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:
NOTES
Jeremy Freeman's scientific contributions
Thyroid radiofrequency ablation (RFA) is a treatment option for thyroid nodules that aims to remove the nodule while preserving the thyroid gland. This procedure has gained popularity in South Korea and other countries as an alternative to thyroidectomy, a surgery that involves removing the entire thyroid gland. However, the adoption of RFA has been slow in the United States due to insurance companies not covering the procedure, making it too costly for many patients.
Dr. Baek, a specialist in thyroid RFA, believes that the procedure is important for preserving thyroid function and improving the quality of life for patients. In contrast to thyroidectomy, which requires patients to take lifelong hormone replacement medication, RFA allows patients to maintain natural thyroid hormone production.
The cost of thyroid RFA is a significant barrier to its adoption in the United States. While the procedure is cheaper in South Korea and other countries, insurance coverage is a major factor in the affordability of treatment for patients. Insurance companies need to recognize the value of RFA and begin covering the procedure in order for it to become more widely available to patients.
Overall, thyroid RFA is a promising treatment option that has the potential to improve the lives of many thyroid nodule patients. It is important for insurance companies to acknowledge the benefits of this procedure and work towards making it more widely accessible to patients.
MORE INFO
www.rfamd.com
RFA Doctor Directory:
www.rfamd.com
During this video, the following topics are discussed:
✅ Finding treatments that are not over-aggressive and less-invasive.
✅ 70% of women and 50% of men have thyroid nodules
✅ Less than 10% of nodules are cancerous
✅ Is radiofrequency ablation (RFA) an effective treatment?
✅ Is radiofrequency ablation (RFA) painful?
✅ How long does radiofrequency ablation (RFA) take to show results or shrinkage of the nodule?
✅ Ultrasound can categorize a nodule by low risk, intermediate, or high risk.
✅ Thyroidectomy comes with risks, including: vocal cord paralysis, bleeding, parathyroid damage, and nerve damage.
✅ Patients must educate themselves before seeing a doctor.
✅ About Dr. Larian
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 (January 2012 – present). He graduated with academic and humanitarian distinction, from UC Irvine School of Medicine. In 2002 after completing a 6-year residency program in Ear, Nose, & Throat (otolaryngology) and Head & Neck Surgery at UCLA, he began his professional career. He then went on to become a founding member and later the Medical Director of the Cedars-Sinai Head & Neck Center of Excellence (November 2009 – October 2011).
CONTACT
Email: info@larianmd.com
Phone: 310.461.0300
Website: https://https://www.parotidsurgerymd....
Hyperparathyroidism:
https://www.
Facebook: https://www.facebook.com/parotidsurge...
Instagram: https://www.instagram.com/babaklarianmd/
✅ About Philip James
He is the host of the popular podcast: Doctor Thyroid
www.docthyroid.com
In 2013, his laryngeal nerve was severed, shoulder nerve damaged, parathyroids ruined, and residual cancer left behind — all for a 1 cm thyroid nodule.
Later, a vocal cord implant was inserted to help him speak.
All the above, the result of a bad thyroid surgery that dampened his quality of life — and left him wondering, what exactly happened — during what should be a low-risk surgery?
His attempts to follow up with UCLA and the UCLA surgeon were ignored.
He then turned to other doctors for answers — this was the beginning of the podcast:
"Doctor Thyroid with Philip James"
100+ episodes later, the Doctor Thyroid podcast is popular amongst patients; allowing them to access information from top doctors, without being limited by geography or economics.
The word he uses to describe his work as patient advocate is, ‘tonglen’. Or, using his pain and hardship to help others.
When not producing podcast episodes or co-hosting live Q&As for patients with top doctors, he leads the creative team at Doctor Marketing and Philip James Media — a marketing agency dedicated to digital communications serving the sectors of healthcare, payments, and Greentech.
The Doctor Thyroid podcast is available in Spanish and English - and listened to in over 30 countries:
www.doctiroides.com (Spanish)
www.docthyroid.com (English)
✅Please email your requests to philip@philipjames.co
LinkedIn: www.linkedin.com/in/philip-james/
Facebook @docthyroid
YouTube @Doctor Thyroid
Twitter @docthyroid
Looking for a RFA doctor?
