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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: surgery
Nov 6, 2017

Bryan McIver, MD, PhD

Dr. McIver contributes to Moffitt Cancer Center almost 20 years of clinical experience in the care of patients with endocrine diseases, specializing in the evaluation of patients with thyroid nodules and thyroid cancer. He has a particular interest in the management of patients with advanced and aggressive forms of cancer and the role of genetic and molecular techniques to improve the accuracy of diagnosis; to tailor appropriate treatment to a patientdisease. Dr. McIver has a long-standing basic research interest in the genetic regulation of growth, invasion and spread of thyroid tumors of all types. His primary research focus is the use of molecular and genetic information to more accurately diagnose thyroid cancer and to predict outcomes in the disease. Dr. McIver received his MB ChB degree from the University of Edinburgh Medical School in Scotland. He completed an Internal Medicine residency at the Royal Infirmary of Edinburgh, followed by a clinical fellowship and clinical investigator fellowship in Endocrinology at the School of Graduate Medical Education at Mayo Clinic in Rochester, MN. Prior to joining Moffitt, he was employed as Professor and Consultant at the Mayo Clinic and Foundation in the Division of Endocrinology & Metabolism. Amongst his most proud accomplishments, Dr. McIver counts his two commitment to education of medical students, residents and fellows; his involvement as a founding member of the World Congress on Thyroid Cancer, an international conference held every four years; and his appointment as a member of the Endowed and Master Clinician Program at the Mayo Clinic, recognizing excellence in patient care.  

In this episode, the follwoiung 

  • By sixty years old, more common to have nodule than not
  • Most nodules are benign
  • When to do a biopsy
  • How to interpret the results of biopsy
  • Advances in thyroid cancer
  • Ultrasound technology advancements
  • Molecular markers
  • Cytopathology categorizations
  • Molecular marker technologies
  • Gene expression classifier
  • Afirma
  • Identifying aggressive cancer
  • Types and sub-types of thyroid cancers
  • Invasive and aggressive thyroid cancers
  • Papillary versus anapestic thyroid cancer
  • Biopsy results in 2 - 3 hours
  • Clinical studies that have transformed thyroid treatment
  • Less aggressive surgery and less radioactive iodine
  • Targeted chemotherapies
  • Immunotherapy
  • The importance of clinical trial environments, or thoughtful philosophy
  • The minimum necessary surgery
  • Do not rush into thyroid cancer surgery

NOTES:

American Thyroid Association

Bryan McIver, MD, PhD

Ian D. Hay, M.D., Ph.D.

Hossein Gharib, M.D.

PAST EPISODES

32: Thyroid Cancer Surgery? The Single Most Important Question to Ask Your Surgeon with Dr. Gary Clayman

Sep 28, 2017

Dr. Bridget Brady is Austin’s first fellowship trained endocrine surgeon. She has a passion for and expertise in disease of the thyroid, parathyroid, and adrenal glands. Since completing her endocrine surgery fellowship in 2006 under Matthias Rothmund, MD, an internationally acclaimed endocrine surgeon, she has performed thousands of thyroidectomies and parathyroidectomies here in Austin. Dr. Brady focuses on a variety of minimally invasive techniques to optimize patients’ medical and cosmetic outcomes. Her fellowship training in Germany and experience in Austin have enabled her to specialize in patients with recurrent or persistent disease of the thyroid and parathyroid, including thyroid cancer. She offers complete diagnostic workups including in-office ultrasounds and FNA biopsies of thyroid nodules and lymph nodes.

Dr. Brady was named director of endocrine surgery for the new medical school in Austin. She was also recently chosen to teach general surgeons seeking additional training in endocrine surgery. Dr. Brady instructs these endocrine surgeons from the Baylor Scott and White fellowship program.

