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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: Category: endocrinology
May 27, 2018

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.

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.

NOTES and REFERENCES

Request an Appointment

Victor Bernet, M.D.

 

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.

NOTES

American Thyroid Association

Bianco Lab

A Controversy Continues: Combination Treatment for Hypothyroidism

 

Jan 31, 2018

Dra. Gabriela Brenta, M.D., Ph.D.

Docente de post grado de la Universidad Favaloro y de las carreras de Especialista en Endocrinología así como de Bioquímica Clínica dependientes de Universidad de Buenos Aires.  Médica adscripta en el Servicio de Endocrinología y Metabolismo de la Unidad Asistencial Dr. César Milstein de Buenos Aires, Sector Tiroides.  Presidente del Comité Científico de la Sociedad Latinoamericana de Tiroides.  Miembro del Dpto. de Tiroides de la Sociedad Argentina de Endocrinología y Metabolismo.   Su área de investigación clínica abarca el efecto cardiovascular y metabólico de las hormonas tiroides.

En esta entrevista, discutimos los siguientes temas:

  • Menos función cardiovascular
  • Hipertensión
  • La conexión entre el funcionamiento del corazón menos y el hipotiroidismo
  • El riesgo cardiovascular
  • Resistencia cardiovascular
  • Mayor colesterol LDL e hipotiroidismo
  • Hipotiroidismo subclínico y riesgo
  • Niveles de TSH
  • Niveles de TSH por encima de 10
  • Colesterol e hipotiroidismo
  • Riesgo residual y estatinas
  • Mejorando la absorción de T4
  • Levotiroxina y buen cumplimiento
  • Osteoporosis
  • Niveles altos de colesterol, tomar estatinas y dolores musculares
  • Mujeres que toman estatinas y un mayor riesgo cardiovascular y altos niveles de TSH
  • Altos niveles de TSH, uso de estatinas e inflamación
  • Colesterol y nivel de conexión tiroidea
  • Conexión de diabetes e hipotiroidismo
  • Niveles normales de TSH en pacientes mayores
  • Riesgos con pacientes mayores

Recursos

Asociación Americana de Tiroides

Jan 30, 2018

In this episode we hear from Doug, and 37 year old, male patient of Hashimoto's.  Discussed, are the following topics:

  • Panic attacks
  • Nervous
  • Sweating
  • Can’t get out of bed
  • Putting on weight
  • Feeling coldness
  • NP Thyroid®
  • L-Tyrosine
  • Synthroid
  • WP Thyroid
  • WP Thyroid and L-Tyrosine combination therapy
  • High heart rate on T3
  • ACTH stimulation test
  • TSH as high as 60
  • T3 suppressing pituitary
  • Experience as a male with Hashimoto’s
  • Brain fog
  • Body aches
  • Food and diet

NOTES:

American Thyroid Association

NP Thyroid

ACTH stimulation test

PubMed

Deiodinase polymorphism testing

FACEBOOK GROUPS

All hormone deficiencies

Hypothyroid Men

Dec 8, 2017

Ezra Cohen, MD, is a board-certified oncologist and cancer researcher. He cares for patients with all types of head and neck cancers, including esophageal, thyroid and salivary gland cancers.

Dr. Cohen is also an internationally recognized expert on novel cancer therapies and heads the Solid Tumor Therapeutics program at Moores Cancer Center. Much of his work has focused on squamous cell carcinomas and cancers of the thyroid, salivary gland, and HPV-related oropharyngeal cancers. As a physician-scientist, he is especially interested in developing novel therapies and understanding mechanisms of sensitivity or resistance; cancer screening; and using medication and other agents to delay or prevent cancer (chemoprevention). He was recently appointed chair of the National Cancer Institute Head and Neck Cancer Steering Committee, which oversees NCI-funded clinical research in this disease.