Search the RFA Directory:
Protecting the nerves during RFA and thyroid surgery with Dr. Julia Noel from Stanford Health Care.
Hosted by Philip James.
Supported by www.rfamd.com.
Find an RFA doctor at www.rfamd.com 🔹🔹🔹
During this interview, the following topics are discussed:
→ Stanford University prioritizes anatomic structures, ultrasound, and how to best protect the laryngeal nerve
→ Pre- procedure ultrasound is instrumental in minimizing risk
→ Risk to the laryngeal nerve is minimal during RFA
→ Where to deliver heat is guided by ultrasound
→ If unintended consequences occurs during RFA, they are usually reversible
→ Most risk is affecting a patient’s voice
→ Technique and space — away from structures — can be controlled with extra fluid
→ Dr. Noel has conducted 80+ RFA procedures at Stanford University
→ What should every practitioner know in regard to protecting the nerves?
→ Commitment to ultrasound anatomy is critical
→ Ultrasound guided procedures
→ The Stanford RFA team for conducting a procedure is one assistant MD or Fellow, medical assistant laying out equipment and vital signs
→ Patient due diligence when selecting an RFA doctor is key: it should include vetting providers for their experience with RFA → Ask if the doctor has done RFA procedures, what’s the plan for follow up?
→ With RFA, are fewer thyroidectomies occurring?With RFA in clinic, patients now have more treatment options → “No hammers looking for nails”
→ Who is the ideal candidate for RFA?
→ Solitary, large, benign thyroid nodule is the ideal candidate → Cost is between $5000 - $10,000
→ Reduction in thyroid nodule size is up to 80%
→ RFA can be used for malignant nodules
→ Why did it take so long for the U.S. to adopt RFA?
FDA processes are laborious and time consuming
→ Is RFA painful? Generally “no”
→ RFA fills a void in treatment options for thyroid nodule
→ Preservation of thyroid function is key — the thyroid is preserved
→ Does insurance cover RFA treatment?
→ Sometimes the insurance company will cover the procedure through an appeal process
About Dr. Julia Noel
✅ TWITTER @JuliaNoelMD
✅ WEBSITE https://profiles.stanford.edu/julia-noel
✅ WEBSITE https://rfamd.com/julia-noel/
✅ Grand Rounds Video on YouTube https://www.youtube.com/watch?v=YeiOQ...
✅ About Philip James
✅ Instagram @philipjames360
✅ TWITTER @docthyroid
✅ LinkedIn @Philip James
✅ Website www.philipjames.co
✅ YouTube https://www.youtube.com/c/DoctorThyroid
🔹🔹🔹
✅ ABOUT Philip James
I shared my story with many of you on my podcast: Doctor Thyroid www.docthyroid.com In 2013, my laryngeal nerve was severed, shoulder nerve damaged, parathyroids ruined, and residual cancer left behind — all for a 1 cm thyroid nodule.Later, a vocal cord implant was inserted to help me speak. The bad result of thyroid surgery dampened my quality of life → and left me wondering, what exactly happened → during what should be a low-risk surgery? My attempts to follow up with UCLA and the surgeon were ignored. So, I turned to other doctors for answers — this was the beginning of the podcast: "Doctor Thyroid with Philip James" 100+ episodes later, the Doctor Thyroid podcast is popular amongst patients; allowing them access to information from top doctors, without being limited by geography or economics. The word I use to describe my work as patient advocate is, ‘tonglen’. Or, using my pain and hardship to help others. When not producing podcast episodes or co-hosting live Q&As for patients with top doctors, I lead the creative team at Philip James Media — we are a marketing agency dedicated to digital communications — serving the sectors of healthcare, payments, and Greentech. The Doctor Thyroid podcast is available in Spanish and English - and listened to in over 30 countries: www.doctiroides.com (Spanish) www.docthyroid.com (English) Please email your requests to philip@philipjames.co 🔹🔹🔹
Looking for a radiofrequency ablation doctor? 🔹www.rfamd.com🔹
Dr. Leonardo Rangel and Radiofrequency Ablation (RFA) for Malignant Thyroid Nodules.