In this episode the following topics are discussed:

  • Austin Thyroid Surgeons sees 30 patients per week with thyroid nodules
  • Up to 80% of US population could have a thyroid nodule(s)
  • less than 5% of Dr Brady's thyroid nodule patients test positive for cancer
  • How relevant is what I don’t know won’t hurt me in thyroid cancer and biopsies of nodules?
  • BETHESDA system or the middle category, also known as indeterminate
  • For thyroid nodules that are indeterminate, historically a surgery would be performed 
  • With molecular testing, surgery can be decreased by up to 50%
  • Afirma molecular testing uses messenger RNA
  • If Afirma comes back suspicious it does NOT necessarily mean it is cancer
  • Insurance covers molecular testing
  • Nest steps for a doctor who would like to incorporate molecular testing
  • Suspicious results with molecular testing can still be benign on final pathology
  • How do you calmly tell a patient they have cancer?

NOTES

Dr. Bridget Brady

Veracyte

American Thyroid Association

 

Sep 20, 2017

Dr. Gerard Doherty, an acclaimed endocrine surgeon, is a graduate of Holy Cross and the Yale School of Medicine. He completed residency training at UCSF, including Medical Staff Fellowship at the National Cancer Institute.  Dr. Doherty joined Washington University School of Medicine in 1993, and became Professor of Surgery in 2001. In 2002 he became Head of General Surgery and the Norman W. Thompson Professor of Surgery at the University of Michigan, where he also served as the General Surgery Program Director and Vice Chair of the Department of Surgery. From 2012 to 2016, Dr. Doherty was the Utley Professor and Chair of Surgery at Boston University and Surgeon-in-Chief at Boston Medical Center before becoming Moseley Professor of Surgery at Harvard Medical School, and Surgeon-in-Chief at Brigham and Women’s Hospital and Dana-Farber Cancer Institute. 

Dr. Doherty was trained in Surgical Oncology, and has practiced the breadth of that specialty, including as founder and co-director of the Breast Health Center at Barnes-Jewish Hospital.  His clinical and administrative work was integral in the establishment of the Siteman Cancer Center at Washington University.  Since joining the University of Michigan in 2002, he has focused mainly on surgical diseases of the thyroid, parathyroid, endocrine pancreas and adrenal glands as well as the surgical management of Multiple Endocrine Neoplasia syndromes. He has devoted substantial effort to medical student and resident education policy.  His bibliography includes over 300 peer-reviewed articles, reviews and book chapters, and several edited books.  

He currently serves as President of the International Association of Endocrine Surgeons, Past-President of the American Association of Endocrine Surgeons, Editor-in-Chief of VideoEndocrinology and Reviews Editor of JAMA Surgery.  He is a director of the Surgical Oncology Board of the American Board of Surgery.

In this episode, the following topics are discussed:

  • Imaging has increased thyroid nodule discovery.
  • Following patients with small thyroid cancer — analogous to prostate cancer.  Better followed than treated.
  • Tiny thyroid cancers can be defined by those nodules less than 1/4 inch in size. 
  • Less RAI is being used as a part of thyroid cancer treatment. This means, less need to do total thyroidectomy or thyroid lobectomy.   
  • Dry mouth and dry eyes are risks to doing RAI.  Also, there is risk to developing a second malignancy.   Most of the secondary cancers are leukemia.
  • Risks to operation include changes to voice and calcium levels.  Thyroid surgery is a safe operation but not risk free.
  • Best question for a patient to ask is, who is my treatment team?
  • The quarterback of treatment team is often the endocrinologist .
  • Cluster of issues can happen after RAI, such as the need to carry water and eye drops for life.
  • For some patients taking thyroid hormone replacement, their blood levels are correct, but still does not feel well on standard treatment protocol.
  • By the end of two weeks, most people go back to what they were doing before surgery with a relatively normal state.
  • Scarring reduction; massage, aloe, Vitamin E.

NOTES:

American Association of Endocrine Surgeons

American Thyroid Association

Aug 29, 2017

Dr. José A. Hakim realiza más de 400 cirugías al año. Es cirujano general. Especialista en cirugía de cabeza y cuello en relación con el cáncer.

