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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
RELATED DOCTOR THYROID INTERVIEWS
21: Diagnosed with Thyroid Cancer and You Say No to Surgery with Dr. Louise Davies
Antonio Bianco, MD, PhD, is head of the division of Endocrinology and Metabolism at Rush University Medical Center. Dr. Bianco also co-chaired an American Thyroid Association task force that updated the guidelines for treating hypothyroidism.
Dr. Bianco’s research has revealed the connection between thyroidectomy, hypothyroidism symptoms, and T4-only therapy. Although T4-only therapy works for the majority, others report serious symptoms. Listen to this segment to hear greater detail in regard to the following topics:
- Combination therapy of adding T3 to T4
- 85% of patients on Synthroid feel fine.
- Nearly 5% of the U.S. population takes T4 or Levothyroxine, as revealed by the NHANE survey. This means 10 - 15 million Americans.
- Residual symptoms of thyroidectomy include depression, difficulty losing weight, poor motivation, sluggishness, and lack of motivation. For some, there is no remedy to these symptoms. For others, adding T3 to T4 shows immediate improvement.
- The importance of physical activity and its benefit in treating depression
- If we normalize T3 does it get rid of hypothyroid symptoms?
- Overlap between menopause and hypothyroid symptoms
Notes:
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.
Many centers from around the world want to know how Memorial Memorial Sloan Kettering Cancer Center treats thyroid cancer. A key member of the MSKCC is Dr. Michael Tuttle.
During this interview, Dr. Tuttle discusses the following points:
- Challenges of managing thyroid cancer as outlined by the guidelines
- Scaling back care for insurance-challenged patients, and adopting a plan that gets the same result without needing the expensive tests
- Desired outcome is survival and no recurrence, a third is for no harm that would be caused by an unnecessary surgery
- Unwanted side affects of thyroid cancer include nerve damage, parathyroid damage, and infections
- RAI sometimes has unwanted side affects
- With technology, ultrasounds and biopsies, we know some cancers do not need to be treated, as they are now being found very early
- Change in ATA guidelines, low risk cancers can be considered for observation
- Two different kinds of patient profiles: Minimalist and Maximalist
- 1cm or 1.5cm?
- Patient characteristic, ultra sound characteristics, and the medical team characteristics weighs who is the most appropriate for observation
- 400 active surveillance patients currently at MSKCC
- Certain parts of the world are harder to offer observation as a treatment due to practicality, examples include Latina America where multi-nodular goiters are common, and Germany still is iodine deficient
About Dr. Tuttle, in his words:
I am a board-certified endocrinologist who specializes in caring for patients with advanced thyroid cancer. I work as part of a multidisciplinary team including surgeons, pathologists, radiologists, nuclear medicine specialists, and radiation oncologists that provides individualized care to patients treated at Memorial Sloan Kettering for thyroid cancer.
In addition to treating patients I am also actively researching new treatments for advanced thyroid cancer. I am a professor of medicine at the Joan and Sanford I. Weill Medical College of Cornell University and travel extensively both in the US and abroad, lecturing on the difficult issues that sometimes arise in the management of patients with thyroid cancer. My research projects in radiation-induced thyroid cancer have taken me from Kwajalein Atoll in the Marshall Islands to the Hanford Nuclear power-plant in Washington State to regions in Russia that were exposed to fallout from the Chernobyl accident.
I am an active member of the American Thyroid Association (ATA) and the Endocrine Society. In addition to serving on the ATA committee that produced the current guidelines for the management of benign and malignant nodules, I am also a Chairman of the National Comprehensive Cancer Network Thyroid Cancer Panel, a consultant to the Endocrinologic and Metabolic Drugs Advisory Committee of the FDA, and a consultant to the Chernobyl Tissue Bank.
