia - Facebook

Dr. Pitoia - web site

Dr. Pitoia - Twitter

Thyroid Cancer Alliance

American Thyroid Association

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

 

May 12, 2017

Bienvenido al episodio 33 de Doctor Thyroid con Philip James.   

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

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

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

Recursos:

Dr. Pitoia - Facebook

Dr. Pitoia - pagina web

Dr. Pitoia - Twitter

ResearchGate

Thyroid Cancer Alliance

American Thyroid Association - Español

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

May 8, 2017

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

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

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

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

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

Other Doctor Thyroid episodes referenced during this interview:

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

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

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

SHOW NOTES:

Dr. Gary Clayman

Thyroid Cancer Overview

Book: Atlas of Head and Neck Surgery

 

Health Grades

Zoc Doc

The American Thyroid Association

May 4, 2017

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

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

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

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

Notas

Nódulos Tiroideos

Regina Castro Publications

American Thyroid Association en Español 

 

 

Apr 25, 2017

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

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

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

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

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

NOTES:

Dr. Andrew Bauer

American Thyroid Association

Apr 22, 2017

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

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

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

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

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

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

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

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

Apr 22, 2017

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

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

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

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

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

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

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

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

Apr 18, 2017

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

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

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

En este episodio explora los siguientes temas:

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

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

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

NOTAS:

The Hormone Foundation

Dr. Alejandro Ayala

GDATFWebsite:  http://gdatf.org/
 
GDATF Online Support Forum: http://gdatf.org/forum/
 
 
 
GDATF YouTube Site (includes free videos on Graves' disease, autoimmunity, and thyroid eye disease): https://www.youtube.com/user/GravesAndThyroid
 
 
Twitter: @GDATF
 
Apr 14, 2017

In this interview, Dr. Hennessey describes the history, refinements, implementation, physiology, and clinical outcomes achieved over the past several centuries of thyroid hormone replacement strategies.

Topics discussed in this episode include:

  • The history of levothyroxin
  • Chinese using thyroid hormone to treat cretinism in the 6th century
  • What is cretinism?
  • Dangers of hypothyroidism during pregnancy
  • Prescribed 3-step process when hypothyroidism is treated when pregnant
  • The history of sheep thyroid as a treatment?
  • In the 1920’s thyroid hormone was synthesized
  • T3 was synthesized in the 1950’s
  • When to take thyroid medication, morning or night?

A rich history of physician intervention in thyroid dysfunction was identified dating back more than 2 millennia. Although not precisely documented, thyroid ingestion from animal sources had been used for centuries but was finally scientifically described and documented in Europe over 130 years ago. Since the reports by Bettencourt and Murray, there has been a continuous documentation of outcomes, refinement of hormone preparation production, and updating of recommendations for the most effective and safe use of these hormones for relieving the symptoms of hypothyroidism. As the thyroid extract preparations contain both levothyroxine (LT4) and liothyronine (LT3), current guidelines do not endorse their use as controlled studies do not clearly document enhanced objective outcomes compared with LT4 monotherapy. Among current issues cited, the optimum ratio of LT4 to LT3 has yet to be determined, and the U.S. Food and Drug Administration (FDA) does not appear to be monitoring the thyroid hormone ratios or content in extract preparations on the market. Taken together, these limitations are important detriments to the use of thyroid extract products.

James V. Hennessey, MD is Director of Clinical Endocrinology at Beth Israel Deaconess Medical Center in Boston, MA. He is an Associate Professor of Medicine at the Harvard medical School.  He completed medical training at the Medical Faculty of the Karl Franzens University in Graz Austria. He served as an Intern and Medical Resident at the New Britain Hospital in Connecticut. He entered active duty with the USAF Medical Corps as an Internist/Flight Surgeon after residency and later completed subspecialty training in endocrinology and metabolism at the Walter Reed Army Medical Center in Washington DC where he conducted research in thyroxine bioequivalence. Following fellowship Dr. Hennessey served as the Chief of Endocrinology at USAF Medical Center Wright-Patterson in Ohio and later joined the faculty at Wright State University School of Medicine as the Director of Clinical Clerkships.

Top 10 most prescribes drugs in the U.S. (monthly) - Monthly prescriptions, nearly 22 million 

 

Apr 7, 2017

¿Cómo sabemos si usted tiene hipotiroidismo?