Dr. Cohen is editor-in-chief of Oral Oncology, the most respected specialty journal in head and neck cancer. A frequent speaker at national and international meetings, he has authored more than 120 peer-reviewed papers and has been the principal investigator of multiple clinical trials of new drugs in all phases of development. 

In this episode, topics include:

  • Drug therapy for patients that fail standard therapy; including surgery and RAI
  • Not all patients have same behavior for their cancer
  • Some cancers are aggressive
  • Not many thyroid cancer patients are affected by this; maybe a few thousand in the U.S., but not tens of thousands
  • What is the treatment protocol for therapy?
  • Lenvatinib or Sorafenib is the treatment for refectory thyroid cancer
  • Lenvatinib tends to be more effective
  • Sorafenib is tolerated by the patient better
  • Other options to consider include, molecular profiling or some thyroid cancers carry mutation that is targetable, or BRAF
  • BRAF inhibitors used with thyroid cancer patients
  • Molecular profiling
  • DNA sequencing
  • Side effects include, what patient will feel and those that appear in blood tests
  • Side effects include fatigue in 60% patients, hand or foot blisters, nausea and vomiting
  • Side effects in blood tests include high blood pressure, increase in liver enzymes, and a reduction in blood counts
  • VEGF receptor
  • CT scans and ultra sounds or thyroglobulin as an indicator that thyroid cancer not responsive to traditional therapy
  • We don’t want to make the patient feel worse; the question is when to treat the patient with drug therapy
  • Drug treatment does no cure the disease
  • Holidays from the drug and be rid of side effects
  • When restarting drug, disease responds again
  • Pediatric care
  • Immunotherapy

NOTES

Ezra Cohen, MD

American Thyroid Association

 

Nov 9, 2017

Kimberly Vanderveen, MD is a Colorado native and graduate of Bear Creek High School in Lakewood, CO. She received her bachelor’s degree with honors from Muhlenberg College in Allentown, PA. She then earned her medical degree from Northwestern University in Chicago, IL in 2001. Dr. Vanderveen completed her surgical residency at UC-Davis in Sacramento, CA. During her residency, she also obtained a master's degree in Clinical Research and was actively involved in cancer research and education. After her surgical training, Dr. Vanderveen completed a fellowship in Endocrine Surgery at the Mayo Clinic in Rochester, MN. She is knowledgeable in both medical and surgical aspects of endocrine diseases. She specializes in surgery for diseases of the thyroid, parathyroid, adrenal glands and is a high volume neck and adrenal surgeon.

In this episode, the following topics are discussed:

  • Two roads of tests: rule out and malignant markers
  • Rule-out tests picks up innocent behavior pattern.  Most common is Afirma
  • Malignant markers, or rule-in tests, are useful at determining extent of surgery, and help avoid a second or third surgery.  ThyroSeq, ThyraMIR, Rosetta
  • Do patients get both tests?  Rule out and behavior?
  • Approximately 15% of FNA’s come back indeterminate.  Some  centers as high as 30%
  • Managing indeterminate nodules when a patient chooses no surgery.
  • Taking into account emotional, financial, and lifestyle goals of the patient.
  • Addressing priorities and goals of the patients should come first.
  • Additional molecular testing, surgery, or active surveillance.
  • Profiling a patient who choose to remove thyroid even if indeterminate — is usually due to fear and the C word.
  • Price of molecular test is $3000 - $6000

NOTES

Kimberly Vanderveen, MD

American Thyroid Association

PAST EPISODES

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

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

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

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

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

 

Oct 21, 2017

A native of Saskatchewan, Canada, Dr. Kaptein began teaching at the Keck School of Medicine in the Endocrinology Division in 1977. She became a tenured Professor of Medicine in 1990, a position she currently holds. Dr. Kaptein is a distinguished member of the Western Society for Clinical Investigation, American Society of Nephrology, the Endocrine Society and the American Thyroid Association. An accomplished researcher and lecturer, Dr. Kaptein has been invited to speak on the topics of Endocrinology and Nephrology in such cities as Montreal, Milan, Tel Aviv, Jerusalem, Vienna and Rotterdam, to name a few.