During this episode the following topics are discussed:
✅we are treating malignant nodules with radiofrequency ablation therapy
✅We are using radiofrequency ablation therapy since 2006
✅it is something that we are really experiencing is the treatment of those malignant thyroid nodules with radiofrequency ablation
✅avoid the risk of thyroidectomy
✅surgeons must give patients all treatment options; including no surgery
✅there are some nodules malignant nodules, they are not amenable for radiofrequency due to position, size, or something like this
✅patient consultations take longer because there are more treatment options to consider
✅ the problem of taking the levothyroxine
✅About Dr. Leonardo Rangel
Staff da Universidade do Estado do Rio de Janeiro
Membro da Sociedade Brasileira de Cirurgia de Cabeça e Pescoço
Membro da Sociedade Americana de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço
Membro da Sociedade Latinoamericana de Tireoidologia
✅Facebook
Rangel MD - Cirurgia de Cabeça e Pescoço
@cabecaepescoco
✅Website
https://www.rfamd.com/leonardo-rangel/
✅ABOUT RFA MD
A guide for locating doctors of radiofrequency ablation. Find radiofrequency ablation doctors from across the world.
rfamd.com
✅
Facebook
@RFADOCTOR
✅
Instagram
@RFADOCTOR
✅
LinkedIn
@rfa-doctor-directory
✅
Twitter
@RFADOC
✅
Internet
www.rfamd.com
✅ ABOUT Philip James
He is the host of the popular podcast: Doctor Thyroid
www.docthyroid.com
🔹
In 2013, his laryngeal nerve was severed, shoulder nerve damaged, parathyroids ruined, and residual cancer left behind — all for a 1 cm thyroid nodule.
Later, a vocal cord implant was inserted to help him speak.
🔹
All the above, the result of a bad thyroid surgery that dampened his quality of life — and left him wondering, what exactly happened — during what should be a low-risk surgery?
🔹
His attempts to follow up with UCLA and the UCLA surgeon were ignored.
He then turned to other doctors for answers — this was the beginning of the podcast:
"Doctor Thyroid with Philip James"
🔹
100+ episodes later, the Doctor Thyroid podcast is popular amongst patients; allowing them to access information from top doctors, without being limited by geography or economics.
🔹
The word he uses to describe his work as patient advocate is, ‘tonglen’. Or, using his pain and hardship to help others.
🔹
When not producing podcast episodes or co-hosting live Q&As for patients with top doctors, he leads the creative team at Doctor Marketing and Philip James Media — a marketing agency dedicated to digital communications serving the sectors of healthcare, payments, and Greentech.
🔹
The Doctor Thyroid podcast is available in Spanish and English - and listened to in over 30 countries:
www.doctiroides.com (Spanish)🔹
www.docthyroid.com (English)🔹
✅Please email your requests to philip@philipjames.co
✅Instagram
@PhilipJames360
✅
LinkedIn
www.linkedin.com/in/philip-james/
✅
Facebook
@docthyroid
✅
YouTube
@Doctor Thyroid
✅
Twitter
@docthyroid
✅
Are you looking for an RFA doctor?
Find one here:
www.rfamd.com
Looking for a radiofrequency ablation doctor? 🔹www.rfamd.com🔹
Radiofrequency Ablation 🛑 REMOVE Thyroid Nodules 🛑 NO SURGERY 🛑 Dr Ralph Tufano
During this podcast, the following topics are discussed:
✅advocate for patients to be as well informed as possible and consider all treatment options for thyroid problems, including avoiding surgery whenever possible and radiofrequency ablation.
✅ five thousand dollars out of pocket and save your thyroid with radiofrequency ablation or thyroidectomy and maybe nothing out of pocket with an insurance paid thyroidectomy?
✅if there are isn't if there are options available if there is an option available to avoid surgery and it gives you an equivalent outcome or maybe even better outcome why wouldn't you choose radiofrequency ablation?
