Info

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
RSS Feed Subscribe in Apple Podcasts
Doctor Thyroid
2018
May
March
January


2017
December
November
October
September
August
July
June
May
April
March
February
January


2016
December
November
October


Categories

All Episodes
Archives
Categories
Now displaying: Category: surgery
May 28, 2018

El Dr. Duque es un Cirujano de Cabeza y Cuello, formado en la Universidad de Miami, actualmente  trabaja en el Hospital Pablo Tobon Uribe de Medellin.

Al años opera unos 220 pacientes con problemas  de tiroides, de estos la mayoría con  cancer de tiroides.

El Dr. Duque ha escrito un libro titulado !Uuuyy. TENGO CANCER DE TIROIDES¡ 

 (Antes de inciar esta entrevista , me gustaria  dejar claro que  el fin de esta entrevista es informativo. Muy respetuosamente le solicitaria todos los que se unen a esta entrevista, No hacer preguntas  sobre casos personales, o mencionar nombres de personas o medicos tratantes , el fin de estas y otras entrevistas que hago es informar.)

Temas de este entrevista uncluye: 

  • Que tan común es el cancer de tiroides, de estos cual es el mas común?
  • Cuéntenos un poco sobre el tratamiento con Yodo radioactivo.
  • Como y porque decido escribir un libro sobre cancer de tiroides
  • Cuando se publicara este libro, donde se puede conseguir
  • Quien es  un buen cirujano de  tiroides, donde puedo buscar un cirujano con experiencia 
  • Nodulos de tiroides
May 28, 2018
Fabián Pitoia, MD, Ph D.
 
Jefe de la sección tiroides, División Endocrinología Hospital de Clinicas decla universidad de Buenos Aires
Sub director de la carrera de medicos especialistas en Endocrinología- hospital de clinicas
 
Docente adscripto de medicina interna.
 
Temas de este entrevista incluye:
 
El tema de hoy es la gestión de la vigilancia activa microcarcinoma
  • ¿qué es el microcarcinoma y qué es la vigilancia activa?
  • Para aquellos que siguen el podcast de Doc Thyroid, es posible que conozcan mi historia, tuve una tiroidectomía y cáncer de tiroides.
  • Cuando escuché la palabra cáncer de mi médico, creó miedo y ansiedad. Pero, ¿la palabra cáncer relacionada con el cáncer de tiroides es diferente? (papilar)
  • ¿Puede decirnos cómo y por qué esto es cierto? Por ejemplo, en comparación con el cáncer de cerebro o el cáncer de páncreas ...
  • ¿Cuántos pacientes con cáncer papilar de tiroides ves un año?
  • ¿Cuántos pacientes con cáncer papilar de tiroides han muerto bajo su cuidado? (La intención de esta pregunta es reducir el miedo en la audiencia sobre la palabra cáncer)
  • Cuéntanos más sobre la vigilancia activa ... es una nueva practica? ¿Y por qué estamos escuchando más sobre esto últimamente?
  • ¿Cómo sabe un paciente si es adecuado para ellos?
  • ¿Cuál es el tratamiento para los pacientes que eligen este tratamiento?
  • ¿Todos los hospitales en América Latina ofrecen vigilancia activa?
  • ¿Cómo puede un paciente encontrar doctores que lo ofrezcan?
  • La Dra. Davies dice que algunos pacientes en su programa dicen sentirse "estúpidos" por dejar el cáncer en su cuerpo. ¿Hay apoyo emocional para aquellos que eligen Vigilancia Activa Microcarcinoma?
May 27, 2018
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

Mar 26, 2018

Doctor Carlos Simón Duque Fisher

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

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

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

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

Información Adicional

American Thyroid Association en español

Doctor Tiroides pagina web

Doctor Tiroides en Facebook

Doctor Tiroides Grupo de apoyo

Facebook Doctor Carlos Duque

Carlos Simón Duque Fisher

Libro ¡Uuuyyy, TENGO CÁNCER DE TIROIDES! 

Mar 22, 2018

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

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

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

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

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

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

In this episode the following topics are discussed:

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

NOTES

Dr. Jeremy Freeman

Jeremy Freeman's scientific contributions

LinkedIn

 

Mar 21, 2018

En esta entrevista hablamos sobre:

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

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

Dr. Antonio Hakim

Mar 15, 2018

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

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

Todays topic's include:

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

NOTES

Vanderbilt Health

Vanderbilt-Ingram Cancer Center

Thyroid research

Funding surgical educational camps in Africa

PubMed

Index Medicus

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

American Thyroid Association

Mar 3, 2018

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

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

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

NOTES

Amanda Laird, MD

American Thyroid Association 

 

Mar 1, 2018

H. Gilbert Welch, MD, MPH

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

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

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

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

In this episode, the following topics are discussed:

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

NOTES

H. Gilbert Welch, MD, MPH

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

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

Should I Be Tested for Cancer? (2006)

Patient Resources

American Thyroid Association 

 