En este entrevista, hablamos sobre:

  • No todos los cánceres de tiroides deben ser operados.
  • No todos los nódulos tiroideos deben ser biopsiados.
  • La mitad de la población tiene nódulos tiroideos. El 10% de esos nódulos tienen cáncer. En Colombia, 2,5 millones de personas tienen cáncer de tiroides. 15 millones de personas tienen cáncer de tiroides en los Estados Unidos, y lo más probable es que no lo sepan.
  • Los estudios muestran que el 30% de los cadáveres tienen nódulos tiroideos con cáncer.
  • Comprender las repercusiones de hacer una biopsia. Si se trata de un nódulo que no requiere cirugía, incluso si es cáncer, decirle a un paciente esto a veces hace más daño en la forma de estrés emocional que lo que es necesario.
  • No sacrificar una tiroides debido a la fobia.
  • La carga es en el médico para no desencadenar paranoia y estrés en el paciente diciéndoles que "podría" tener cáncer, en el caso de llevar a cabo una biopsia en un nódulo cuando no es necesario.
  • Una tiroidectomía cambia una vida, incluyendo la piel seca, aumento de peso, calcio, pérdida de voz o cambio de voz - estos pueden ser peores que vivir con cáncer de tiroides papilar.
  • ¿Qué necesita ocurrir en la comunidad médica para cambiar el paradigma que no necesitamos para operar en todo el cáncer de tiroides?
  • La patología es la clave para cambiar el paradigma.
  • El cáncer no es igual en todos los casos. Piense en el cáncer de tiroides similar a la vista sobre el cáncer de próstata en los hombres.
Aug 25, 2017

Dr. Shaha specializes in head and neck surgery, with a particular interest in thyroid and parathyroid surgery. He uses an algorithm of selective thyroid tumor criteria (the size, location, stage and type of cancer, along with the patient’s age), to tailor therapy to each individual’s circumstances. This can help thyroid cancer patients avoid unnecessary and potentially damaging over-treatment, while still providing the best option for control of their cancer and better quality of life after treatment. Dr. Shaha works very closely with Memorial Sloan Ketterings’ endocrinologists to monitor the careful post-treatment hormone balancing necessary for thyroid cancer patients. Many academic hospitals and medical societies worldwide have invited Dr. Shaha to speak on the principles of targeted thyroid surgery and to share his expertise in the treatment of head and neck cancers.

 

In this interview, topics include:

  • The first question a surgeon should ask and why.
  • When talking active surveillance or observation, changing the language to deferred intervention,  ‘we are going to defer’.
  • Understanding the biology of the cancer
  • The biology of thyroid cancer is a friendly cancer.
  • Anxiety when diagnosed with cancer.
  • Medical legalities — spend a lot of time with patient — and empower patient.
  • Let the treatment not be worse than the disease.
  • Large tumors, more than 4 cm,  bulky nodes,  voice hoarseness,  vocal cord is paralyzed.  All circumstances where surgery maybe advocated.
  • If a tumor is benign but there is presence of compressive goiters, or deviation of trachea or swallowing difficulty.
  • Considering the condition of the patient, age, cardiac issues.
  • When voice is critical to the patients livelihood, such as teachers, politicians, and singers.
  • Main three complications of surgery include bleeding, change of voice, calcium problems.
  • Non-academic surgeons.
  • Cancer treatment requires a team: surgeons, anesthesiologist, pre-op, radiologist, pathologist, endocrinologists, oncologists.
  • When wind pipe is involved with tumor.
  • When in surgical business a long time, you become humble no matter how good you are.
  • Family present during consultation.
  • God gave you an organ — you took it away — now you are on a pill — since the surgery its ’just’ not the same.
  • When treatment is out of the box — many will not agree with you.
  • How to develop a scale to measure quality of life.
  • To avoid scarring, surgery maybe conducted through the armpit in Korea and Japan.
  • Fibrosis
  • Progress in understanding biology of thyroid cancer only cancer, that there is 98% survival.

NOTES:

Dr. Ashok R. Shaha

 

RELATED EPISODES:

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

40: New Research Reveals Thyroid Surgery Errors 5x More Frequent Than Reported with Dr. Maria Papaleontiou from Michigan Medicine

42: Flame Retardants Connected to Thyroid Cancer, with Dr. Julie Ann Sosa from Duke University

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

 

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

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

36: 1 in 3 People Die With Thyroid Cancer — Not From with Dr. Seth Landefeld from UAB

 

American Thyroid Association

Aug 6, 2017

This episode is recorded from Boston and the World Congress on Thyroid Cancer, where leading doctors and researchers have gathered to share the latest medical research and trends related to thyroid disease. 