- Clinical Expertise: Thyroid Cancer
- Languages Spoken: English
- Education: MD, University of Louisville School of Medicine
- Residencies: Dwight David Eisenhower Army Medical Center
- Fellowships: Madigan Army Medical Center
- Board Certifications: Endocrinology and Metabolism
NOTES
21: Diagnosed with Thyroid Cancer and You Say No to Surgery with Dr. Louise Davies
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:
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:
PAST EPISODES
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-Ingram Cancer Center
Funding surgical educational camps in Africa
Aggressive Variants of Papillary Thyroid Carcinoma: Hobnail, Tall Cell, Columnar, and Solid
Antonio Bianco, MD, is the Charles Arthur Weaver Professor of Cancer Research in the Department of Internal Medicine. He is the president of Rush University Medical Group and vice dean for clinical affairs in Rush Medical College.
Bianco came to Rush from the University of Miami Health System, where he served as professor of medicine and chief of the Division of Endocrinology, Diabetes and Metabolism.
He has more than 30 years of experience in the thyroid field. He has been recognized with a number of national and international awards and membership in prestigious medical societies. A well-rounded investigator in the field of thyroid disease, Bianco led two American Thyroid Association task forces: one charged with drafting guidelines for thyroid research (as chair) and another responsible for developing guidelines for the treatment of hypothyroidism (co-chair).
Bianco’s research interests include the cellular and molecular physiology of the enzymes that control thyroid hormone action (the iodothyronine deiodinases). He has contributed approximately 250 papers, book chapters and review articles in this field, and has lectured extensively both nationally and internationally. Recently, he has focused on aspects of the deiodination pathway that interfere with treatment of hypothyroid patients, a disease that affects more than 10 million Americans. He directs an NIH-funded research laboratory where he has mentored almost 40 graduate students and postdoctoral fellows.
This episode includes the following topics:
- Thyroid produces thyroxin of T4.
- T4 is not the biologically active, rather it is T3
- T3 is biologically active
- Transformation of T4 to T3 happens throughs the body
- Levothyroxine has become the standard of care for treating hypothyroid patients
- T3 is the biologically active hormone, it could be by giving T4 only we are falling short
- Evidence based medicine wants to only treat with proven and documented therapy; T3 combination therapy is still not scientifically proven
- If patient takes T3 in the morning, it peaks about three hours later
- We have not developed a delivery system to maintain stable T3 levels
- The most important that we can challenge the pharmacy community is to deliver T3 in a way that it mimics the way it behaves in the human body
- Surveyed 12,000 patients and the ones on desiccated thyroid have higher QoL compared to those on Levothyroxine
- I was okay, I had a job, and then I had TT, and from that day forward my life is not the same. Brain fog, and lack motivation
- We do not yet have evidence proving that combination therapy works, but some patients report improvement to QoL
- Mood disorders, depression, brain fog, memory loss, and lack of motivation are reported by TT patients
- T3 combination therapy does not
- Many symptoms of hypothyroidism is similar to menopause
- Depression like symptoms, difficult for weight loss, low motivation, less desire for physical activity, brain fog, memory loss are all symptoms patients report post TT
- Cannot yet yet distinguish between positive effects of T3 and placebo effects
- Side effects of T3 may include palpitation or sweating
- Improvement with combination T3 can be immediate, as reported by patients
- Patients on Levothyroxine most likely to be on statins, beta-blockers, and anti depressants
- Blood tests for TT patients, taking T3 and not
- Time of day to take blood tests
- Time blood sample depending on when patient takes lab work. Ideally 3 or 4 hours after taking the T3 tablet
- Hypothyroid-like symptoms could be depression
- There is greater likelihood of depression symptoms for those taking
- Nearly 5% of the U.S. population takes T4 or Levothyroxine, as revealed by the NHANE survey. This means 10 – 15 million Americans.
- Levothyroxine is the most prescribed drug in the U.S.
NOTES
A Controversy Continues: Combination Treatment for Hypothyroidism
Dr. Akira Miyauchi
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:
- Financial burden of surgery versus total cost of active surveillance over ten years.
- Stretching Exercises for Neck
Setting patient expectations prior to FNA to manage anxiety - When the laryngeal nerve is severed during thyroid surgery, it can and should be repaired, with proper surgeon skill and training.
- 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.