Jan 10, 2018

Dr. Eduardo Faure

Especialista en Endocrinología. UBA

Médico egresado de la Facultad de Medicina de la Universidad Nacional de Rosario.  Especialista en Endocrinología egresado de la Facultad de Medicina de la Universidad de Buenos Aires.  Especialista recertificado por AMA (Asociación Médica Argentina) / SAEM (Sociedad Argentina de Endocrinología y Metabolismo) años 2003 y 2009. Realizó su formación como Endocrinólogo en el Servicio de Endocrinología del Complejo Médico PFA Churruca-Visca. Buenos Aires. Argentina.   Se sub-especializó en el área de Tiroides.  Actualmente se desempeña como Médico de Planta del Servicio de Endocrinología del Complejo Médico PFA Churruca-Visca.  Es Jefe de la Sección Tiroides de dicho Servicio.   Sus trabajos de investigación se basan fundamentalmente en Tiroides. 
Fue docente de Fisiología de la Cátedra de Fisiología Humana de la Facultad de Medicina de la Universidad Nacional de Rosario.  Es docente de la Carrera de Médicos Especialistas en Endocrinología de la Universidad de Buenos Aires.   Es colaborador Docente de la Unidad Docente Hospitalaria “Churruca-Visca” dependiente de la Facultad de Medicina de la Universidad Nacional de Buenos Aires.   Fue docente estable de la Carrera de Especialización en Endocrinología Ginecológica y de la Reproducción en la Universidad Favaloro.   Es Miembro Activo de las siguientes sociedades: Sociedad Argentina de Endocrinología y Metabolismo y de la Sociedad Latinoamericana de Tiroides.   Forma parte del Departamento de Tiroides de la Sociedad Argentina de Endocrinología y Metabolismo.  Es invitado por Sociedades Nacionales e Internacionales como disertante en temas relacionados con Tiroides.  Ex Director de la Sociedad Latinoamericana de Tiroides (LATS).   Chair de la Educational Task Force de la Sociedad Latinoamericana de Tiroides (LATS).

Durante este episodio, escuchamos más detalles sobre lo siguiente:

  1. Calidad de vida después de la cirugía
  2. Complicaciones
  3. Riesgo de obesidad
  4. ¿Necesitaré quimioterapia?
  5. Otros tratamientos relacionados con el cáncer de tiroides que se necesitan?

NOTES

American Thyroid Association (en Español)

14: When Your Medical Professional Gets Thyroid Cancer with Dr. Aime Franco from University of Arkansas

Dec 29, 2017

Professor Akira Miyauchi (Figure 1) is President and COO of Kuma Hospital, Center of Excellence in Thyroid Care, Kobe, Japan. He is a Japanese endocrine surgeon, and a pioneer in active surveillance, and visionary in regard to treatment of thyroid cancer.  World renowned researcher, and lecturer. As the associate professor of the Department of Surgery, Kagawa Medical University, he proposed and initiated a clinical trial of active surveillance for low-risk papillary micro cancer in collaboration with Kuma Hospital in 1993. In 2001, he was appointed the President of Kuma Hospital. Since then, he has been keen on the study of evaluating treatments for papillary micro cancer, observation versus surgery.

During this episode, the following topics are discussed:

  1. Financial burden of surgery versus total cost of active surveillance over ten years. 
  2. Setting patient expectations prior to FNA to manage anxiety
  3. When the laryngeal nerve is severed during thyroid surgery, it can and should be repaired, with proper surgeon skill and training. 
  4. Rather than being stationery and immobile, patients should practice neck stretching exercise within 24 hours proceeding surgery.  There should be no fear about separating the incision. 
  5. The most common question asked to Dr. Miyauchi by surgeons from around the world. 

Total cost of surgery is 4.1x the cost compared to the cost of active surveillance.  In the U.S., the cost is higher. 

By providing patient an active surveillance brochure prior to FNA, they are more open to not proceeding with surgery for small thyroid cancer management. 

Patient voice restores to near normal when repair of laryngeal nerve is done correctly.  All surgeons should be executing this to perfection.

When doing next stretches one-day post surgery, patients report feeling much better and less pain, even one year after surgery.

Protocol for delaying surgery depends on the patient’s age.  Older patients are less likely to require surgery.  75% of patients will not require surgery for their lifetime. 

NOTES

Akira Miyauchi, MD

American Thyroid Association

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

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

PAPERS and RESEARCH

Estimation of the lifetime probability of disease progression of papillary microcarcinoma of the thyroid during active surveillance

Comparison of the costs of active surveillance and immediate surgery in the management of low-risk papillary microcarcinoma of the thyroid.

Incidences of Unfavorable Events in the Management of Low-Risk Papillary Microcarcinoma of the Thyroid by Active Surveillance Versus Immediate Surgery

TSH-suppressive doses of levothyroxine are required to achieve preoperative native serum triiodothyronine levels in patients who have undergone total thyroidectomy.

Stretching exercises to reduce symptoms of postoperative neck discomfort after thyroid surgery: prospective randomized study.

Improvement in phonation after reconstruction of the recurrent laryngeal nerve in patients with thyroid cancer invading the nerve.

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

1 2 Next »