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Doctor Thyroid

Welcome to Doctor Thyroid with your host, Philip James. This is a meeting place for you to hear from top thyroid doctors and healthcare professionals. Information here is intended to help those wanting to 'thrive' regardless of setbacks related to thyroid cancer. Seeking good health information can be a challenge, hopefully this resource provides you with better treatment alternatives as related to endocrinology, surgery, hypothyroidism, thyroid cancer, functional medicine, pathology, and radiation treatment. Not seeing an episode that addresses your particular concern? Please send me an email with your interest, and I will request an interview with a leading expert to help address your questions. Philip James philipjames@docthyroid.com
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Mar 1, 2024

In an enlightening episode of the RFAMD podcast, hosted by Philip James, Dr. Emad Kandil from Tulane University casts a new light on the treatment of thyroid conditions, challenging conventional surgical approaches and advocating for the pioneering method of thyroid ablation. This interview not only delves into Dr. Kandil’s personal journey into medicine but also explores the evolving landscape of thyroid treatment, highlighting the potential benefits of ablation over traditional surgery.

Personal Journey to Medicine

The episode begins with a personal anecdote from Dr. Kandil, tracing his initial passion for mathematics and critical thinking to a pivotal moment in his youth involving his brother’s seizure. This incident, occurring in his native Egypt, steered him away from engineering towards a career in medicine, driven by a newfound desire to make a tangible impact on people’s lives.

Thyroid Ablation: A Minimally Invasive Alternative

With thousands of thyroid surgeries under his belt, Dr. Kandil is not your typical advocate against surgery. However, his pioneering work in thyroid ablation in the United States, with nearly a thousand procedures to his credit, positions him uniquely in this field. Thyroid ablation, he explains, is increasingly being used to treat a variety of thyroid conditions, ranging from benign nodules to certain thyroid cancers, offering a less invasive option with fewer complications and a lesser impact on patients’ quality of life.

Challenges in Adopting New Medical Techniques

The conversation takes a critical turn as Dr. Kandil addresses the challenges in the widespread adoption of thyroid ablation. He emphasizes the need for proper training and expertise among physicians to prevent complications. His concerns extend to the rapid expansion of training programs, warning against unqualified practitioners who might cause more harm than good.

Patient-Centric Approach and Recovery

Dr. Kandil also sheds light on the patient experience during and after thyroid ablation. He notes that most procedures are performed under local anesthesia, with some patients preferring sedation. The recovery is notably swift, with many patients able to leave the same day, which is a significant advantage over traditional surgery.

Navigating the Healthcare System

A significant portion of the interview is dedicated to discussing the cost of thyroid ablation in the United States and the challenges patients face due to the lack of insurance coverage for this new procedure. Dr. Kandil stresses the importance of patient education and advocacy, urging patients to thoroughly research their options and seek second opinions.

Looking Towards the Future

In his concluding remarks, Dr. Kandil reflects on the future of thyroid treatment. He envisions a shift towards fewer surgeries, enhanced by advancing technologies and precision techniques. His message is clear: the medical community must adapt to new, less invasive methods that prioritize patient well-being and quality of life. Dr. Emad Kandil’s interview with Philip James marks a significant step in bringing attention to thyroid ablation as a viable alternative to surgery. His insights and personal journey serve as a beacon for both medical professionals and patients navigating the complex world of thyroid treatment. As this method gains traction, it promises to reshape the landscape of thyroid care, prioritizing minimally invasive procedures that offer better outcomes and improved quality of life for patients.

Are you an ablation doctor or searching for one?

Get listed on the directory at www.rfamd.com ✅

🔷🔷🔷🔷

About Philip James

As the host of the popular RFAMD and Doctor Thyroid podcasts, Philip James remains committed to sharing inspiring stories, valuable insights, and groundbreaking discoveries in the world of healthcare, making a positive impact on the lives of countless listeners.

Philip’s thought-provoking interviews have covered a wide range of healthcare topics, from cutting-edge technologies and surgical advancements to patient experiences and the impact of medical research on society.

Feb 25, 2024

Pioneering the Future of Thyroid Care: A Conversation with Dr. Julia Noel

Palo Alto, CA — In a recent episode of the RFAMD podcast, host Philip James welcomed a trailblazer in the field of thyroid treatment, Dr. Julia Noel of Stanford University School of Medicine. Known for her pioneering work in thyroid ablation, Dr. Noel shared insights on the evolving landscape of thyroid care, emphasizing innovative ablation technologies that are reshaping patient experiences.