At the Congress, Dr. Okamoto presented on Thyroid Cancer Guidelines Around the World

He helped write the Japanese guidelines on thyroid cancer.  He is Professor & Chair of the Department of Surgery at Tokyo Women’s Medical University. 

Key points from this episode include:

  • Most Western countries carry out total thyroidectomies, whereas in Japan, the approach is more conservative with a fundamental practice of hemithyroidectomy whenever possible.
  • By not doing a total thyroidectomy, this allows the patient to not avoid taking thyroid replacement medication.
  • Complete thyroidectomy is conducted when 80-90% of lymph nodes have metastasis.
  • I-131 treatment is decreasing despite cases of cancer increasing
  • For I-131 treatment, patients wait more than 6 months post surgery.
  • When receving I-131 treatment, patients be admitted to hospital for several days.
  • TSH suppression therapy is common in Western countries, whereas in Japan, measures are taken to avoid TSH suppression by not removing all of the thyroid.
  • Normal TSH in Japan is 4.3 or less.
  • Culturally, Japanese patients are typically conservative compared to Western countries.  Even high risk patients opt for no TT.
  • In Japan people are less aggressive and more patient as a culture, and this is reflected in their approach to treating thyroid cancer.
  • For medullary thyroid cancer, treatment management differs in japan.  In Westerm countries, they receive TT.  But, in Japan, if its not familial it is treated with hemithyrodectmy.  Only when familial, is it treated with TT.
  • Calcitonin
  • Follicular diagnosis is difficult, benign and malignant is a big issue. 
  • Active surveillance is spreading now, the question is why?  We must consider the patient’s view.  Research from Japan focuses on the size of tumor, but must consider patient’s view. 

NOTES

Book: Treatment of Thyroid Tumor: Japanese Clinical Guidelines

American Thyroid Association

RELATED EPISODES

38: Thyroid Surgery? Be Careful, Not All Surgeons Are Equal and Here is Why

35: Rethinking Thyroid Cancer – When Saying No to Surgery Maybe Best for You

6: A Must Listen Episode Before Getting Surgery – Do Not Do It Alone

 

 

Aug 1, 2017

This episode is recorded from Boston at the World Congress on Thyroid Cancer, where thyroid doctors and researchers gathered to share the latest medical research and medical improvements related to thyroid disease. 

Dr. Özer Makay is an expert in nerve monitoring during thyroid surgery, and has been a guest faculty member in South Korea, Italy, France, the Netherlands, Germany, Belgium and Bulgaria. 

He has received 17 awards and honors for his scientific studies.  He has authored a 300-page book on nerve monitoring during thyroid surgery. 

This episode covers the following topics:

  • Protecting the recurrent laryngeal nerve (RLN) and superior laryngeal nerve during thyroid surgery.
  • Outcomes of damaging these nerves during surgery include no voice, hoarseness, shortness of breath, problem with drinking water or aspiration, impaired physical exertion with something as simple as climbing a flight of stairs.
  • Why some centers have a higher occurrence of damage during thyroid surgery and include an error rate as high as 10%
  • The cause of the damaged nerve include stretching or traction, and cutting or stitching.
  • How to reduce risk.
  • Is it possible to reattach a cut nerve?
  • Surgeons who are opponents of using a nerve monitor.
  • Pitfalls of using nerve monitoring. 

Also discussed are thyroid cancer trends in Turkey including:

  • Incidence being in the top 5 in the world.
  • Now the number one cancer for women.
  • Proximity to Chernobyl.
  • Screening and awareness as a reason for the increase.
  • 50% of population has a thyroid nodule.In the words of Dr. Özer Makay

Biography:  In the words of Dr. Özer Makay

I was born in 1974 in the Netherlands. After finishing the primary school there, I completed my secondary and high school educations at Bornova Anatolian High School in Izmir/Turkey. I graduated from Ege University, School of Medicine and started my residency at the General Surgery Department of Ege University, School of Medicine. During my studentship, I did my surgical internship at London King’s College Hospital. During my surgical residency, in 2002, I received education regarding “Laparoscopic Surgery” at Free University Hospital, Amsterdam from Prof. Miguel Cuesta and carried out scientific studies there. I had the opportunity to meet with the robotic surgery system here and did use this system at the experimental investigation laboratory.