✅with radiofrequency ablation now it's exciting because for thyroid nodules they can be removed without doing surgery
✅before radiofrequency ablation all you had was surgery really and obviously with surgery we talked about the possible risks of surgery and of course probably more concerning sometimes to a lot of people is if you take out half of the thyroid even if you're functioning normally with thyroid your thyroid levels you're having normal thyroid function 25% of those patients will still need thyroid hormone
✅the beauty of radiofrequency ablation is that first of all in most circumstances it's no general anesthesia you can do it in the office much like when you go to your dentist and maybe you're getting a cavity filled you get novocaine or lidocaine to numb up the neck area and then under guidance with an ultrasound you take a needle
✅the beauty of that is that the overwhelming majority of times radiofrequency ablation does not change your thyroid function so think about it we're talking about an invasive procedure surgery general anesthesia complication risk
✅ they have a thyroid problem goiter or a nodule that can be treated by radiofrequency ablation that they seriously consider radiofrequency ablation in preserving the thyroid as a treatment option versus a surgery or a thyroidectomy
✅radiofrequency ablation is very effective and more effective than surgery in fact in ablating and controlling papillary micro-cancer without any real complications
✅radiofrequency ablation seems to be a little more focused and maybe a little bit more able to control that destructive process in that area so you can protect those important structures
✅About Dr. Ralph Tufano
Dr. Ralph P. Tufano is the Director of the Division of Head and Neck Endocrine Surgery 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.
Dr. Tufano has performed every type of minimally invasive endoscopic and robotic thyroid and parathyroid surgery over the years and was director of the initial team that developed the now internationally accepted approach for the scarless transoral thyroidectomy and parathyroid surgery.
Website
https://rfamd.com/doctors/dr-ralph-tufano/
✅ABOUT RFA MD
A guide for locating doctors of radiofrequency ablation. Find radiofrequency ablation doctors from across the world.
rfamd.com
✅
Facebook
@RFADOCTOR
✅
Instagram
@RFADOCTOR
✅
LinkedIn
@rfa-doctor-directory
✅
Twitter
@RFADOC
✅
Internet
www.rfamd.com
✅ ABOUT Philip James
He is the host of the popular podcast: Doctor Thyroid
www.docthyroid.com
🔹
In 2013, his laryngeal nerve was severed, shoulder nerve damaged, parathyroids ruined, and residual cancer left behind — all for a 1 cm thyroid nodule.
Later, a vocal cord implant was inserted to help him speak.
🔹
100+ episodes later, the Doctor Thyroid podcast is popular amongst patients; allowing them to access information from top doctors, without being limited by geography or economics.
🔹
The word he uses to describe his work as patient advocate is, ‘tonglen’. Or, using his pain and hardship to help others.
🔹
The Doctor Thyroid podcast is available in Spanish and English - and listened to in over 30 countries:
www.doctiroides.com (Spanish)🔹
www.docthyroid.com (English)🔹
✅Please email your requests to philip@philipjames.co
✅Instagram
@PhilipJamesMedia
✅
LinkedIn
www.linkedin.com/in/philip-james/
✅
Facebook
@docthyroid
✅
YouTube
@Doctor Thyroid
✅
Twitter
@docthyroid
✅
¿Está buscando un médico RFA?
Encuentre un médico aquí:
www.rfamd.com
🔹 Roberto Valcavi 🔹 MD, FACE, ECNU Reggio Emilia, Italy
RFA for benign nodules, for cystic nodules, for hyper functioning nodules, benign nodules, and now for malignant micro-papillary tumors.
During this episode the following topics are discussed:
The six steps that go into the RFA
STEP 1: setup of the patient. The setup of the patient is in an operatory room -- the safety of a operatory room is by far greater than the setting of an ambulatory room so
STEP 2: prepare for anesthesia.
STEP 3: electrode needle insertion; it is done at the point exactly at the point transistorically...
Step 4: preparation in regard to the laryngeal nerve…. the laryngeal nerve is the most delicate point. The laryngeal nerve may be cooled.
Step 5: extraction; simply take out the needle and at the same time it must. Use compression; avoids bleeding both internal and external
Step 6: Final check.
✅ About Roberto Valcavi
20 years and 1800+ RFA procedures done; laser since 2000
and radiofrequency ablation starting in 2010.
