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
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Doctor Thyroid





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Now displaying: March, 2018
Mar 26, 2018

Doctor Carlos Simón Duque Fisher

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

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

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

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

Información Adicional

American Thyroid Association en español

Doctor Tiroides pagina web

Doctor Tiroides en Facebook

Doctor Tiroides Grupo de apoyo

Facebook Doctor Carlos Duque

Carlos Simón Duque Fisher


Mar 23, 2018

In this interview, some of the key points include:

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

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

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

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

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

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

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

In this episode the following topics are discussed:

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


Dr. Jeremy Freeman

Jeremy Freeman's scientific contributions



Mar 21, 2018

En esta entrevista hablamos sobre:

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

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

Dr. Antonio Hakim

Mar 20, 2018

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

In this episode, the following topics are discussed:

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



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

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

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

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

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

American Thyroid Association

Overdiagnosed: Making People Sick in the Pursuit of Health

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

Jody Gelb



Mar 15, 2018

James L. Netterville, M.D.
Mark C. Smith Professor of Head and Neck Surgery, Professor of Otolaryngology
Director, Head & Neck Oncologic Surgery
Associate Director, Bill Wilkerson Center for Otolaryngology and Communication Sciences

Dr. Netterville is the Director of Head and Neck Surgery at Vanderbilt and is an international leading authority of treating head and neck cancer. He is one of the world's experts in the treatment of skull base tumors and has a vast clinical experience.

Todays topic's include:

  • Reoccurrence thyroid disease patients in paratracheal, thyroid bed, and cervical lymph nodes
  • Papillary thyroid cancer and subtypes: tall cell, columnar, oncocytic, clear cell, hobnail
  • The extreme importance of the pathologist
  • Facebook is one of the number one sources of referrals
  • The changing landscape of researching physicians
  • PubMed and Index Medicus have replaced the library and medical literature
  • In past 5 years patients are seeking advice from peers and experiences from others
  • Patients have become the bets marketers for physicians versus the institution
  • performing thyroid surgery on professional singers
  • Patients are attached to a doctor and care team, which is often driven by social media
  • Paratracheal region, and difficulty in ultrasound
  • Selective neck dissection
  • The evil remnant: when a surgeon inadvertently leaves thyroid cancer behind
  • Three areas where thyroid cancer reoccurs: where remnant is left behind, hidden paratracheal lymph nodes,
  • Lymph nodes in levels II, III, IV
  • Some surgeons’ misperceptions about the effectiveness of RAI as a means to cleaning up poor surgery
  • Doing a thyroid surgery is easy.  Doing it right is hard.  The importance of finding a surgeon who knows how to do it right
  • Damage to RLN and leaving cancer behind or remnant, is due to inexperience
  • Working around larynx and voice box during thyroid surgery
  • Challenges with the trachea during thyroid surgery
  • Grafting the RLN
  • Grafting the RLN, in line graft, ends of motor nerves and sewing them back to the RLN
  • Thyroid marketing and the term minimally invasive 
  • Superior RLN protection
  • Preserving the cricothyroid muscle, especially singers
  • The importance of being a good listener
  • Vetting a surgeon by searching social media or reputation, publications, and volume
  • Is thyroid cancer a cancer or just a nuisance.  Chances are it is not going to kill you.
  • Doctors managing their reputation online
  • RAI and killing gross disease fallacy
  • A surgeon's personal brand versus institution branding
  • Online eduction


Vanderbilt Health

Vanderbilt-Ingram Cancer Center

Thyroid research

Funding surgical educational camps in Africa


Index Medicus

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

American Thyroid Association

Mar 10, 2018

Antonio Bianco, MD, is the Charles Arthur Weaver Professor of Cancer Research in the Department of Internal Medicine. He is the president of Rush University Medical Group and vice dean for clinical affairs in Rush Medical College.

Bianco came to Rush from the University of Miami Health System, where he served as professor of medicine and chief of the Division of Endocrinology, Diabetes and Metabolism.

He has more than 30 years of experience in the thyroid field. He has been recognized with a number of national and international awards and membership in prestigious medical societies. A well-rounded investigator in the field of thyroid disease, Bianco led two American Thyroid Association task forces: one charged with drafting guidelines for thyroid research (as chair) and another responsible for developing guidelines for the treatment of hypothyroidism (co-chair).

Bianco’s research interests include the cellular and molecular physiology of the enzymes that control thyroid hormone action (the iodothyronine deiodinases). He has contributed approximately 250 papers, book chapters and review articles in this field, and has lectured extensively both nationally and internationally. Recently, he has focused on aspects of the deiodination pathway that interfere with treatment of hypothyroid patients, a disease that affects more than 10 million Americans. He directs an NIH-funded research laboratory where he has mentored almost 40 graduate students and postdoctoral fellows.