After being a specialist registrar in May 2005, I started to work at the division of “Endocrine Surgery” of the General Surgery Department of Ege University. During my fellowship, I worked under the supervision of Prof. Enis Yetkin, Prof. Mahir Akyıldız and Prof. Gökhan İçöz. During this period, I became the first Turkish surgeon to have the right to get the title “Fellow of European Board of Surgery – div. Endocine Surgery” by passing the “UEMS Board Examination for Endocrine Surgery”. At the Ege University, we started the “Laparoscopic Adrenalectomy Programme’ in 2008, together with Prof. Dr. Mahir Akyıldız. Besides, the “Robotic Surgery Programme’ was launched in 2012. I promoted to “Associate Professor of Surgery” in 2012. I have been invited to become a member of the European Board of Endocrine Surgery Committee. This makes me the first Turkish member of this committee. Besides, I was chosen as “the national representative” of a “European Union Health Project” concerning this area.

To date, I own more than 80 national and international publications. Furthermore, I participated in more than 30 national and international scientific meetings as speaker, instructor and guest surgeon. I served as president, scientific secretary or organization/scientific committee member for national and international congresses and meetings. I had been in South Korea, Italy, France, the Netherlands, Germany, Belgium and Bulgaria as guest faculty member. I received 17 awards and honors because of my scientific studies presented during national and international scientific congresses. I speak English, Dutch and German fluently and Spanish at elementary level.

My essential areas of interests are “endocrine surgery” and “robotic surgery”. As Ege University, we are the most experienced center of our country regarding “robotic adrenalectomy”.

NOTES

Dr. Özer Makay

Contact

Facebook

Publications

World Congress on Thyroid Cancer

American Thyroid Association

Jul 19, 2017

Doctor Califano es Endocrinóloga del Instituto de Oncología AH Roffo, Universidad de Buenos Aires.
Es miembro del Departamento de Tiroides de la Sociedad Argentina de Endocrinología y Metabolismo y de la Sociedad Latinoamericana de Tiroides.
Es coautora del Consenso Multisocietario Argenino para el Manejo del Cáncer de Tiroides Diferenciado.

En esta entrevista, discutimos lo siguiente:

  1. ¿Qué es un nódulo? 
  2. ¿Qué sucede durante ecografia?
  3. ¿Qué sucede durante la oja fina?
  4. Si es cáncer, ¿siempre hace la cirugía?
  5. Si no es cáncer, ¿algunas veces hace cirugía?
  6. ¿Qué sucede durante la cirugía? ¿Cuánto tiempo se tarda en recuperarse?
  7. ¿Es necesario radioactivo?  
  8. ¿Qué sucede durante la RAI? ¿Hay efectos secundarios? Dieta especial.
  9. Si se elimina mi tiroides, ¿cómo será mi vida después? T4
  10. ¿Cómo elijo al mejor cirujano?
  11. ¿Cuáles son los errores médicos que usted ve con más frecuencia y cómo pueden evitarse?
  12. ¿A qué hora del día debo tomar mi medicamento para la tiroides?
Jun 26, 2017

I sometimes get asked, why am I doing this podcast? 

What started out as a pet project is now being listened to in over 30 countries and with as many as 20000 downloads per episode.  So far, thyroid patients are embracing the opportunity to hear from the world’s leading thyroid doctors, and gaining the information needed to make better decisions related to health.

So why did I start Doctor Thyroid?

My motivation for doing this podcast is to help patients avoid bad experiences related to thyroid cancer and thyroid disease, including bad surgery.   And, provide resources to help make better health decisions and improve quality of life.

My thyroid surgery resulted in errors, which have downgraded my quality of life significantly.  Knowing what I know now, I would have picked a different surgeon, or chosen no surgery at all.  Because, as this interview will discuss, although perceived as safe, thyroid surgery is not without risks. 

To be published next month, new research reveals thyroid surgery errors are five times more likely than previously reported. 