✅ www.rfamd.com/roberto-valcavi/
✅ABOUT RFA MD
A guide for locating doctors of radiofrequency ablation. Find radiofrequency ablation doctors from across the world.
rfamd.com
✅
Facebook
@RFADOCTOR
✅
Instagram
@RFADOCTOR
✅
LinkedIn
@rfa-doctor-directory
✅
Twitter
@RFADOC
✅
Internet
www.rfamd.com
✅ ABOUT Philip James
He is the host of the popular podcast: Doctor Thyroid
www.docthyroid.com
🔹
In 2013, his laryngeal nerve was severed, shoulder nerve damaged, parathyroids ruined, and residual cancer left behind — all for a 1 cm thyroid nodule.
Later, a vocal cord implant was inserted to help him speak.
🔹
All the above, the result of a bad thyroid surgery that dampened his quality of life — and left him wondering, what exactly happened — during what should be a low-risk surgery?
🔹
His attempts to follow up with UCLA and the UCLA surgeon were ignored.
He then turned to other doctors for answers — this was the beginning of the podcast:
"Doctor Thyroid with Philip James"
🔹
100+ episodes later, the Doctor Thyroid podcast is popular amongst patients; allowing them to access information from top doctors, without being limited by geography or economics.
🔹
The word he uses to describe his work as patient advocate is, ‘tonglen’. Or, using his pain and hardship to help others.
🔹
When not producing podcast episodes or co-hosting live Q&As for patients with top doctors, he leads the creative team at Doctor Marketing and Philip James Media — a marketing agency dedicated to digital communications serving the sectors of healthcare, payments, and Greentech.
🔹
The Doctor Thyroid podcast is available in Spanish and English - and listened to in over 30 countries:
www.doctiroides.com (Spanish)🔹
www.docthyroid.com (English)🔹
✅Please email your requests to philip@philipjames.co
✅Instagram
@PhilipJamesMedia
✅
LinkedIn
www.linkedin.com/in/philip-james/
✅
Facebook
@docthyroid
✅
YouTube
@Doctor Thyroid
✅
Twitter
@docthyroid
✅
Are you looking for an RFA doctor?
Find one here:
www.rfamd.com
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:
Other Doctor Thyroid episodes referenced during this interview:
The Parathyroid, and a Safer — Less-Scarring Thyroid Surgery with Dr. Babak Larian from Cedars-Sinai
SHOW NOTES:
Book: Atlas of Head and Neck Surgery
University of Chicago Medicine researchers Briseis Aschebrook-Kilfoy, PhD, assistant research professor in epidemiology, and Raymon Grogan, MD, assistant professor of surgery lead the North American Thyroid Cancer Survivorship Study (NATCSS).
For their most recent research, Aschebrook-Kilfoy and Grogan recruited 1,174 thyroid cancer survivors – 89.9 percent female with an average age of 48
After treatment, thyroid cancer survivors face a lifetime of cancer surveillance and an anxiety-inducing high rate of recurrence, which could contribute to their findings.
"The goal of this study is to turn it into a long-term, longitudinal cohort," said Grogan, who hopes to develop a tool that physicians can use to assess the psychological wellbeing of thyroid cancer survivors. "But, there was no way to do that with thyroid cancer because no one had ever studied quality of life or psychology of thyroid cancer before.”
In this episode, we will explore:
The spiritual, social, psychological, and physical impacts of thyroid cancer. Some of the sometimes over-looked physical impacts include dry mouth, voice problems, dry eyes, dental problems, fatigue, dry skin, and hypoglycemia.
What happens to vocal cords after surgery? Even when not paralyzed, quality of voice is effected.
Often times, family members don't take treatment seriously. Society, healthcare professionals, and the media have minimized thyroid cancer, and in return has made patients feel minimized.
Anxiety about reoccurrence, RAI treatment, and self-concept, influence quality of life for thyroid cancer patients.
A 2011 study by Aschebrook-Kilfoy and Grogan found that thyroid cancer, which is most common in women, will double in incidence by 2019.
Dr. Spencer's major areas of research interest are thyroid physiology and pathology, thyroglobulin and thyroid cancer, immunoassay techniques, thyroid hormone metabolism, and the cost-effective use of thyroid tests. Her current research includes clinical significance of Tg and TgAb in patients with thyroid cancers, parameters for optimizing thyroid hormone suppression of TSH for DTC. Studies on hypothalamic/pituitary mechanisms for regulating TSH, and testing for thyroid dysfunction during pregnancy.