In this interview, Dr. Kaptein discusses the need to consider each patient before making treatment decisions.  In some cases, this may mean foregoing the removal of cancerous lymph nodes. 

NOTES

American Thyroid Association

Dr. Elaine Kaptein

 

 

Oct 19, 2017

Carmelo Nucera, M.D., Ph.D., is currently an Assistant Professor at Harvard Medical School, Boston, in the Division of Cancer Biology and Angiogenesis (Department of Pathology), Beth Israel Deaconess Medical Center. Dr. Nucera received his M.D. and Ph.D. in Experimental Endocrinology and Metabolism from Italy.
Dr. Nucera is highly driven by an intense desire to make important contributions that will directly benefit patients. Dr. Nucera is strongly committed to make discovery aimed to immediately cure patients that are suffering with aggressive tumors and rare/orphan cancer disease.
Dr. Nucera has a clinical background and intensely served patients with fatal human diseases.

In this episode, Dr. Nucera discusses a combination drug therapy using vemurafenib and palbociclib represents a novel therapeutic strategy to treat papillary thyroid carcinoma (PTC). 

NOTES
Carmelo Nucera

Researchers identify novel therapeutic strategy for drug-resistant thyroid cancers

Publication: Thyroid Cancer and resistance to BRAFV600E inhibitors

American Thyroid Association

 

Oct 19, 2017

Dr. Angela M. Leung is an Assistant Professor of Medicine at the UCLA David Geffen School of Medicine and an endocrinologist at both UCLA and the VA Greater Los Angeles Healthcare System.

After pursuing her undergraduate studies at Occidental College, Dr. Leung completed her internal medicine residency and endocrinology fellowship training at Boston University School of Medicine. She also studied at the Boston University School of Public Health and obtained a master's degree in Epidemiology.

Dr. Leung has particular clinical and research interests in thyroid disorders, and she also sees patients regarding parathyroid and adrenal disorders.  She has published widely and lectures frequently on thyroid disease, including hyperthyroidism, hypothyroidism, thyroid nodules, thyroid cancer, and thyroid disease during pregnancy.

In this episode, the following topics are explained:

  • Optimizing thyroid health prior to conception
  • Thyroid issues that affect pregnancy
  • Hypothyroid as result of surgery or Hashimotos
  • Hyperthyroidism and pregnancy
  • Adjusting current thyroid treatment, meaning optimizing thyroid levels by adjusting dosage of thyroid medication
  • TSH levels in light of pregnancy
  • Planned pregnancy usually means a dose increase
  • What happens if someone does not get treatment during pregnancy?
  • Hypothyroidism and the fetus
  • Brain development for the fetus
  • Lower IQ scores and hypothyroid in pregnancy
  • CATS study from UK and Italy
  • Iodine and pregnancy
  • Iodine intake prior to pregnancy
  • Armour thyroid and pregnancy
  • Concerns regarding animal derived thyroid replacement
    TSH levels

NOTES

Dr. Angela Leung

CATS study

American Thyroid Association

49: Thyroid and Pregnancy⎥Why It Matters, with Dr. Elizabeth Pearce from Boston University

Sep 29, 2017

Dr. Paul Y. Casanova-Romero, M.D., M.P.H., F.A.C.P., F.A.C.E, E.C.N.U, que se unió a Palm Beach Diabetes y Endocrine Specialists en 2012, recibió su grado médico con honores (Summa Cum Laude) y Doctor en Ciencias Médicas (DMSc), de la Universidad de Zulia, la Escuela de Medicina en Venezuela. Posteriormente se unió a la facultad de su Alma Mater y en 1998, el Grupo de Investigación del Programa de Prevención de la Diabetes (D.P.P.) en el Instituto de Investigación de la Diabetes-Universidad de Miami. Completó su posgrado en Medicina Interna y Endocrinología (Jackson Memorial Hospital) y estudios de postgrado en Salud Pública (M.P.H.) con el Premio de Mérito Académico en la Universidad de Miami.