From Mathematics to Medicine

Dr. Noel’s journey into the medical field was not typical. Initially drawn to mathematics, inspired by her father, she found her calling in surgery, where she could blend problem-solving skills with a hands-on approach. This unique blend of analytical thinking and surgical precision has defined her career.

Ablation Over Surgery: A Paradigm Shift

Central to Dr. Noel’s practice is thyroid ablation, a technique that offers an alternative to traditional surgery. With over thousands of surgeries to her credit, she has been a vocal advocate for techniques like radiofrequency, ethanol, and microwave ablation. These methods, she notes, are crucial in reducing the need for invasive procedures, preserving thyroid function, and improving quality of life.

The Technology at the Forefront

During the interview, Dr. Noel highlighted the rapid advancement in ablation technology. She pointed out that while radiofrequency ablation is currently the most user-friendly and researched method, emerging technologies promise even more groundbreaking developments. These future techniques may not even rely on heat generation, opening new avenues for treatment.

Navigating the Risks

With any medical procedure come risks, and thyroid ablation is no exception. Dr. Noel candidly discussed potential complications like voice changes, discomfort, and nodal rupture. However, she reassured that most of these risks are minor and reversible, underlining the importance of skilled execution and patient awareness.

A Surge in Patient Education

An interesting aspect of Dr. Noel’s work is her approach to patient education and outreach, particularly through social media. She stressed the importance of accurate, high-quality information in guiding both patients and physicians, acknowledging the growing role of digital platforms in patient advocacy.

Challenges in Training and Standardization

As thyroid ablation gains popularity, Dr. Noel emphasized the need for standardized training and guidelines. She expressed concern over the “Wild Wild West” atmosphere as more doctors seek to learn these techniques, underscoring the need for cautious and well-guided adoption of the technology.

The Cost Factor

Addressing the practical aspects of thyroid ablation, Dr. Noel spoke about the variability in insurance coverage and costs in the United States. She noted that while some patients on the West Coast enjoy substantial coverage, others face significant out-of-pocket expenses, highlighting the need for broader insurance acceptance.

Looking to the Future

Dr. Noel’s vision for the future of thyroid treatment is one of optimism, contingent on the acceptance of new medical codes and continued technological innovation. She sees a world where thyroid nodules and cancer are treated more efficiently and less invasively, a testament to the dynamic nature of medical progress.

Dr. Julia Noel’s interview on the RFAMD podcast provides a compelling look into the future of thyroid care. Her dedication to advancing treatment options, patient education, and the safe adoption of new technologies sets a benchmark in the field of thyroid health. As these technologies evolve, Dr. Noel’s insights offer a valuable perspective on the potential for improved patient care and the importance of informed medical choices.

Are you an ablation doctor or searching for one?

Get listed on the directory at www.rfamd.com ✅

🔷🔷🔷🔷


About Philip James

As the host of the popular RFAMD and Doctor Thyroid podcasts, Philip James remains committed to sharing inspiring stories, valuable insights, and groundbreaking discoveries in the world of healthcare, making a positive impact on the lives of countless listeners.

Philip’s thought-provoking interviews have covered a wide range of healthcare topics, from cutting-edge technologies and surgical advancements to patient experiences and the impact of medical research on society.

 
Feb 22, 2024

Thyroid Ablation: A Game-Changer in Preserving Quality of Life

www.rfamd.com

Thyroid disorders, particularly those requiring surgery, have long been a concern for patients due to the potential lifelong dependence on medication and associated quality of life changes. However, a significant shift is occurring in thyroid treatment with the advent of thyroid ablation, a technique that is rapidly gaining preference among patients and physicians alike.

The Rise of Thyroid Ablation

In a recent podcast interview on RFAMD, Dr. Erivelto Volpi, a renowned head and neck surgeon from São Paulo, Brazil, shared his extensive experience in thyroid ablation. Dr. Volpi, who has performed around 8,000 thyroid surgeries and 400 thyroid ablations in over 35 years, notes the growing trend towards thyroid ablation. He attributes this shift primarily to the preservation of the patient’s quality of life, a crucial factor often overshadowed in traditional surgical approaches.

Why Patients Prefer Thyroid Ablation

Dr. Volpi explains that most patients seeking thyroid ablation do so not just to avoid surgery but to maintain their quality of life. They fear the changes that lifelong medication post-surgery might bring, having seen friends or family struggle with hormone replacements. Thyroid ablation, which involves radiofrequency or microwave treatment, offers an effective alternative. It shrinks benign thyroid nodules and even treats initial cancers, preserving thyroid function and thus the patient’s pre-existing quality of life.