Dr. Spencer earned her PhD from Glasgow University in Scotland. She then went on to complete two fellowships, one in Clinical Biochemistry at Glasgow, and the other at the National Academy of Clinical Biochemistry.
resources:
www.thyroidlab.com/updates
Dr. Breen completed a residency with Dr. Gary Weiner at Pearl Natural Health and continues to see patients at this location. Her training and expertise in the areas of IBD/IBS, thyroid health, bio-identical hormones, gynecology, IV therapy, herbal, nutritional and lifestyle changes offers people a holistic, integrative and comprehensive model of care.
Dr. Breen is a wife and mother of two children. She enjoys living in the Pacific Northwest where she hikes, snow skis, and gardens. She has a special love for animals, including her two cats, fermented foods and Tabata workouts.
In this episode, the following topics are discussed:
NOTES:
In this episode our guest is Dr. Martin Milner. Today's interview features information on optimizing medication with slow-release compounded thyroid replacement.
Can adding adjusting your medication from T4 to slow release with T3 really make you feel better? The answer is, yes! And, could also be the key to losing weight.
We also discuss the following topics, painful feet, dizziness, fatigue, hair loss, iron deficiency, chronic pain, fibromylagia, adrenal connection to to inflammation, sleep problems, muscle spasms, caution with your morning smoothies, and why you should stand up when taking T3.
Want to find a compounding pharmacy that will make your slow release T3 and T4? Start here: http://www.pccarx.com/
Dr. Milner has published several articles on new treatment protocols for hypothyroidism. Most recently, ” Hypothyroidism: Optimizing Medication with Slow-Release Compounded Thyroid Replacement” was published in the peer review journal of compounding pharmacists, International Journal of Pharmaceutical Compounding (IJPC) Vol. 9 No. 4 July/August 2005. In 2006 and 2007 he lectured around the United States guiding physicians and compounding pharmacists in the management of hypothyroidism using his protocol of slow released compounded thyroid replacement. Also to his credit are “Wilson’s Syndrome and T3 therapy – A Clinical Guide to Safe and Effective Patient Management” IJPC Vol. 3 No. 5, Sept/Oct 1999, p. 344-349 and Assessment and Management of Thermoregulation, IJPC Vol. 3 No. 5, Sept/Oct 1999, p. 350-351. Reprints of many of these and other Dr. Milner articles are available at CNMWellness.com, the medical education website of the Center for Natural Medicine. Dr. Milner co-authored chapter 14 in An Alternative Medicine Definitive Guide to Cancer by J. Diamond and W.L. Cowden, the most definitive text on alternative cancer therapies. He also served as the primary consulting physician for Judith Sach’s book Natural Medicine for Heart Disease. The has authored many articles over the years in cardiology.
Dr. Milner is well published with texts, medical journal articles and studies in cardiology, endocrinology, pulmonology, oncology, and environmental medicine. Dr. Milner published in May 2005, Menopause Revolution: Smashing the HRT Myth- Alternatives to Manufactured Drug Therapy , Agora Health Books. He enjoys what he calls practicing “integrated endocrinology” balancing all the endocrine hormones using bio-identical hormone replacement and amino acid neurotransmitter precursors.
Today's guest is Wendy Sacks, M.D., endocrinologist in the Division of Endocrinology, Diabetes and Metabolism and the Thyroid Cancer Program at Cedars-Sinai in Los Angeles.
Some of the topics covered include radioactive iodine treatment, blood testing, the role of the pathologist, selecting the right hospital and medical team for your thyroid cancer treatment, monitoring thyroid cancer reoccurrence, and supplementation.
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.
One-third of all thyroid nodule fine needle aspirations come back indeterminate. When surgery is performed on these cases, pathology of the thyroid reveals that many times the nodule is benign. Through molecular profiling, patients with indeterminate thyroid nodules, can now avoid unnecessary surgery and get more accurate pathology results from the fine needle aspiration.