- Total cost of surgery is 4.1x the cost compared to the cost of active surveillance. In the U.S., the cost is higher.
- Incidence versus mortality
- Worldwide trends related to thyroid cancer
- Papillary Microcarcinoma of the Thyroid (PMCT)
- Unfavorable events following immediate surgery
- Results of research which began in 1993
- The current trend in the incidence of thyroid cancer is expected to create an added cost of $3.5 billion by 2030, to the individual and as a society.
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.
Listen to Doctor Thyroid here!
Akira Miyauchi, MD
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. Listen to Doctor Thyroid here!
Dr. Jorge Calvo
Lugar de estudio:
U. de Panamà, Hospital de la Caja de Seguro Social, Fundaciòn Santa Fe (Colombia) U. Del Norte (Argentina), Sistema Integrado de Salud (Veraguas)
Otros estudios:
Laparoscopía, Curso de postgrado de Cirugía Gastrointestinal, Curso de postgrado de Cirugía de Cabeza y Cuello
En este episodio, se tratan los siguientes temas:
- ¿Cómo será la vida después de la cirugía?
- Embarazo después del cáncer de tiroides
- Parálisis de las cuerdas vocales
- Las complicaciones incluyen voz e hipo-calcio
- Sangrado durante la cirugía
- Tratamiento para hypo-calcium
- Vitamina D
- Embarazo y radiación
- TSH elevada después de la cirugía
- Problemas de TSH suprimido
- Número uno de miedo del paciente cuando se le diagnostica cáncer de tiroides y antes de la cirugía
- 32 años como cirujano tiroideo - cáncer papilar de tiroides
- Vigilancia activa
- Tasas de mortalidad del cáncer papilar de tiroides
- Recurrencia
- La mejor hora del día para tomar un reemplazo de tiroides
Más información:
www.doctiroides.com
Brittany Henderson, MD, ECNU is board-certified in internal medicine and endocrinology, with advanced training in thyroid disorders, including Hashimoto’s thyroiditis, Graves Disease, thyroid nodules, and thyroid cancer. Originally from Cleveland, Ohio, she graduated in the top 10% of at her class at Northeastern Ohio Medical University, where she received the honor of Alpha Omega Alpha (AOA). She completed her endocrinology fellowship training under a National Institutes of Health (NIH) research-training grant at Duke University Medical Center. She then served as Medical Director for the Thyroid and Endocrine Tumor Board at Duke University Medical Center and as Clinical Director for the Thyroid and Endocrine Neoplasia Clinic at Wake Forest University Baptist Medical Center.
Topics discussed in this episode include:
- How to interpret my thyroid results?
- Why did I get this? Is it something I did?
- Thyroid controls nearly all body systems: heart, weight, brain, bowel.
- Testing and diagnosis: beyond blood-work
- TSH is the most common check
- TSH is like the reading of your electric meter: it tells you big picture for a month, not daily — it is not a fluid system, it changes by the hour
- TSH is not the cure all for reading thyroid health
- Full thyroid panel: Free T4 and Free T3 is important — highest in morning, lowest around 2p or 3p in the afternoon
- There is no one size fits all to Hashimoto’s — there are different types
- Blood tests: preparing for lab tests
- ‘Normal’ TSH but a patient does not feel normal
- Normal TSH range is controversial — .5 to 3 TSH is normal — if on thyroid replacement target 1.5
- Suppressed TSH
- Dangers of suppressed TSH for thyroid cancer replacement or those on too much on thyroid replacement — heart failure, osteoporosis
- T3 symptoms of TSH is kept too low for too long
- The T4 — T3 relationship
- T4 is money in savings account — but you cant use it now — T3 is money in your pocket and available now
- Preferred thyroid replacement — but, issues with synthetic and desiccated
- The goal — T4 and T3 as stable as possible throughout the day — in light of absorption and interfering food
- Compounded medications
- A doctor must listen to the patient
- Generic levothyroxine and fillers — who is the manufacturer
- What is better, Nature or Armour?
- Why do some people do better on various thyroid replacement formulations?
