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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: November, 2018
Nov 11, 2018

M. Regina Castro, MD is a consultant in the Division of Endocrinology at the Mayo Clinic in  Rochester, MN.  She is an Associate Professor of Medicine. She is the Associate Program Director for the Endocrinology Fellowship program,  and Director of Endocrinology rotation for the  Internal Medicine Residency.  She is also a member of the Thyroid Core Group at Mayo Clinic. She served from 2009 to 2015 as Thyroid Section Editor for AACE Self-Assessment Program and has authored several chapters on Hyperthyroidism, Thyroid Nodules and thyroid cancer. She has served on various committees of the ATA, including Patient Education and Advocacy committee, the  editorial board of Clinical Thyroidology  for Patients (CTFP),  Trainees and Career Advancement committee  and  is at present  the  Chair of the Patient Affairs and Education Committee. She currently serves on the ATA Board of Directors. Her professional/academic Interests:  Clinical research related to thyroid nodules and thyroid cancer,  clinical care of patients with various thyroid diseases, and medical education.

During this interview, the following topics are addressed:

  • What is a thyroid nodule?  A lump that could be benign or cancerous
  • The prevalence depends on how you search for them
  • 60% of people in the U.S. will have nodules
  • 90% are benign
  • Sometimes done during routine physical exam
  • Sometimes the patient discovers it
  • Usually is discovered when imaging is done for other reasons — during CT scan
  • Medical history of radiation to head or neck as a child, family history of thyroid cancer, size of nodule, abnormal lymph nodes in the neck
  • Usually patients with a nodule are asymptomatic
  • Best test to look at the nodule is an ultrasound of the nodule
  • Features in the ultra sound determines how suspicious a nodule is
  • A biopsy is ordered based on appearance, if nodules are clearly defined are more likely to suggest they are benign
  • If nodule looks dark or borders are irregular, or increased blood flow within the nodule may cause concern
  • Quality and resolution of thyroid ultra sound is high resolution and provides a clear look
  • Coaching patients through the anxiety through a possible biopsy
  • The majority of nodules can be observed
  • ATA guidelines suggest observation based on the result of the biopsy
  • Suspicious nodules that are less than 1cm are sometimes determined to best observe and not remove
  • Cancer will be in only 5% of biopsies
  • A smaller, low risk cancer should warrant a lesser surgery — and reduce the chance of surgical complications
  • When to remove a nodule even if no cancer? 
  • If other structures are being obstructed, such as breathing or swallowing, sometimes surgery relieves symptoms regardless if cancer or not
  • Observation — and follow up recommendations
  • 15% are labeled indeterminate
  • If surgery, surgeon needs to be experienced — many surgeons conducting thyroid surgery are low in experience
  • The Mayo Clinic thyroid cancer team
  • Biopsy results in two hours versus two weeks

NOTES

The American Thyroid Association

Dr. Regina Castro

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

 

Nov 9, 2018

Dr. Milner is well published with texts, medical journal articles and studies in cardiology, endocrinology, pulmonology, oncology, and environmental medicine. Dr. Milner calls his practice “integrated endocrinology” balancing all the endocrine hormones using bio-identical hormone replacement and amino acid neurotransmitter precursors.

 Dr. Milner’s articles include treatment protocols for hypothyroidism, ”Hypothyroidism: Optimizing Medication with Slow-Release Compounded Thyroid Replacement” was published in the peer review journal of compounding pharmacists, International Journal of Pharmaceutical Compounding. 

In this interview, the following topics are discussed:

  • Starving in the midst of plenty
  • Slow release T3 and T4
  • Hypothyroidism
  • Hyperthyroidism or Graves Disease
  • Often RAI leads to hypothyroidism
  • Visiting a naturopath while being treated by traditional endocrinologist
  • TSH suppression for thyroid cancer patients
  • Ordering blood tests of TSH, Free T4, Free T4, and reverse T3
  • Converting T4 into T3
  • Slow released T3
  • Manufactured T3 is not slow release
  • 2005 article was published
  • 150,000 pharmacist in U.S., and about 5,000 are compounding
  • Slow release blends are the same T4 from Synthroid and T3 from Cytomel
  • Slow release agent is hydroxypropyl melanose
  • Side effects of too much T3 or T4
  • The risk is compounder error or inconsistency
  • Binder sensitivity is another reason for compounding
  • Desiccated thyroid hormone compared to slow release
  • Auto-immune disease and desiccated treatment
  • Overwhelming response to slow release is when patients symptoms of hypothyroidism alleviate
  • A small percentage of people do not do better on slow release
  • Basel body temperatures
  • 96.5 temperature in the morning, and hypothyroid symptoms is a concern in regard to treatment
  • Testing temperature in the morning, ideally done using mercury thermometer
  • How to use temperature testing as an indicator of hypothyroidism
  • Body temp should be over 97.8 first thing in the morning
  • Hypothyroidism will be overweight and difficult to lose weight, and brain fog, sluggish, dry skin, hair loss,
  • Eating well, active, and weight gain
  • Hypoglycemic or adrenal overload and low body temperature
  • High cortisol levels
  • Standard of care of Cytomel in contrast with conventional endocrinologist
  • T3 has a short half life
  • Half life — How long does it take a drug to bring blood levels to normal levels? 
  • Half life of T3 is up to 70 days
  • Starving in the midst of plenty with T4
  • Insurance coverage of slow release T3 — T4
  • Cost of slow release T3 — T4 is approximately $40 monthly
  • Most important testing for TT patient is checking parathyroid gland status — and their role in calcium function
  • Important to measure calcium for TT patients
  • Caution about soy, broccoli, brussel sprouts, cauliflower, and calcium and thyroid hormone
  • When to thyroid replacement hormone — first thing in the morning, 1 hour before eating,
  • T4 replacement before bed — advantages to more stable levels
  • Slow release, combination therapy, should be taken in the morning
  • Estrogen deficiency
  • Brief summaries of the following symptoms: painful feet, dizziness, fatigue, hair loss, iron deficiency, chronic pain, tyrosine turning into dopamine and then adrenaline, sleep problems and anxiety and hypothyroidism, insomnia and cortisone and adrenaline at nigh and DHEA, cortisol measured throughout the day, muscle spasms,
  • Avoid refined sugar and high amounts of alcohol
  • Drink more water
  • Caution: food and its importance: smoothies and soluble fiber — fiber interacts with nutrients.    Avoid this, as it effects absorption of medications
  • Emotional attachment to disease — fixation and complaining without making changes. 

NOTES

International Academy of Compounding Pharmacists

75: Fat, Foggy, and Depressed After Thyroidectomy? You May Benefit From T3, with Dr. Antonio Bianco from Rush University

19: Hypothyroidism – Moving From Fat, Foggy & Fatigued to Feeling Fit & Focused with Elle Russ

Hypothyroidism: Optimizing Therapy with Slow-Release Compounded Thyroid Replacement

 

Nov 5, 2018

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

In this episode, Dr. Wartofsky discusses the following:

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

NOTES

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

American Thyroid Association

Leonard Wartofsky

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