The Global Perspective and Acceptance

Thyroid ablation is not just a localized phenomenon. Dr. Volpi highlights its rapid adoption worldwide, with countries like South Korea, Brazil, Italy, France, Spain, Turkey, and Egypt leading in this practice. This global acceptance is partly due to patient advocacy and the internet, which have empowered patients to seek the best treatment options, often traveling across borders to access this care.

The Procedure and Its Benefits

Compared to conventional surgery, thyroid ablation is minimally invasive, with fewer complications like voice changes. Recovery is swift, often within 24 to 48 hours, significantly quicker than traditional surgery. This aspect further reinforces its preference among patients.

Are you an ablation doctor or searching for one?

Get listed on the directory at www.rfamd.com ✅

🔷🔷🔷🔷


About Philip James

As the host of the popular RFAMD and Doctor Thyroid podcasts, Philip James remains committed to sharing inspiring stories, valuable insights, and groundbreaking discoveries in the world of healthcare, making a positive impact on the lives of countless listeners.

Philip’s thought-provoking interviews have covered a wide range of healthcare topics, from cutting-edge technologies and surgical advancements to patient experiences and the impact of medical research on society.

 
Feb 20, 2024

FIND A THYROID ABLATION DOCTOR at www.rfamd.com FOLLOW @DoctorThyroid #thyroid #thyroidcancer #ultrasound 

Introduction

⦿ Host: Welcome by the host of the RFAMD podcast.

⦿ Guest: Introduction of Dr. Giovanni Mauri, a medical professional from Milan, Italy.

Dr. Mauri's Journey into Medicine

⦿ Childhood Influence: Inspired by his father, a radiologist.

⦿ Career Choice: Fascination with radiology and interventional radiology.

⦿ Family Background: His father worked in diagnostic radiology in an oncological hospital.

History of Ablation in Italy

⦿ Early Adoption: Discussion of pioneers in ablation treatments in Italy, starting in the 1980s.

⦿ Development: The evolution of ablation techniques, from ethanol ablation for liver cancers to radiofrequency ablation.

Dr. Mauri's Specialization

⦿ Scope of Ablation: Treating various cancers (liver, kidney, lung, bone, soft tissues) with thermal ablation.

⦿ Focus on Thyroid Ablation: Special emphasis on treating both benign and malignant thyroid diseases.

Patient Success Stories

⦿ Personal Case: A female patient treated multiple times for lymph node metastasis, avoiding further surgery.

⦿ Impact on Patients: Emphasizing the success and life-changing effects of successful thyroid ablation treatments.

Thyroid Surgery vs. Ablation

⦿ Patient Perspective: Benefits in terms of invasiveness and future hormonal treatment.

⦿ Medical Community: Surgeons appreciating the option of ablation to manage resources and time effectively.

Global Trends in Thyroid Ablation

⦿ FDA Approval: The significant impact of FDA approval in the U.S. in 2018.

⦿ Rapid Growth: Thyroid ablation as the fastest-growing field in ablation treatments worldwide.

Dangers of Rapid Growth

⦿ Training and Expertise: Emphasizing the necessity of proper training and the risks posed by inexperienced practitioners.

⦿ Comparison of Techniques: Differences between traditional surgery and ultrasound-guided ablation procedures.

Pioneers in Thyroid Ablation

⦿ Innovations: Introduction of specifically designed needles and techniques in Korea and Italy. ⦿ Global Adoption: The spread of thyroid ablation practices to countries like South America, North America, and Europe.

Risks of Thyroid Ablation

⦿ Medical Risks: Potential damages during the procedure, such as bleeding or nerve damage.

⦿ Technical Challenges: Importance of ultrasound skills and adjunctive techniques to minimize risks.

Risks of Thyroid Ablation

⦿ Medical Risks: Potential damages during the procedure, such as bleeding or nerve damage. 

⦿ Technical Challenges: Importance of ultrasound skills and adjunctive techniques to minimize risks.

Unsuccessful Cases

⦿ Benign Nodules: Rare unsuccessful cases, often due to initial under-treatment.

⦿ Malignant Tumors: Possibility of incomplete ablation, with options for re-treatment.

Selecting the Right Provider

⦿ Criteria for Choosing: Experience of the physician, ideally in a hospital setting for beginners.

⦿ Importance of Supervision: Emphasis on proper environment and supervision for new practitioners.

Addressing Skepticism

⦿ Literature and Communication: Using scientific evidence and open discussions to address concerns.