This episode includes the following topics:

  • Thyroid produces thyroxin of T4. 
  • T4 is not the biologically active, rather it is T3
  • T3 is biologically active
  • Transformation of T4 to T3 happens throughs the body
  • Levothyroxine has become the standard of care for treating hypothyroid patients
  • T3 is the biologically active hormone, it could be by giving T4 only we are falling short
  • Evidence based medicine wants to only treat with proven and documented therapy; T3 combination therapy is still not scientifically proven
  • If patient takes T3 in the morning, it peaks about three hours later
  • We have not developed a delivery system to maintain stable T3 levels
  • The most important that we can challenge the pharmacy community is to deliver T3 in a way that it mimics the way it behaves in the human body
  • Surveyed 12,000 patients and the ones on desiccated thyroid have higher QoL compared to those on Levothyroxine
  • I was okay, I had a job, and then I had TT, and from that day forward my life is not the same.  Brain fog, and lack motivation
  • We do not yet have evidence proving that combination therapy works, but some patients report improvement to QoL
  • Mood disorders, depression, brain fog, memory loss, and lack of motivation are reported by TT patients
  • T3 combination therapy does not
  • Many symptoms of hypothyroidism is similar to menopause
  • Depression like symptoms, difficult for weight loss, low motivation, less desire for physical activity, brain fog, memory loss are all symptoms patients report post TT
  • Cannot yet yet distinguish between positive effects of T3 and placebo effects
  • Side effects of T3 may include palpitation or sweating
  • Improvement with combination T3 can be immediate, as reported by patients
  • Patients on Levothyroxine most likely to be on statins, beta-blockers, and anti depressants
  • Blood tests for TT patients, taking T3 and not
  • Time of day to take blood tests
  • Time blood sample depending on when patient takes lab work.  Ideally 3 or 4 hours after taking the T3 tablet
  • Hypothyroid-like symptoms could be depression
  • There is greater likelihood of depression symptoms for those taking
  • Nearly 5% of the U.S. population takes T4 or Levothyroxine, as revealed by the NHANE survey.  This means 10 – 15 million Americans. 
  • Levothyroxine is the most prescribed drug in the U.S.


American Thyroid Association

Bianco Lab

A Controversy Continues: Combination Treatment for Hypothyroidism


Mar 6, 2018

18 years ago Lorrie was diagnosed with Graves’ disease.  Then, in 2017 she received a diagnosis of thyroid cancer. 

In this episode we hear Lorrie describe the following:

  • Papillary thyroid cancer
  • Long delayed pathology results
  • Graves’ disease
  • Balancing Graves’ disease and a thyroid cancer diagnosis
  • Emotional roller coaster of feeling optimistic and other days of sadness.
  • The feelings and emotions of related to a cancer diagnosis
  • Being careful about the information shared on the Internet and potential negativity
  • Support network and family
  • Nodule size was 1.1 cm, but with history of Graves’ disease, she decided to forego active surveillance


American Thyroid Association


Mar 3, 2018

Dr. Amanda Laird, MD is an endocrine surgeon and Chief of Endocrine Surgery at the Rutgers Cancer Institute of New Jersey in New Brunswick, New Jersey. She is currently licensed to practice medicine in New Jersey and New York. She is affiliated with Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Hospital.

In this interview, Dr. Laird reflects on a decade of treating papillary thyroid cancer patients and reports none have died.  In this interview we also explore these questions:

  1. Prognosis and what will happen in the long run and quality of life.
  2. Surgery complications.
  3. Levothyroxine side-effects, including weight gain. 
  4. Life after surgery and RAI.
  5. What causes thyroid cancer.
  6. What time of day to take thyroid replacement medication.
  7. What blood tests should be ordered and is fasting necessary prior to thyroid lab work.


Amanda Laird, MD

American Thyroid Association 


Mar 1, 2018

H. Gilbert Welch, MD, MPH

An internationally recognized expert on the effects of medical screening and over-diagnosis

Dr. Gilbert Welch’s work is leading many patients and physicians think carefully about what leads to good health. For Welch, the answer is often “less testing” and “less medicine” with more emphasis on non-medical factors, such as diet, exercise, and finding purpose in life.

Welch’s research examines the problems created by medicine’s efforts to detect disease early: physicians test too often, treat too aggressively, and tell too many people that they are sick. Most of his work has focused on overdiagnosis in cancer screening: in particular, screening for melanoma, thyroid, breast, and prostate cancer. He is the author of three books: Less Medicine, More Health: 7 Assumptions That Drive Too Much Health Care (2015), Overdiagnosed: Making People Sick in the Pursuit of Health(2012), and Should I Be Tested for Cancer? (2006). His op-eds on health care have appeared in numerous national media outlets, including the Los Angeles TimesThe New York Times, the Washington Post, and the Wall Street Journal.

Welch is a professor of medicine at the Geisel School of Medicine, an adjunct professor of business administration at the Tuck School of Business, and an adjunct professor of public policy at Dartmouth College. He has initiated and taught courses on health policy, biostatistics, and the science of inference.

In this episode, the following topics are discussed:

  • overdiagnosis is about how its found, and is a side effect of screening
  • when screening for early forms of cancer
  • some cancer is never going to cause the patient problems
  • some cancer never becomes clinically evident
  • we are looking so hard for cancer, that there is more than is possible
  • birds, rabbits, turtles
  • can’t fence in birds or aggressive cancers
  • rabbits you can catch if you build enough fences
  • turtles aren’t going anywhere anyway
  • certain organs have a lot of turtles, prostate, lung, thyroid, breast
  • ovedrdiagniosis only occurs when we are trying to look for early forms
  • screening can benefit, but also cause harm
  • breasts, prostate, and thyroid carry a lot of cancers. 
  • overcoming cancer phobia, and reducing patient anxiety. 
  • the best test is not the one that finds the most cancers, the best test is to find the ones that matter
  • paradigm shift is happening in regard to cancer. 
  • liquid biopsies, looking at biomarkers
  • CA125


H. Gilbert Welch, MD, MPH

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

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

Should I Be Tested for Cancer? (2006)

Patient Resources

American Thyroid Association