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.

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

Los temas presentados incluyen:

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

REFERENCIA:

Clinica Aleman

Dr. Hernán Tala

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American Thyroid Association (español)

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

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

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

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

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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

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

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World Congress on Thyroid Cancer

American Thyroid Association