The study was conducted by Dr. Maria Papaleontiou.  She is an Assistant Professor of Internal Medicine with an appointment in the Division of Metabolism, Endocrinology and Diabetes. She graduated medical school from the prestigious Charles University in the Czech Republic and subsequently spent several years conducting research at the Geriatrics Division at Weill Cornell Medical College. She then completed her internal medicine residency at Saint Peter’s University Hospital in New Jersey and her endocrinology fellowship at the University of Michigan. She joined the faculty at the University of Michigan in 2013. She is a recipient of Fulbright and Howard Hughes Medical Institute scholarships.  Dr. Papaleontiou’s practice focuses on thyroid disorders and thyroid cancer. She is especially interested in the treatment of endocrine disorders in older adults. She also conducts health services research in the field of thyroidology and aging.

NOTES

Dr. Maria Papaleontiou

Complications from thyroid cancer surgery more common than believed, study finds

National Cancer Institute (NCI)

RELATED DOCTOR THYROID INTERVIEWS

Dr. Ralph Tufano: Be Careful, Not All Surgeons Are Equal and Here is Why 

Dr. Gary Clayman: The Single Most Important Question to Ask Your Surgeon

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

Jun 22, 2017

Dr. Rashika Bansal is a PGY-2 resident in Internal Medicine at St. Joseph's Regional Medical Center in Paterson, NJ.  Her major research has been with diabetes prevalence and awareness in rural India, with special interest in thyroid disease. 

In this episode Dr. Bansal shares the research she presented at AACE 2017 and ENDO 2017, regarding the poor readability scores for thyroid cancer web sites.

The challenge for these web sites and health institutions is to translate thyroid education from complex to simple and easy to understand.  Currently, many patients are not following with treatment, citing confusion after being exposed to the various thyroid cancer education resources.  

NOTES

Thyroid Education Scores Low for Readability

Thyroid patient education materials not adequately targeted to patient reading level

 

Jun 13, 2017

In this interview, items discussed include:

  • the emotional burden of being diagnosed with cancer and the haste that sometimes follows
  • the unnecessary damage of thyroid surgery, including the cutting of the laryngeal nerve resulting in vocal cord paralysis, low calcium levels and a need to supplement calcium and Vitamin D for life, and leaving residual disease behind
  • knowing your risk factor and finding the right medical team to address it

Dr. Ralph P. Tufano is the Director of the Division of Head and Neck Endocrine Surgery at The Johns Hopkins School of Medicine, and conducts thyroid and parathyroid surgery with a focus on optimizing outcomes.  He is a recognized world authority on the management of thyroid cancer, thyroid nodules, benign thyroid diseases and parathyroid disease.  He has expertise in the management of thyroid cancer nodal metastases, advanced and invasive thyroid cancers as well as recurrent thyroid cancers.  His work in molecular markers, improving surgical outcomes, nerve monitoring and exploring novel treatment techniques for thyroid and parathyroid diseases has helped the medical field tailor and personalize treatment for patients with these conditions.  He is a Charles W. Cummings Professor, sits on the American Thyroid Association Board of Directors, is Director of the Division of Head and Neck Endocrine Surgery, and is a part of the Department of Otolaryngology-Head and Neck Surgery.  He conducts approximately 450 thyroid surgeries annually.  

NOTES:

American Thyroid Association

Dr. Ralph P. Tufano

Doctor Thyroid past episodes

May 29, 2017

The USPSTF upholds its 1996 recommendation against screening for thyroid cancer among asymptomatic adults.

The USPSTF commissioned the systematic review due to the rising incidence of thyroid cancers against a background of stable mortality, which is suggestive of over-treatment. And in view of the results, the task force concluded with “moderate certainty” that the harms outweigh the benefits of screening.

The USPSTF emphasizes, however, that this recommendation pertains only to the general asymptomatic adult population, and not to individuals who present with throat symptoms, lumps or swelling, or those at high risk for thyroid cancer.

A global problem

The over-diagnosis of thyroid cancer is worldwide.  

South Korean doctors treated these newly diagnosed thyroid cancers by completely removing the thyroid—a thyroidectomy. People who undergo these surgeries require thyroid replacement hormones for the rest of their lives. And adjusting the dose can be difficult. Patients suffer from too much thyroid replacement hormone (sweating, heart palpitations, and weight loss) or too little (sleepiness, depression, constipation, and weight gain). Worse, because of nerves that travel close to the thyroid, some patients suffer vocal-cord paralysis, which affects speech.