Un consultor privado endocrinólogo y orador nacional desde 2006, el Dr. Paul Y. Casanova-Romero de investigación extensa sobre la prevención de la diabetes, trastornos de la tiroides, síndrome metabólico y otros trastornos endocrinos han sido ampliamente publicadas. Sigue colaborando en estudios de investigación en Estados Unidos y Latinoamérica, el más reciente en pruebas moleculares de tiroides. El Dr. Casanova-Romero está certificado por la Junta en Medicina Interna, así como en Endocrinología, Diabetes y Metabolismo. Es miembro del Colegio Americano de Endocrinología (F.A.C.E.) y miembro del Colegio Americano de Médicos (F.A.C.P.). Actualmente es profesor voluntario de medicina en la Universidad de Miami.

Dr. Paul Y. Casanova-Romero se especializa en el tratamiento de la enfermedad de la tiroides incluyendo nódulos tiroideos, hipotiroidismo, hipertiroidismo y cáncer de tiroides, enfermedad paratiroidea, diabetes, pre-diabetes, trastornos lipídicos y otros trastornos endocrinos. Él ha estado usando la prueba molecular para la caracterización de los nódulos de la tiroides desde 2010. Él ha satisfecho con éxito los requisitos para la certificación endocrina en el ultrasonido del cuello (ECNU) para realizar la biopsia internamente guiada por ultrasonido de la aspiración de la aguja fina de nódulos de tiroides, de la paratiroides, nodos.

Es miembro del panel de membresía de la American Thyroid Association, miembro activo de la Endocrine Society, la Asociación Americana de Endocrinólogos Clínicos, la American Diabetes Association, el American College of Physicians y la National Lipid Association.

En esta entrevista hablamos sobre esta temas:

  • ¿Cómo se identifican los nódulos y por qué ocurren? autoexamen o en la oficina del médico
  • La mayoría de los nódulos son benignos pero ocurren porque en mas de 70% de la población
  • ¿Qué tests puede realizar un médico para evaluar el nódulo?
  • Ninguna test es 100%
  • Ultrasonido - qué están buscando en general
  • Que es ojo fina y el proceso general
  • Tests moleculares
  • ¿Qué tipos de resultados se pueden obtener de la citología y qué significan?
  • La mayoria de ojo finas son benigno
  • Maligno o sospechoso de malignidad, todavía tiene la posibilidad de no ser cáncer
  • Los arco iris - 3,4,5 - indeterminate categoria 
  • Systema BETHESDA
  • ¿Qué tests adicionales se pueden realizar para resolver los nódulos indeterminados? - Tests moleculares
  • Que son todas los tests moleculares?  Y son las mismas?
  • Dr. Casanova prefiere usar test de Afirma, este es por que

MAS INFORMACIÓN

Dr. Paul Casanova

American Thyroid Association (español)

La prueba de la expresión génica de Afirma puede reducir cirugías innecesarias del cáncer de tiroides

Afirma

Sep 18, 2017

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

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

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

In this interview, we discuss the following topics:

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

NOTES

Dr. Antonio Bianco

Dr. Jacqueline Jonklaas

American Thyroid Association

Sep 10, 2017

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

In this episode, Dr. Wartofsky discusses the following:

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

Related episodes:

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

NOTES

Leonard Wartofsky

American Thyroid Association

 

Aug 18, 2017

Many centers from around the world want to know how Memorial Memorial Sloan Kettering Cancer Center treats thyroid cancer.  A key member of the MSKCC is Dr. Michael Tuttle. 

