In this episode, topics include:

• Hypothyroidism and hyperthyroidism during pregnancy
• Pregnant and without a thyroid
• Avoiding T3 during pregnancy, including concerns with desiccated thyroid
• If being treated for hypothyroidism already, the importance of upping dose while pregnant
• Pregnant with auto-immunity
• Pregnant with Graves’ disease
• The dangers of pregnancy and overt hypothyroidism or hyperthyroidism
• Three-percent of pregnancies are affected
• The importance of iodine during pregnancy

Dr. Pearce received her undergraduate and medical degrees from Harvard and a masters’ degree in epidemiology from the Boston University School of Public Health. She completed her residency in internal medicine at Beth Israel Deaconess Medical Center, and her fellowship in endocrinology at the Boston University Medical Center. She is currently an Associate Professor of Medicine at Boston University School of Medicine. She has served as a member of the board of directors of the American Thyroid Association and is currently on the management council of the Iodine Global Network.  She recently co-chaired the ATA’s Thyroid in Pregnancy Guidelines Task Force. She was the 2011 recipient of the ATA’s Van Meter Award for outstanding contributions to research on the thyroid gland.

NOTES

Elizabeth Pearce

American Thyroid Association

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

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.

NOTES

Listen to Doctor Thyroid

American Thyroid Association

Dr. Michael Tuttle

RELATED EPISODES

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