¿Qué significa si es difícil concentrarse o enfocar la mente?

¿Qué significa si usted tiene altos niveles de TSH?

¿Cómo se diagnostica el hipotiroidismo?

¿Qué es Hashimotos?

¿Cuál es el tratamiento para el hipotiroidismo?

¿Puede la dieta ayudar con el hipotiroidismo?

¿Cuándo es el mejor momento del día para tomar su medicina de hipotiroidismo?

¿Dónde puede encontrar un médico para tratar el hipotiroidismo?

Dra. Sandra Daniela Licht de Hospital General de consultorio particular y en INEBA ( Instituto de Neurociencias de Buenos Aires)
Endocrinologia

ESPECIALIDAD
Establecimiento: General de Agudos J. M. Ramos Mejía. Título: Clinica Medica.
Establecimiento: Hospital General de Agudos Carlos G.
Durand. Titulo: Endocrinologia


ACTIVIDAD ACADEMICA Y DOCENTE
Instructora de Residentes de Endocrinología, Htal Durand (1993-1995)
Docente de la Diplomatura en Enfermedades Tiroideas de la Facultad de Medicina de la Universidad Nacional de Tucumán


SOCIEDADES CIENTIFICAS
• Miembro Titular, Sociedad Argentina de Endocrinología y Metabolismo.
• Miembro Titular, Sociedad Latinoamericana de Tiroides.
• Miembro Titular, The Endocrine Society.
• Miembro Titular, American Thyroid Asociation.
• Miembro del Comité de Asuntos Internacionales, The Endocrine Society (2005-2006).
• Miembro del Comité Hormone Foundation, The Endocrine Society (2007-2010).
• Miembro del Comité Patient Education and Advocacy Committee, American Thyroid Association (2008).
• Miembro del Comité Clinical Affaires, American Thyroid Association.
• Miembro del Comité Working Group on Disparities in Clinical Trials, The Endocrine Society.
• Miembro del Comité de Publicaciones, The Endocrine Society.
• Miembro del Comité Clinical Guidelines, The Endocrine Society.
• Asesora médica de ACTIRA.
• Asociación de Pacientes con Cáncer de Tiroides de la República Argentina.
• Miembro del Medical Advisory Panel of Thyroid Cancer Alliance (desde el año 2011).

Asociación Americana de la Tiroides - Español

Apr 3, 2017

In this episode, we hear from Judy O'Reilly.  
Judy was diagnosed with thyroid cancer in 2011.  Following surgery, Judy speaks about the frequent challenges, including adjusting medication dosages, hypothyroidism, and her energy levels hitting the wall during daily activities.  

For Judy, the cancer diagnosis forced the conversation of talking about death with her children and husband.  A singer and musician, the thyroid cancer and resulting surgery has caused vocal challenges.

In this episode, we hear from Judy O'Reilly.
Judy was diagnosed with thyroid cancer in 2011.  Following surgery, Judy speaks about the frequent challenges, including adjusting medication dosages, hypothyroidism, and her energy levels hitting the wall during daily activities.

For Judy, the cancer diagnosis forced the conversation of talking about death with her children and husband.  A singer and musician, the thyroid cancer and resulting surgery has caused vocal challenges.

She is the founder and former facilitator of THYCA Atlanta. Prior to starting the once/month support group held at Emory University’s Winship Cancer Institute, Judy O'Reilly offered email and phone support. Judy began her involvement/volunteering with THYCA one year after diagnosis/surgery/RAI. Prior to thyroid cancer, Judy O’Reilly had been a music educator and an entertainer. She was the female vocalist for the Atlanta Blue Notes Big Band, as well as their Combo. As a solo performer (piano/vocals), Judy specialized in senior care facilities offering up an extensive selection of the great American songbook. Ms. O’Reilly resigned/retired from performing soon after a second surgery - a completion of a previous partial thyroidectomy - due to complications. In 2015 Judy began a return to entertaining as a volunteer in the grand piano lobby of the Winship Cancer Institute, Atlanta.

 

Apr 2, 2017

This episode details the medical approach to thyroid nodules.  Topics include:

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

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

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

• How to know if your thyroid nodule is cancerous?

• When is surgery done despite the nodule being benign?