⦿ Surgical Alternatives: Emphasizing ablation as a reversible option compared to definitive surgery.

Types of Ablation

⦿ Radiofrequency vs. Microwave: Discussion on the advantages and risks of each type in thyroid treatments.

Guidelines and Clinical Experience

⦿ Lag in Guidelines: The delay in incorporating new treatments like ablation into official guidelines.

⦿ Individualized Treatment: Tailoring treatment options based on clinical experience, despite guidelines.

Guidelines and Clinical Experience

⦿ Lag in Guidelines: The delay in incorporating new treatments like ablation into official guidelines.

⦿ Individualized Treatment: Tailoring treatment options based on clinical experience, despite guidelines.

Patient Perception and Decision Making

⦿ Overdiagnosis and Overtreatment: Addressing the issue of overdiagnosis in thyroid cancer and the role of minimally invasive treatments.

⦿ Patient Preferences: Understanding patient choices in treatment options, including active surveillance.

Second Opinions and Treatment Choices

⦿ Changing Treatment Plans: Cases where patients change their mind after seeking a second opinion.

⦿ Informed Decision Making: The importance of providing comprehensive information to patients.

Innovations in Thyroid Treatment

⦿ New Technologies: Exploring new treatments like embolization, expanding the scope of minimally invasive procedures.

Conclusion and Rapid Fire Questions 

⦿ Future of Thyroid Treatment: Predictions about the shift towards ablation in the next decade.

⦿ Importance of Communication: The crucial role of clear communication in discussing cancer treatments with patients.

 

For podcast inquiries or if you would like to be a guest. Contact: philip@rfamd.com

Sep 29, 2023

September is Thyroid Cancer Awareness Important, surgery isn’t always necessary for treating thyroid cancer. In fact: as many as one in three people have thyroid cancer and do not die from it, rather, with it. 

In the world of medicine, it’s not uncommon for patients to feel overwhelmed and uncertain when faced with a diagnosis that requires surgery. For Peter Miller, a 64-year-old man from the UK, this was certainly the case when he was diagnosed with thyroid goiter. Three specialists recommended thyroidectomy as the only viable treatment option, but Peter was hesitant to undergo such a procedure due to the potential risks and complications associated with it.

Fortunately, Peter took matters into his own hands and conducted his own research, which led him to an alternative treatment option – Radiofrequency Ablation (RFA). Through an article written by Philip James and the Philip James YouTube channel, Peter discovered Dr. Roberto Valcavi, an Appalachian doctor in Italy, who had experience performing the RFA procedure.

After discussing his options with Dr. Valcavi via email and video consultation, Peter underwent the RFA procedure in Italy. The results were remarkable – Peter experienced significant improvement in his symptoms, and he was happy to have avoided surgery.

Peter’s story highlights the importance of being an advocate for your own health and well-being. Conducting research, seeking second opinions, and exploring all treatment options are crucial steps in making informed medical decisions. Peter’s success with RFA also underscores the importance of raising awareness about this non-surgical treatment option.

Despite its efficacy, RFA is not widely available in many countries, and healthcare professionals may not be aware of it as a treatment option for thyroid goiter. It is crucial to raise awareness about RFA so that patients have access to all viable treatment options.

Peter’s experience with RFA serves as an inspiration for patients who may be hesitant to undergo surgery for thyroid goiter. Being your own advocate, doing research, and exploring all treatment options can lead to better health outcomes. And with the help of knowledgeable medical professionals like Dr. Valcavi, patients can find the right treatment option that works best for them.

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About Dr. Roberto Valcavi

Roberto Valcavi MD, FACE, ECNU is specialist in Endocrinology and specialist in Internal Medicine. 20 years and 1800+ RFA procedures done; laser since 2000 and radiofrequency ablation starting in 2010.

At present, Dr. Roberto Valcavi is Director of the E.T.C. (Endocrine & Thyroid Clinic) in Reggio Emilia, Italy, dedicated to the diagnosis and therapy of endocrine neck (thyroid, parathyroid, lymph nodes) benign and malignant lesions. 

He is specialized in ultrasound- guided ablative therapy of thyroid nodules by radio frequency (RFA), minimally invasive surgery that is able to effectively treat more than 90 % of benign thyroid nodules and over 80 % of malignant thyroid nodules, saving the thyroid gland.

View Full Profile: Dr. Roberto Valcavi

About Philip James

As the host of the popular RFAMD and Doctor Thyroid podcasts, Philip James remains committed to sharing inspiring stories, valuable insights, and groundbreaking discoveries in the world of healthcare, making a positive impact on the lives of countless listeners.