Are you a patient and your doctor has said your thyroid nodule is indeterminate and is recommending surgery as an option? The key is, to confirm that molecular profiling was performed.
Jennifer Kuo, MD is Director of the Thyroid Biopsy Program, Director of the Endocrine Surgery Research Program, and Instructor in Surgery, at the Columbia University Medical Center. Dr. Kuo received her medical degree from the College of Physicians and Surgeons at Columbia University and completed surgical training at the University of California, Davis Medical Center, in Sacramento. Her new position follows completion of her clinical fellowship in the Department of Surgery, Division of Endocrine Surgery. Dr. Kuo has clinical expertise in minimally invasive endocrine surgery and fine-needle thyroid biopsy and is dedicated to the advancement of the field of endocrine surgery.
NOTES:
RELATED DOCTOR THYROID EPISODES
23: You Have a Thyroid Nodule, What Happens Next? with Dr. Regina Castro from The Mayo Clinic
In this episode, we hear from Elle Russ, Author of The Paleo Thyroid Solution, and former hypothyroidism sufferer. Elle discusses:
Elle Russ is a writer, health/life coach, and host of the Primal Blueprint Podcast. She is becoming the leading voice of thyroid health in the burgeoning Evolutionary Health Movement (also referred to as Paleo, Primal, or Ancestral Health). Elle has a B.A in Philosophy from The University of California at Santa Cruz and is a certified Primal Health Coach. She sits on the advisory board of The Primal Health Coach Program created by Mark Sisson, bestselling author of The Primal Blueprint. Exasperated and desperate, Elle took control of her own health and resolved two severe bouts of hypothyroidism on her own – including an acute Reverse T3 problem. Through a devoted paleo/primal lifestyle, intensive personal experimentation, and a radically modified approach to thyroid hormone replacement therapy…Elle went from fat, foggy, and fatigued – to fit, focused, and full of life!
NOTES:
Elle Russ web site
Primal Blueprint Podcast
http://blog.primalblueprint.com/
Yahoo Natural Thyroid Support Group
https://beta.groups.yahoo.com/neo/groups/NaturalThyroidHormones/info
Combination Therapy of T4 and T3 as a way to combat Hypothyroidism
Thyroidectomy often leads to hypothyroidism-like symptoms. This includes brain fog, sluggishness, weight gain, unmotivated, and water accumulation.
Dr. Bianco’s research has revealed the connection between thyroidectomy, hypothyroidism symptoms, and T4 only therapy. Although T4 only therapy works for the majority, others report serious symptoms. Listen to this segment to hear greater detail in regard to the following topics:
Combination therapy of adding T3 to T4
85% of patients on Synthroid feel fine.
Nearly 5% of the U.S. population takes T4, as revealed by the NHANE survey
Residual symptoms of thyroidectomy include depression, difficulty losing weight, poor motivation, sluggishness, and lack of motivation. For some, there is no remedy to these symptoms.
The importance of physical activity and its benefit in treating depression
If we normalize T3 does it get rid of hypothyroid symptoms?
Overlap between menopause and hypothyroidism symptoms
Dr. Antonio Bianco, Rush University Medical Center as professor of medicine, senior vice chair in the Department of Internal Medicine and division chief of endocrinology at Rush University Medical Center. He has more than 30 years of experience in thyroid research.
Bianco’s research interests have been in the cellular and molecular physiology of the enzymes that control thyroid hormone action in which he contributed more than 200 papers, book chapters and review articles, and lectured extensively both nationally and internationally.
Recently, he has focused on the aspects of the deiodination pathway that interfere with treatment of hypothyroid patients, a disease that affects more than 10 million Americans. He is Director of Bianco Labs.
Notes:
Bianco Lab
Bianco Lab on Facebook
https://www.facebook.com/biancolab/
NHANES Survey
The National Health and Nutrition Examination Survey (NHANES) is a program of studies designed to assess the health and nutritional status of adults and children in the United States. The survey is unique in that it combines interviews and physical examinations.
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:
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In this interview, items discussed include:
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.