• Decreasing patient anxiety with quick biopsy results

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

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

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

NOTES:

M. Regina Castro, M.D.

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

 

American Thyroid Association 

 

Mar 22, 2017

You have been diagnosed with thyroid cancer, and choose no surgery.  Although thyroid cancer diagnosis has spiked around the world, a trend is to pass on surgery if the cancer is identified as low risk.  In doing so, mortality rate does not increase and it avoids unfavorable events sometimes related to surgery, such as vocal chord paralysis, hypothyroidsm, financial costs, and lifelong thyroid hormone treatment. 

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

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

Topics covered, include:

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

NOTES

Akira Miyauchi, MD, PhD (Kuma Hospital)

Mar 17, 2017

You have been diagnosed with thyroid cancer, and contrary to your doctor's advice, you choose to not proceed with surgery.  Is this a patient trend, and how often are patients making this decision?

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

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

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

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

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

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

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

NOTES:

JAMA Abstract: Dr. Davies

Thyroid Stories Project

Dr. Michael Tuttle, from Sloan Kettering

Yasuhiro Itoa and Akira Miyauchi 

Nonoperative management of low-risk differentiated thyroid carcinoma

 

Mar 15, 2017

En este episodio, estamos con la Dra. Alicia Gauna, Jefa División Endocrinología del Hospital Ramos Mejía, Buenos Aires.  Ella es Coordinadora del Comité de Recertificación de Endocrinología y Metabolismo (CREM), Directora de Beca de Dra. Florencia Rodriguez, Ministerio de Salud Pública, 2012-2013, Integrante del Comité Científico del XV Congreso Latinoamericano de Tiroides. Brasil, 2013.

En esta entrevista, Dra Gauna comparte información clave sobre hipotiroidismo y cáncer de tiroides.

  • Los temas incluyen:
  • Síntomas del hipotiroidismo
  • Síntomas de hipotiroidismo en la salud mental
  • Diagnóstico del hipotiroidismo
  • Menopausia e hipotiroidismo
  • Embarazo e hipotiroidismo
  • Cáncer de tiroides e hipotiroidismo

Notas:

YouTube con Dra. Gauna

https://www.youtube.com/watch?v=Nb-o5RVszaY

http://www.revistaohlala.com/1452915-que-sabes-de-tiroides

Mar 10, 2017

In this episode, we hear from Elle Russ, Author of The Paleo Thyroid Solution, and former hypothyroidism sufferer.  Elle discusses:

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

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

 

NOTES:
Elle Russ web site

http://www.elleruss.com/

 

Primal Blueprint Podcast

http://blog.primalblueprint.com/

 

Yahoo Natural Thyroid Support Group

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

Mar 6, 2017

Dr. Schneider specializes in endocrine surgery, treating diseases of the thyroid, parathyroid, and adrenal glands. He utilizes several minimally invasive techniques to treat endocrine disorders (endoscopic thyroidectomy, minimally invasive parathyroidectomy, laparoscopic adrenalectomy, focused exploration for recurrent thyroid cancer).

This episode explores the following topics:

  • Treatment options for Graves' disease.
  • Treatment options for hyperthyroidism.
  • Dangers of hyperthyroidism medication.
  • Symptoms of hyperthyroidism.
  • Why smokers are a higher risk in the treatment of hyperthyroidism.

 

NOTES:

Dr. David Schneider

http://www.uwhealth.org/findadoctor/profile/david-f-schneider-md-ms/8885

 

Feb 21, 2017

El Dr Fabián Pitoia es Médico Endocrinólogo, es Jefe de la Sección Tiroides y Coordinador del Área Investigación de la División Endocrinología  del Hospital de Clínicas - Universidad de Buenos Aires, es Docente adscripto de la Facultad de Medicina - Jefe de Trabajos prácticos de Medicina B (Facultad de Medicina - UBA) y Docente de la Carrera de Especialistas en Endocrinología y Metabolismo de la UBA.

Especialidad recertificada en Diciembre de 2013.

El Dr Pitoia tiene más de 200 publicaciones de sus investigaciones, más de 50 listadas en Pubmed,  ha sido primer autor de las Guías Latinoamericanas para el diagnóstico y tratamiento del cáncer de tiroides, también el primer autor de las Guías Intersocietarias Argentinas para manejo de pacientes con cáncer de tiroides 2014.