Philip’s thought-provoking interviews have covered a wide range of healthcare topics, from cutting-edge technologies and surgical advancements to patient experiences and the impact of medical research on society.

Content on the RFAMD and Doctor Thyroid with Philip James websites and podcasts is for informational purposes only and not a substitute for professional medical advice. See our full Legal Disclaimer for details.

Sep 28, 2023

September is Thyroid Cancer Awareness Important, surgery isn’t always necessary for treating thyroid cancer. In fact: as many as one in three people have thyroid cancer and do not die from it, rather, with it. 

In this interview, Dr. Giovanni Mauri, an interventional radiologist specializing in ablation for the treatment of various conditions including thyroid cancer, shares his insights with Philip James on the Doctor Thyroid and RFAMD podcasts.

Dr. Mauri highlights one of the recent advancements in the field of ablation – the possibility of treating small thyroid cancers (up to one or two centimeters) without surgery. This innovative approach allows for the complete treatment of the cancer while preserving the thyroid gland.

He advises every patient diagnosed with thyroid cancer to be aware that ablation is a valid treatment option. He emphasizes the importance for both physicians and patients to know that this option exists, and encourages patients to seek advice about the possibility of being treated by ablation instead of surgery.

The interview concludes with Dr. Mauri extending an invitation for anyone with doubts about this procedure to reach out to him. His contact information is available in the episode description for those interested in learning more about treating thyroid cancer with ablation.

The discussion provides a fresh perspective on thyroid cancer treatment, focusing on non-surgical options and the potential benefits of ablation. The interview wraps up with a farewell from Italy.

🔷🔷🔷🔷

About Philip James

As the host of the popular RFAMD and Doctor Thyroid podcasts, Philip James remains committed to sharing inspiring stories, valuable insights, and groundbreaking discoveries in the world of healthcare, making a positive impact on the lives of countless listeners.

Philip’s thought-provoking interviews have covered a wide range of healthcare topics, from cutting-edge technologies and surgical advancements to patient experiences and the impact of medical research on society.

Content on the RFAMD and Doctor Thyroid with Philip James websites and podcasts is for informational purposes only and not a substitute for professional medical advice. See our full Legal Disclaimer for details.

Sep 27, 2023

September is Thyroid Cancer Awareness Important, surgery isn’t always necessary for treating thyroid cancer. In fact: as many as one in three people have thyroid cancer and do not die from it, rather, with it. 

In a comprehensive interview conducted by Philip James from the RFAMD and Doctor Thyroid podcasts, Dr. Greg Randolph from Harvard Medical School shares his insights on patient-centered approaches for treating thyroid nodules. The interview focuses on thyroid ablation, a procedure that treats thyroid nodules without surgery.

Dr. Randolph emphasizes the importance of not only measuring the volumetric reduction of the nodule after ablation but also considering patient-reported outcomes. These outcomes include the patient’s perception of the nodule, such as whether they still have a lump sensation in their neck or a visible lump. Despite the successful reduction of the nodule size on ultrasound, the patient may still perceive a visual or physical presence, thus it’s critical to include what’s meaningful for the patient in the outcomes.

He also discusses the importance of understanding a patient’s concerns and expectations. Whether it’s a benign nodule or a low-stage malignancy, each patient will have their own concerns and priorities. Some may fear the potential of a hidden cancer while others may be apprehensive about surgical procedures. Hence, the treatment decision should be apparent after a thorough discussion of the patient’s preferences and the medical realities.

Lastly, he stresses the importance of physicians offering a variety of treatment options. For benign nodules or small cancers, patients should have the option to select from different rational treatments. Dr. Randolph also advocates for spending adequate time with the patient, allowing them to ask questions and make informed decisions.

This patient-centered approach fosters a less paternalistic, more collaborative physician-patient relationship, ensuring that the patient’s desires and concerns are addressed during the treatment process.

🔷🔷🔷🔷

About Philip James

As the host of the popular RFAMD and Doctor Thyroid podcasts, Philip James remains committed to sharing inspiring stories, valuable insights, and groundbreaking discoveries in the world of healthcare, making a positive impact on the lives of countless listeners.

Philip’s thought-provoking interviews have covered a wide range of healthcare topics, from cutting-edge technologies and surgical advancements to patient experiences and the impact of medical research on society.

Content on the RFAMD and Doctor Thyroid with Philip James websites and podcasts is for informational purposes only and not a substitute for professional medical advice. See our full Legal Disclaimer for details.