Over-diagnosis and over-treatment of thyroid cancer hasn’t been limited to South Korea. In France, Italy, Croatia, Israel, China, Australia, Canada, and the Czech Republic, the rates of thyroid cancer have more than doubled. In the United States, they’ve tripled. In all of these countries, as had been the case in South Korea, the incidence of death from thyroid cancer has remained the same.

1 in 3 people die with thyroid cancer, not of.

NOTES

As heard on NPR

Dr. Seth Landefeld

American Thyroid Association

RELATED DOCTOR THYROID INTERVIEWS

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

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

www.docthyroid.com

May 20, 2017

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

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

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

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

Other active surveillance research

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

The team

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

 

About Dr. Allen Ho

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

NOTES

American Thyroid Association

Cedars-Sinai clinical trial

MSKCC thyroid cancer active surveillance

THYCA Support Group

 

Active Surveillance of Thyroid Cancer Under Study

 

May 8, 2017

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

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

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

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

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

Other Doctor Thyroid episodes referenced during this interview:

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

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

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

SHOW NOTES:

Dr. Gary Clayman

Thyroid Cancer Overview

Book: Atlas of Head and Neck Surgery

 

Health Grades

Zoc Doc

The American Thyroid Association

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

Mar 22, 2017

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

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

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

Topics covered, include:

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

NOTES

Akira Miyauchi, MD, PhD (Kuma Hospital)

Mar 17, 2017

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

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

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

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

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

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

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

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

NOTES:

JAMA Abstract: Dr. Davies

Thyroid Stories Project

Dr. Michael Tuttle, from Sloan Kettering

Yasuhiro Itoa and Akira Miyauchi 

Nonoperative management of low-risk differentiated thyroid carcinoma

 

Mar 6, 2017

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

This episode explores the following topics:

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

 

NOTES:

Dr. David Schneider

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

 

Feb 21, 2017

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

Especialidad recertificada en Diciembre de 2013.

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

En esta entrevista, discutiremos:

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

 

Notes:

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

https://twitter.com/fabian_pitoia

www.glandulatiroides.com.ar 

Www.cancerdetiroides.com.ar
Feb 18, 2017

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

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

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

NOTES:

Dr. Babak Larian

http://www.larianmd.com/

P: 310.461.0300

American Thyroid Association Guidelines

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

Feb 7, 2017

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

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

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

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

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

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

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

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

¿Actualmente está trabajando en algún estudio o investigación?

Nov 15, 2016

Dr. Douglas Van Nostrand, MD is the Director of Nuclear Medicine and the Program Director of the Nuclear Medicine Residency Program at Washington Hospital Center and Professor of Medicine, Georgetown University Hospital Center.

His specialty is nuclear medicine, and his primary area of interest and expertise is the nuclear medicine diagnosis and treatment of thyroid cancer. He has held numerous academic and medical society positions including Clinical Professor of Radiology and Nuclear Medicine, Uniformed Services University of Health Sciences; past President, Mid-Eastern Society of Nuclear Medicine, Director of Continuing Medical Education Department, and other elected positions of the Medical Staff of Good Samaritan Hospital. He has over 150 articles published and has been the co-editor of seven medical books including the medical textbook entitled Thyroid Cancer, A Comprehensive Guide to Clinical Management.

In this episode, get the critical questions to ask prior to committing to a surgeon.  And, other useful strategies to make sure a patient gets the best outcome possible.  

 

Oct 19, 2016

Hear about the advances in thyroid ultra sound technology, along with the patient process from diagnosis to surgery. Key topics in this episode include how to research a surgeon, requesting a second opinion, selecting the best hospital, and the challenges faced when operating on the neck.

This episode features Dr. Joseph Sniezek, who is the Medical Director of Head & Neck Endocrine Surgery for Swedish Health Services. 

Too often, the time between being told by your doctor to get an ultrasound to biopsy, often results in anxiety and a disconnect between surgeon - radiologist - pathologist.  Now, with better technology, especially in the area of ultra sound, the multiple trips to specialists can be eliminated. 

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