During this interview, Dr. Tuttle discusses the following points:

  • Challenges of managing thyroid cancer as outlined by the guidelines
  • Scaling back care for insurance-challenged patients, and adopting a plan that gets the same result without needing the expensive tests
  • Desired outcome is survival and no recurrence, a third is for no harm that would be caused by an unnecessary surgery
  • Unwanted side affects of thyroid cancer include nerve damage, parathyroid damage, and infections
  • RAI sometimes has unwanted side affects
  • With technology, ultrasounds and biopsies, we know some cancers do not need to be treated, as they are now being found very early
  • Change in ATA guidelines, low risk cancers can be considered for observation
  • Two different kinds of patient profiles: Minimalist and Maximalist
  • 1cm or 1.5cm?
  • Patient characteristic, ultra sound characteristics, and the medical team characteristics weighs who is the most appropriate for observation
  • 400 active surveillance patients currently at MSKCC
  • Certain parts of the world are harder to offer observation as a treatment due to practicality, examples include Latina America where multi-nodular goiters are common, and Germany still is iodine deficient

About Dr. Tuttle, in his words:

I am a board-certified endocrinologist who specializes in caring for patients with advanced thyroid cancer. I work as part of a multidisciplinary team including surgeons, pathologists, radiologists, nuclear medicine specialists, and radiation oncologists that provides individualized care to patients treated at Memorial Sloan Kettering for thyroid cancer.

In addition to treating patients I am also actively researching new treatments for advanced thyroid cancer. I am a professor of medicine at the Joan and Sanford I. Weill Medical College of Cornell University and travel extensively both in the US and abroad, lecturing on the difficult issues that sometimes arise in the management of patients with thyroid cancer. My research projects in radiation-induced thyroid cancer have taken me from Kwajalein Atoll in the Marshall Islands to the Hanford Nuclear power-plant in Washington State to regions in Russia that were exposed to fallout from the Chernobyl accident.

I am an active member of the American Thyroid Association (ATA) and the Endocrine Society. In addition to serving on the ATA committee that produced the current guidelines for the management of benign and malignant nodules, I am also a Chairman of the National Comprehensive Cancer Network Thyroid Cancer Panel, a consultant to the Endocrinologic and Metabolic Drugs Advisory Committee of the FDA, and a consultant to the Chernobyl Tissue Bank.

  • Clinical Expertise: Thyroid Cancer
  • Languages Spoken: English
  • Education: MD, University of Louisville School of Medicine
  • Residencies: Dwight David Eisenhower Army Medical Center
  • Fellowships: Madigan Army Medical Center
  • Board Certifications: Endocrinology and Metabolism

NOTES

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

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

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

The American Thyroid Association

Aug 15, 2017

In this episode, topics include:

  • Hypothyroidism and hyperthyroidism during pregnancy
  • Pregnant and without a thyroid
  • Avoiding T3 during pregnancy, including concerns with desiccated thyroid
  • If being treated for hypothyroidism already, the importance of upping dose while pregnant
  • Pregnant with auto-immunity
  • Pregnant with Graves’ disease
  • The dangers of pregnancy and overt hypothyroidism or hyperthyroidism
  • Three-percent of pregnancies are affected
  • The importance of iodine during pregnancy

Dr. Pearce received her undergraduate and medical degrees from Harvard and a masters’ degree in epidemiology from the Boston University School of Public Health. She completed her residency in internal medicine at Beth Israel Deaconess Medical Center, and her fellowship in endocrinology at the Boston University Medical Center. She is currently an Associate Professor of Medicine at Boston University School of Medicine. She has served as a member of the board of directors of the American Thyroid Association and is currently on the management council of the Iodine Global Network.  She recently co-chaired the ATA’s Thyroid in Pregnancy Guidelines Task Force. She was the 2011 recipient of the ATA’s Van Meter Award for outstanding contributions to research on the thyroid gland.