Sep 26, 2023

September is Thyroid Cancer Awareness Important, surgery isn’t always necessary for treating thyroid cancer. In fact: as many as one in three people have thyroid cancer and do not die from it, rather, with it.

 

We recently had the unique opportunity to converse with esteemed Dr. Erivelto Volpi from Brazil at the Thyroid Ablation Conference held in Italy.

As an authority on thyroid treatments, he took the time to share his insights and valuable experience with us. Just a week before, we had caught up with him at the World Congress on Thyroid Cancer in London, and we were delighted to sit down with him again.

The conference presented a golden opportunity for specialists from around the globe to converge, exchange thoughts, and learn from the experts in the field. One area that stood out more than ever at this conference was the exploration of thyroid cancer treatment with ablation. Dr. Volpi explained, “it is a new field, and in selected patients, we can offer the opportunity to avoid surgery using thermal ablations technologies.”

Dr. Volpi emphasized that it is crucial to understand that ablation is indeed a viable option for treating thyroid cancer. However, patient selection plays an integral role in determining its effectiveness. “Usually, nodules up to one centimeter located inside the thyroid parenchyma are considered suitable cases. The results in terms of the treatment outcomes are exactly the same as those from a conventional surgery,” he noted.

Brazil has been at the forefront of using ablation as a treatment option for thyroid nodules for over a decade. As this methodology is now gaining momentum globally, including in the U.S. and countries like Indonesia, Dr. Volpi offers lessons from Brazil’s experience.

His key piece of advice for doctors new to this treatment method is to begin with benign and small-sized nodules. “When you start to do RFA (Radiofrequency Ablation), always start with benign nodules and not so huge nodules. For patients with cosmetic or symptomatic nodules, RFA is a very good option when starting your learning curve,” he advises. This strategy, he believes, will be beneficial not just for patients, but also for doctors who are beginning to learn this procedure.

 

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About Dr. Erivelto Volpi

Dr. Erivelto Volpi é um Cirurgião de Cabeça e Pescoço, especialista em doenças da tireoide e da paratireoide.

Dr. Erivelto Volpi teve toda seu treinamento no Hospital das Clínicas da Universidade de São Paulo, onde permanceu por 30 anos, 4 anos como médico residente em Cirurgia Geral e Cirurgia de Cabeça e Pescoçoe 26 anos como médico do Serviço de Cirurgia de Cabeça e Pescoço, onde atuou no atendimento e cirurgias de pacientes e no  treinamento de médicos residentes e estagiários, além da formação de alunos de graduação e pós-graduação.

Sua tese de Doutorado em 2011 foi sobre segurança em cirurgia de tireoide, especificamente na monitorização neuro-fisiológica intra-operatória dos nervos laríngeos (responsáveis pela movimentação das cordas vocais).

Dr. Volpi sempre esteve interessado em tratamentos minimamente invasivos, sendo um dos pioneiros no Brasil na realização de Tireoidectomias Minimamente Invasivas (MIVAT), tendo feito seu treinamento na Universidade de Pisa com o Dr. Paolo Miccoli.

Sempre preocupado em oferecer o melhor aos seus pacientes, Dr. Volpi em 2018 realizou seu treinamento em Ablação por Radiofrequência em Seoul, na Coréia do Sul com o Prof. Baek, o desenvolvedor da técnica de Ablação por Radiofrequência (RFA).

Retornando ao país, foi um dos primeiros médicos a realizar o procedimento, deste então tem tratado pacientes de todo o Brasil e da América do Sul, além de ter uma das maiores experiências da América Latina neste tratamento, hoje Dr. Volpi é responsável por um curso de treinamento em RFA, tendo já treinado médicos do Brasil, América Latina e EUA. 

View Full Profile: Dr. Erivelto Volpi

About Philip James

As the host of the popular RFAMD and Doctor Thyroid podcasts, Philip James remains committed to sharing inspiring stories, valuable insights, and groundbreaking discoveries in the world of healthcare, making a positive impact on the lives of countless listeners.

Philip’s thought-provoking interviews have covered a wide range of healthcare topics, from cutting-edge technologies and surgical advancements to patient experiences and the impact of medical research on society.

Content on the RFAMD and Doctor Thyroid with Philip James websites and podcasts is for informational purposes only and not a substitute for professional medical advice. See our full Legal Disclaimer for details.