En esta entrevista, discutiremos:

  • Los síntomas que una experiencia del paciente puede saber que tienen un problema
  • Si cirugía siempre es una necesidad
  • Cuándo se quita sólo la mitad de la tiroides?
  • Cómo ayuda la patología en el diagnóstico?
  • Cuál es la mejor manera de encontrar un buen cirujano?
  • Los análisis de sangre relacionados con los pacientes con tiroides?

 

Notes:

https://www.facebook.com/Dr.Pitoia/

https://twitter.com/fabian_pitoia

www.glandulatiroides.com.ar 

Www.cancerdetiroides.com.ar
Feb 18, 2017

Dr. Babak Larian is a highly experienced, board certified Ear, Nose, & Throat Specialist and Head & Neck surgeon. Dr. Larian is the current Clinical Chief of the Division of Otolaryngology at Cedars-Sinai Hospital in Los Angeles.  Dr. Larian's Center For Head and Neck Surgery is located in Beverly Hills, California.

In this episode, Dr. Larian discusses his experience treating thyroid disorders, including his medical missions to Central America.  During this interview, you will hear greater detail about the following topics:

  • The most recent American Thyroid Association’s guidelines and updates to treating thyroid cancer compared to past approaches
  • Minimally invasive thyroid surgery, which results in less scarring and less discomfort
  • Breaking away from the old tradition of a large incision 
  • Testing for parathyroid imbalance
  • What might it mean when the patient feels anxious, has to urinate during the night, impaired mental function, and calcium imbalance? 
  • Which blood test reveals possible parathyroid issues?
  • The common denominator in patients who recover post thyroid cancer surgery
  • A parathyroid trend in women 40 - 60 years old
  • The importance of staying in tune with your body and its signals

NOTES:

Dr. Babak Larian

http://www.larianmd.com/

P: 310.461.0300

American Thyroid Association Guidelines

http://www.thyroid.org/professionals/ata-professional-guidelines/

Feb 9, 2017

Dr. Aime Franco is professor at the University of Arkansas.  She leads a research group investigating the role of thyroid hormones in tumorigenesis.  She is also actively involved, both locally and nationally, advocating for the importance of biomedical research and the importance of engaging patients and survivors in cancer research.

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

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

in this interview we explore the following:

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

What were some personal insecurities when facing thyroid cancer surgery?

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

How often and when should thyroid blood markers be tested?

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

Feb 7, 2017

El Dr. Carlos Simon Duque es un especialista en cabeza y cuello de Colombia. En esta entrevista, discutiremos una visión general del cáncer de tiroides, incluyendo las siguientes preguntas:

¿Qué debe saber un paciente antes de la cirugía, qué esperar?

Después de la cirugía, un paciente puede sentir síntomas como hipotiroidismo. ¿Cómo lo manejas mejor?

¿Cuáles son algunas de las luchas mas complicados que usted ve con sus pacientes después de la tiroidectomía?

¿Qué pacientes recuperan mejor? ¿Qué puede hacer un paciente para sentirse mejor después de la cirugía?

¿Cuándo es el mejor momento del día para tomar la medicina de la tiroides?

Usted ha trabajado tanto en los Estados Unidos como en Colombia, ¿cuáles son algunas de las diferencias en la atención y el tratamiento?

¿Qué has descubierto a lo largo del camino, que le dirías a usted de 30 años de edad si puede?

¿Actualmente está trabajando en algún estudio o investigación?

Jan 23, 2017

How well does your body make energy?

How does your body repair?

How well are your anti-oxidants working?

How well do you rid your body of free radicals?

Are you pre-conditioned to crisis?

The next generation of lab testing and diagnosis has arrived with resources such as Cyrex Labs and Nutreval. 

Thyroid health issues mimic other ailments, such as inflammation, gluten intolerance, and increased permeability (leaky gut).   

In this episode, hear from Dr. Engelman, recognized as one of the top doctors in functional integrative medicine, he has advanced degrees and certifications in functional, metabolic, anti-aging and stem cell medicine. Engelman Health Institute is advanced science, and personalized care. This "new medicine" incorporates the best of traditional practices and natural and alternative diagnostic modalities.

http://www.engelmanhealth.com/

https://www.gdx.net/product/nutreval-fmv-nutritional-test-blood-urine

https://www.cyrexlabs.com/

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