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In this interview, the following topics are discussed:
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Thyroid Change Resources
Website: www.ThyroidChange.org
Facebook: www.facebook.com/ThyroidChange
Twitter: www.twitter.com/ThyroidChange
This episode details the medical approach to thyroid nodules. Topics include:
• 60% of the U.S. population has thyroid nodules
• Discovered when evaluating other neck issues such as an unrelated pain
• What happens when you are told you have a thyroid nodule?
• How to know if your thyroid nodule is cancerous?
• When is surgery done despite the nodule being benign?
• Decreasing patient anxiety with quick biopsy results
• The American Thyroid Association as a resource for patients and physicians
• A word of caution about sourcing medical information from online resources
Dr. M Regina Castro is an endocrinologist in Rochester, Minnesota and is affiliated with Mayo Clinic. She received her medical degree from Central University of Venezuela and has been in practice for more than 20 years. Dr. Castro accepts several types of health insurance, listed below. She is one of 78 doctors at Mayo Clinic who specialize in Endocrinology, Diabetes & Metabolism. She also speaks multiple languages, including Spanish and French.
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Dr. Wartofsky is Professor of Medicine, Georgetown University School of Medicine and Chairman Emeritus, Department of Medicine, MedStar Washington Hospital Center. He trained in internal medicine at Barnes Hospital, Washington University and in endocrinology with Dr. Sidney Ingbar, Harvard University Service, Thorndike Memorial Laboratory, Boston. Dr. Wartofsky is past President of both the American Thyroid Association and The Endocrine Society. He is the editor of books on thyroid cancer for both physicians and for patients, and thyroid cancer is his primary clinical focus. He is the author or coauthor of over 350 articles and book chapters in the medical literature, is recent past Editor-in-Chief of the Journal of Clinical Endocrinology & Metabolism, and is the current Editor-in-Chief of Endocrine Reviews.
In this episode, Dr. Wartofsky discusses the following:
Related episodes:
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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.
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Not all thyroid cancer patients who receive a thyroidectomy require radioactive iodine, but for those whose cancer maybe more aggressive and spread beyond the thyroid area, often radioactive iodine (RAI) is protocol.
RAI treatment may vary depending on the hospital. For example, in this interview you hear protocol for RAI at Cedars Sinai.
In this interviews, Dr. Alan Waxman explains what occurs leading up to, during, and after RAI. Topics discussed include:
Alan D. Waxman, MD is Director of Nuclear Medicine at the S. Mark Taper Foundation Imaging Center at Cedars Sinai. He is also a member of the Saul and Joyce Brandman Breast Center – A Project of Women’s Guild and the Thyroid Cancer Center at Cedars-Sinai Medical Center. He is a clinical professor of radiology at Los Angeles County + University of Southern California (USC) Medical Center. Dr. Waxman’s participation in research has led to the development of many new imaging techniques and equipment adaptations. A leading expert in nuclear medicine imaging, Dr. Waxman has directed efforts to develop innovations in whole-body tumor imaging using new and existing radiolable compounds. Dr. Waxman is an active member and officer of the Society of Nuclear Medicine. He has authored numerous publications and lectured extensively throughout the world. Dr. Waxman is a graduate of the USC Medical School, where he completed his postgraduate training. He also completed a clinical research fellowship at the National Institutes of Health.
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Salivary gland toxicity after radioiodine therapy for thyroid cancer.
RELATED EPISODES
Dr. Aime Franco is professor at the University of Arkansas. She leads a research group investigating the role of thyroid hormones in tumorigenesis. She is also actively involved, both locally and nationally, advocating for the importance of biomedical research and the importance of engaging patients and survivors in cancer research.
After, completing her Ph.D. in Cancer Biology, she became a thyroid cancer research fellow at Memorial Sloan-Kettering Cancer Center in the Human Oncology and Pathogenesis Program.
Dr. Franco is a survivor of thyroid cancer, and balances her research as a mom and competitive triathlete.
in this interview we explore the following:
Does thyroid cancer have a good prognosis compared to other cancers because its different or because we are aggressive with surgery and radiation therapy?
What were some personal insecurities when facing thyroid cancer surgery?
What are the questions in regard to TSH that the medical community is overlooking?
Which prescription medication works best?
How often and when should thyroid blood markers be tested?
You may find Dr. Franco here, http://physiology.uams.edu/faculty/aime-franco/