NOTES

Elizabeth Pearce

American Thyroid Association

Aug 10, 2017

Dr. Hernán Tala es endocrinólogo de la Clinica Alemana en Santiago, Chile. Su area especialidad incluye cáncer de tiroides avanzado, endocrinologia general, y enfermedades tiroides.

Los temas presentados incluyen:

  • Una mejor comprensión de la biología del cáncer de tiroides, y que no todo el cáncer de tiroides es igual. La enfermedad es única en cada paciente.
  • La importancia de entender el perfil del cáncer en cada paciente.
  • Diagnóstico del nódulo.
  • Perfil molecular del nódulo tiroideo.
  • Una pausa en la exploración universal del cáncer de tiroides.
  • Vigilancia activa
  • Menos radiación, o ningún tratamiento de radiación en los casos que anteriormente recibirían radiación
  • La importancia para los médicos de compartir una comprensión universal de la vigilancia activa, por lo que los pacientes obtener una recomendación coherente.
  • Hipotiroidismo en pacientes con tiroidectomía total.
  • El cáncer de tiroides es lento en comparación con otros tipos de cáncer.
  • Qué se requiere para la adopción adicional de la innovación del tratamiento del cáncer de tiroides.
  • Los riesgos de la cirugía de la tiroides.

REFERENCIA:

Clinica Aleman

Dr. Hernán Tala

Facebook

American Thyroid Association (español)

35: Rethinking Thyroid Cancer – When Saying No to Surgery Maybe Best for You with Dr. Allen Ho

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

41: Molecular Profiling and Unnecessary Thyroid Surgeries with Jennifer Kuo from Columbia University

 

Jul 27, 2017

La glándula tiroides es un órgano importante del sistema endocrino. Está ubicada en la parte anterior del cuello, justo por encima de donde se encuentran las clavículas. La tiroides produce hormonas que controlan la forma como cada célula en el cuerpo usa la energía. Este proceso se denomina metabolismo.

Hipotiroidismo es una afección en la cual la glándula tiroides no produce suficiente hormona tiroidea. Esta afección a menudo se llama tiroides hipoactiva.

Este episodio Dra. Gabriela Brenta discute sobre hipotiroidismo, las causas, los síntomas, pruebas y exámenes, el tratamiento, pronóstico, posibles complicaciones, y cuándo contactar a un médico.

Dra. Gabriela Brenta, M.D., Ph.D.

Docente de post grado de la Universidad Favaloro y de las carreras de Especialista en Endocrinología así como de Bioquímica Clínica dependientes de Universidad de Buenos Aires.  Médica adscripta en el Servicio de Endocrinología y Metabolismo de la Unidad Asistencial Dr. César Milstein de Buenos Aires, Sector Tiroides.  Presidente del Comité Científico de la Sociedad Latinoamericana de Tiroides.  Miembro del Dpto. de Tiroides de la Sociedad Argentina de Endocrinología y Metabolismo.   Su área de investigación clínica abarca el efecto cardiovascular y metabólico de las hormonas tiroides.

Jul 13, 2017

Not all thyroid cancer patients who receive a thyroidectomy require radioactive iodine, but for those whose cancer maybe more aggressive and spread beyond the thyroid area, often radioactive iodine (RAI) is protocol. 

RAI treatment may vary depending on the hospital.   For example, in this interview you hear protocol for RAI at Cedars Sinai. 

In this interviews, Dr. Alan Waxman explains what occurs leading up to, during, and after RAI.   Topics discussed include:

  • If staying at the hospital after taking RAI, how long is the stay required?
  • Should you go home after RAI?
  • What is the benefit of staying overnight at the hospital when receiving RAI?
  • Worldwide trends toward prescribing lower doses of RAI.
  • Is there risk in RAI causing leukemia?
  • The importance of ultrasound prior to administering RAI of done.
  • The need to stimulate TSH prior to administering RAI.
  • Withdrawal versus injections in raising TSH levels.
  • Damage to salivary glands. 