Sep 25, 2023

September is Thyroid Cancer Awareness Important, surgery isn’t always necessary for treating thyroid cancer. In fact: as many as one in three people have thyroid cancer and do not die from it, rather, with it. 

 

A recent interview from the TNT conference on thyroid ablation in Italy, Philip James of the Doctor Thyroid and RFAMD podcasts had a one-on-one discussion with Dr. Catherine Sinclair, a seasoned head and neck surgeon from Melbourne, Australia. Having served at Mount Sinai in New York for 11 years before relocating back to Melbourne in 2021, Dr. Sinclair offers a unique perspective and extensive expertise in thyroid surgery and laryngology.

The Importance of Nerve Protection

As a specialist who’s invested in both head and neck surgery and the voice box, Dr. Sinclair developed a keen interest in thyroid surgery due to the significant risks it presents to the vocal nerves during thyroid procedures, including during ablation. The laryngeal nerves, in particular, tend to be the patients’ greatest concern during thyroid procedures due to the potential damage they might sustain.

Many patients seeking Dr. Sinclair’s services are often singers or professional voice users who want to avoid surgery out of fear for their vocal nerves. As such, they prefer ablation. However, as she explains, it is crucial that they understand the risks to the laryngeal nerves and other vital structures in the area and the strategies used to mitigate these risks during ablation.

Limitations in Nerve Monitoring

In surgery, nerve monitoring is employed to keep track of and protect the nerves. But with ablation, patients are usually awake, which means the conventional nerve monitoring technology can’t be used. This presents a significant area of research on how to protect the nerves when the patient is conscious.

Dr. Sinclair emphasizes that though the risk is slightly lessened with surgery, it still exists. To counter this, specific strategies are used to minimize potential damage, but it’s never a guarantee that no injuries will occur.

Patients’ Preparedness and Awareness

Patients must ask about the surgeon’s experience, the number of ablations performed, and any potential complications that they should worry about. The more experienced the surgeon, the less likely there are to be complications of any kind, nerve injury included.

Contrary to some patients’ assumptions, nerve monitoring isn’t used in ablation since it requires general anesthesia. Early in her ablation experience, Dr. Sinclair used nerve monitoring on patients under general anesthesia. This procedure showed that nerve potentials remain stable as long as lower energy is used at the back of the thyroid gland where the nerves run. Furthermore, by minimizing time spent in the critical zones, nerve injury can be mostly prevented.

Real-time Vocal Assessment

During ablation, Dr. Sinclair often asks her patients to count in a monotone. This simple technique allows her to detect any changes in the voice, a potential indicator of nerve damage due to heat during the procedure. According to her, this method has helped prevent nerve issues.

State of Thyroid Ablation in Australia

Until recently, Dr. Sinclair was the only one performing thyroid ablations in Australia. Now, a colleague has started doing them in Western Australia. However, given the demand and the country’s size, she anticipates more physicians will adopt this procedure. Her main concern is ensuring that it’s done safely, with physicians possessing good ultrasound skills, interventional biopsy skills, and comprehensive knowledge of neck anatomy.

Final Thoughts

Dr. Sinclair’s parting advice to those considering thyroid ablation or thyroidectomy is to have realistic expectations. They should understand that injuries can happen despite the best precautions. However, the experience of the proceduralist can help lessen complications, and there are strategies to reduce the likelihood of nerve damage. Patients should also be well-informed and know what questions to ask their proceduralist before opting for ablation.

Interested parties can reach Dr. Sinclair by email at Catherine@melbournethyroidsurgery.com. She encourages inquiries from both domestic and international individuals.

About Philip James

As the host of the popular RFAMD and Doctor Thyroid podcasts, Philip James remains committed to sharing inspiring stories, valuable insights, and groundbreaking discoveries in the world of healthcare, making a positive impact on the lives of countless listeners.

Philip’s thought-provoking interviews have covered a wide range of healthcare topics, from cutting-edge technologies and surgical advancements to patient experiences and the impact of medical research on society. LinkedIn

Content on the RFAMD and Doctor Thyroid with Philip James websites and podcasts is for informational purposes only and not a substitute for professional medical advice. See our full Legal Disclaimer for details.

Sep 25, 2023

September is Thyroid Cancer Awareness Important, surgery isn’t always necessary for treating thyroid cancer. In fact: as many as one in three people have thyroid cancer and do not die from it, rather, with it. 

In a recent episode of the Doctor Thyroid and RFAMD podcasts, Dr. Vaninder Dhillon, an esteemed laryngologist and ENT surgeon from Johns Hopkins, highlighted the critical issue of voice and swallow risks associated with thyroidectomy and thyroid ablation.