- Gut biome
- The environment and thyroid disease
- Defining leaky gut
- Avoid foods that gut inflammation thereby worsening auto-immune disease
- Three food foes: processed foods, sugar, and iodine disruptors
- Is adrenal fatigue real?
- Supplements: vitamins and Hashimoto’s
- Nutrients needed to produce thyroid hormone, such as optimizing iron and selenium
- Anti-inflammatory vitamins and Vitamin A and Vitamin D
- Anti-oxidant vitamins — Vitamin B1, Vitamin C, and Glutathione
- What time of day to take to thyroid replacement medication
- What happens if you miss a day of thyroid replacement hormone?
- What does an endocrinologist feel about a patient seeing a Naturopath or an integrative medicine specialist?
NOTES
57: The Gut⎥Antibiotics Danger, Fixing Inflammation, and Thyroid Health, with Dr. Lisa Sardinia
42: Flame Retardants Connected to Thyroid Cancer, with Dr. Julie Ann Sosa from Duke University
LGR5 is associated with tumor aggressiveness in papillary thyroid cancer.
Hedgehog signaling in medullary thyroid cancer: a novel signaling pathway.
Facebook, Instagram, and Twitter: @DrHendersonMD, @charlestonthyroid, @hashimotosbook
Websites: www.charlestonthyroid.com and www.drhendersonmd.com
Victor J. Bernet, MD, is Chair of the Endocrinology Division at the Mayo Clinic in Jacksonville, Florida and is an Associate Professor in the Mayo Clinic College of Medicine. Dr. Bernet served 21+ years in the Army Medical Corps retiring as a Colonel. He served as Consultant in Endocrinology to the Army Surgeon General, Program Director for the National Capitol Consortium Endocrinology Fellowship and as an Associate Professor of Medicine at the Uniformed Services University of Health Sciences. Dr. Bernet has received numerous military awards, was awarded the “A” Proficiency Designator for professional excellence by the Army Surgeon General and the Peter Forsham Award for Academic Excellence by the Tri-Service Endocrine Society. Dr. Bernet graduated from the Virginia Military Institute and the University of Virginia School of Medicine. Dr. Bernet completed residency at Tripler Army Medical Center and his endocrinology fellowship at Walter Reed Army Medical Center. Dr. Bernet’s research interests include: improved diagnostics for thyroid cancer, thyroidectomy related hypocalcemia, thyroid hormone content within supplements as well as management of patient’s with thyroid cancer. He is the current Secretary and CEO of the American Thyroid Association.
In this episode Dr. Bernet describes that Hashimoto’s thyroiditis is an autoimmune condition that usually progresses slowly and often leads to low thyroid hormone levels — a condition called hypothyroidism. The best therapy for Hashimoto’s thyroiditis is to normalize thyroid hormone levels with medication. A balanced diet and other healthy lifestyle choices may help when you have Hashimoto’s, but a specific diet alone is unlikely to reverse the changes caused by the disease.
Hashimoto’s thyroiditis develops when your body’s immune system mistakenly attacks your thyroid. It’s not clear why this happens. Some research seems to indicate that a virus or bacterium might trigger the immune response. It’s possible that a genetic predisposition also may be involved in the development of this autoimmune disorder.
A chronic condition that develops over time, Hashimoto’s thyroiditis damages the thyroid and eventually can cause hypothyroidism. That means your thyroid no longer produces enough of the hormones it usually makes. If that happens, it can lead to symptoms such as fatigue, sluggishness, constipation, unexplained weight gain, increased sensitivity to cold, joint pain or stiffness, and muscle weakness.
If you have symptoms of hypothyroidism, the most effective way to control them is to take a hormone replacement. That typically involves daily use of a synthetic thyroid hormone called levothyroxine that you take as an oral medication. It is identical to thyroxine, the natural version of a hormone made by your thyroid gland. The medication restores your hormone levels to normal and eliminates hypothyroidism symptoms.