Alan D. Waxman, MD is Director of Nuclear Medicine at the S. Mark Taper Foundation Imaging Center at Cedars Sinai. He is also a member of the Saul and Joyce Brandman Breast Center – A Project of Women’s Guild and the Thyroid Cancer Center at Cedars-Sinai Medical Center. He is a clinical professor of radiology at Los Angeles County + University of Southern California (USC) Medical Center. Dr. Waxman’s participation in research has led to the development of many new imaging techniques and equipment adaptations. A leading expert in nuclear medicine imaging, Dr. Waxman has directed efforts to develop innovations in whole-body tumor imaging using new and existing radiolable compounds. Dr. Waxman is an active member and officer of the Society of Nuclear Medicine. He has authored numerous publications and lectured extensively throughout the world. Dr. Waxman is a graduate of the USC Medical School, where he completed his postgraduate training. He also completed a clinical research fellowship at the National Institutes of Health.

NOTES:

Dr. Alan Waxman

Salivary gland toxicity after radioiodine therapy for thyroid cancer.

Blog by Philip James

American Thyroid Association

RELATED EPISODES

34: What Happens When Thyroid Cancer Travels to the Lungs? with Dr. Fabian Pitoia from the Hospital of University of Buenos Aires

30: Thyroid Cancer and Children with Dr. Andrew Bauer from the Perelman School of Medicine, U of Pennsylvania

Jul 5, 2017

This is an in depth discussion about the connection between flame retardants and plastics, and thyroid cancer.  These chemicals, also known as endocrine disruptors, have a clear connection to thyroid cancer occurrence.

The research is presented by Julie Ann Sosa, MD MA FACS is Chief of Endocrine Surgery at Duke University and leader of the endocrine neoplasia diseases group in the Duke Cancer Institute and the Duke Clinical Research Institute. She is Professor of Surgery and Medicine. Her clinical interest is in endocrine surgery, with a focus in thyroid cancer. She is widely published in outcomes analysis, as well as cost-effectiveness analysis, meta-analysis, and survey-based research, and she is director of health services research. 

NOTES:

Study Associates Flame Retardants with Papillary Thyroid Cancer

Flame retardants used in furniture may increase thyroid cancer risk

Trends in Thyroid Cancer Incidence and Mortality in the United States, 1974-2013

How to Buy a Sofa without Toxic Flame Retardants

Julie Ann Sosa, MD

Jun 1, 2017

Antonio Bianco, MD, PhD, is head of the division of Endocrinology and Metabolism at Rush University Medical Center.   Dr. Bianco also co-chaired an American Thyroid Association task force that updated the guidelines for treating hypothyroidism.

Dr. Bianco’s research has revealed the connection between thyroidectomy, hypothyroidism symptoms, and T4-only therapy.  Although T4-only therapy works for the majority, others report serious symptoms.  Listen to this segment to hear greater detail in regard to the following topics:

  • Combination therapy of adding T3 to T4
  • 85% of patients on Synthroid feel fine.
  • Nearly 5% of the U.S. population takes T4 or Levothyroxine, as revealed by the NHANE survey.  This means 10 - 15 million Americans. 
  • Residual symptoms of thyroidectomy include depression, difficulty losing weight, poor motivation, sluggishness, and lack of motivation.  For some, there is no remedy to these symptoms.  For others, adding T3 to T4 shows immediate improvement. 
  • The importance of physical activity and its benefit in treating depression
  • If we normalize T3 does it get rid of hypothyroid symptoms?
  • Overlap between menopause and hypothyroid symptoms

Notes:

American Thyroid Association

Bianco Lab

Bianco Lab on Facebook

NHANES Survey

The National Health and Nutrition Examination Survey (NHANES) is a program of studies designed to assess the health and nutritional status of adults and children in the United States. The survey is unique in that it combines interviews and physical examinations.

May 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 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 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

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
 
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