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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: April, 2017
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 

 

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