You may hear about products that contain a form of thyroid hormones derived from animals. They often are marketed as being natural. Because they are from animals, however, they aren’t natural to the human body, and they potentially can cause health problems. The American Thyroid Association’s hypothyroidism guidelines recommend against using these products as a first-line treatment for hypothyroidism.
Although hormone replacement therapy is effective at controlling symptoms of Hashimoto’s thyroiditis, it is not a cure. You need to keep taking the medication to keep symptoms at bay. Treatment is usually lifelong. To make sure you get the right amount of hormone replacement for your body, you must have your hormone levels checked with a blood test once or twice a year.
If symptoms linger despite hormone replacement therapy, you may need to have the dose of medication you take each day adjusted. If symptoms persist despite evidence of adequate hormone replacement therapy, it’s possible those symptoms could be a result of something other than Hashimoto’s thyroiditis. Talk to your health care provider about any bothersome symptoms you have while taking hormone replacement therapy.
NOTES and REFERENCES
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Allen S. Ho MD is Associate Professor of Surgery, Director of the Head and Neck Cancer Program, and Co-Director of the Thyroid Cancer Program at Cedars-Sinai Medical Center. As a fellowship-trained head and neck surgeon. His practice focuses on the treatment of head and neck tumors, including HPV(+) throat cancers and thyroid malignancies. He leads the multidisciplinary Cedars-Sinai Head and Neck Tumor Board, which provides consensus management options for complex, advanced cases. Dr. 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. Dr. Ho has published as lead author in journals that include Nature Genetics, JCO, JAMA Oncology, and Thyroid, and is Editor of the textbook Multidisciplinary Care of the Head and Neck Cancer Patient (Springer 2018). Dr. Ho serves on national committees within the AHNS and ATA, and leads a national trial on thyroid cancer active surveillance (ClinicalTrials.gov ID: NCT02609685). He maintains expertise in transoral robotic surgery (TORS), minimally invasive thyroidectomy approaches, and nerve preservation techniques. Dr. Ho’s overarching aim is to partner with patients to optimize treatment and provide compassionate, exceptional care.
In this interview — a discussion about Dr. Ho’s research; Parallels Between Low-Risk Prostate Cancer and Thyroid Cancer: A Review. Topics include:
- prostate and thyroid cancer parallels
- prostate cancer and practical acceptance of active surveillance
- randomized and followed patients through true active surveillance
- overall survival, comparing thyroid and prostrate cancer
- tolerance of risk
- Older versus younger patient priorities
- Younger patient thought process
- Weighing quality of life and risk
- Hypothyroidism, parathyroidism, laryngeal nerve risk in thyroidectomy… asymptomatic patients being made symptomatic due to treatment
- Physicians have embraced active surveillance for prostate cancer more than thyroid
- The patient leans on physician for guidance
- The Finland study: 17M in U.S. have thyroid cancer
- Extrapolation — Patients who die of other conditions, in autopsies very small thyroid cancers found in 36% of patients
- A lot of small cancers that need not be diagnosed
- The physicians perspective and influencing the active surveillance decision
- Shared decision making process
- Terminology… some people choose active surveillance even when nodule is greater than 2cm
- Jury is still out on what is considered safe size
- Size and lymph node spread is still being defined
- Moving away from Gleason system
- Some cancers are aggressive
- Some cancers are slow and not lethal
- Incidental cancers
- The word cancer or the c word… and shifting away from fear
- Radiology guidelines
- The Cedars Sinai active surveillance program
- 50% of patients who are offered surveillance accept it… which mirrors Japan
- Alienation of active surveillance patients
- Anxious, calm, and risk and prioritize risks of surgery
- Thyroid cancer tends to strike younger patients. Prostrate cancer tends to be older.
- Prostrate cancer may not improve survival
- Surgery in thyroid versus prostate is safer
- Radiation ad toxicity
NOTES
Parallels Between Low-Risk Prostate Cancer and Thyroid Cancer: A Review
77: Broadway Performer Says No to Thyroid Cancer Surgery → Surveillance Instead
Vigilancia activa en el tratamiento del microcarcinoma de tiroides.