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The interview sheds light on the importance of preserving the voice and offered insights into innovative approaches to avoid surgery.

Dr. Dhillon, who has extensive experience in both laryngology and endocrine head and neck surgery, underscored the significance of the voice and swallow outcomes in patients undergoing these procedures. Her research and clinical practice focus on improving outcomes and quality of life for patients who may face post-operative issues with their voice and swallow, as well as those with general voice and swallow complaints.

One of the most common complications after thyroid surgery is vocal cord paralysis, which can have a significant impact on a patient's voice. While the overall percentage of patients experiencing voice issues after thyroidectomy varies, it can be as high as 30 to 50 percent, with temporary paralysis affecting up to 15 percent. Although permanent paralysis is rarer (1-2 percent), it remains a concern for patients.

During the interview, Dr. Dhillon emphasized the importance of differentiating between voice and swallowing outcomes, as the latter is often overlooked. Swallowing complaints are higher than voice complaints, with some studies showing up to 60 percent of patients experiencing temporary swallowing issues post-operatively.

Voice and swallow assessments are crucial before and after surgery. Dr. Dhillon stressed the need for a comprehensive evaluation, including endoscopy and video stroboscopy, to examine the larynx more closely during speech. These assessments help in identifying potential issues with the recurrent laryngeal nerve and the superior laryngeal nerve.

Dr. Dhillon's team has implemented voice and swallow tests before surgery, and they continue to monitor patients post-operatively to ensure any issues are addressed promptly. This proactive approach helps patients feel more confident and informed about the potential risks to their voice and swallow function.

The conversation also discussed the rise of radiofrequency ablation (RFA) as an alternative to surgery. RFA is a minimally invasive technology for treating thyroid nodules and thyroid cancers. While RFA has a lower risk of voice and swallow complications than surgery, Dr. Dhillon stressed the importance of a thorough pre-RFA laryngeal exam to ensure optimal outcomes.

However, Dr. Dhillon acknowledged that more research is needed to fully understand the potential voice and swallow risks associated with RFA. Standardized protocols and patient-reported outcomes can be vital in evaluating these risks and ensuring patient safety during the procedure.

Dr. Vaninder Dhillon highlighted the importance of safeguarding the voice and swallow function in thyroid surgery and ablation. By proactively evaluating and addressing potential complications, patients can make informed decisions and seek appropriate interventions to protect their vocal and swallowing abilities. The ongoing research and innovative approaches in this field offer hope for improved outcomes and a better quality of life for those affected by thyroid conditions.

About Dr. Vaninder Dhillon

Assistant Professor of Otolaryngology – Head and Neck Surgery

Vaninder “Vinny” K. Dhillon, M.D., is an assistant professor of otolaryngology – head and neck surgery at Johns Hopkins University School of Medicine, specializing in both children and adults. She practices out of Johns Hopkins Otolaryngology – Head and Neck Surgery in Bethesda, Maryland. Dr. Dhillon is also affiliated with Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center in Baltimore, Maryland, as well as Sibley Memorial Hospital in Washington, D.C.

Dr. Dhillon has an expertise in endocrine surgery, laryngology, otolaryngology, parathyroid diseases and surgery, swallowing disorders, thyroid diseases and surgery, and voice problems.

Dr. Dhillon earned her medical degree from Keck School of Medicine of University of Southern California. She completed a residency in otolaryngology at Los Angeles County and University of Southern California Medical Center.

View Full Profile: https://www.rfamd.com/vaninder-dhillon/

🔷🔷🔷🔷

About Philip James

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.

The word he uses to describe his work as patient advocate is, ‘tonglen’. Or, using his pain and hardship to help others.

LinkedIn

-------------

Content on the RFAMD and Doctor Thyroid with Philip James websites and podcasts is for informational purposes only and not a substitute for professional medical advice. See our full Legal Disclaimer for details.

 

Sep 22, 2023

September is Thyroid Cancer Awareness Important, surgery isn’t always necessary for treating thyroid cancer. In fact: as many as one in three people have thyroid cancer and do not die from it, rather, with it. 

In recent years, innovative methods in thyroid cancer management have drastically changed the field, and potentially the future of cancer treatments overall. A thought-provoking revelation comes from a discussion held at the World Congress on Thyroid Cancer in London, where a paradigm-shifting concept was discussed by two highly respected figures in the field.

Dr. Akira Miyauchi of Kuma Hospital in Kobe, Japan, and Dr. Michael Tuttle from Sloan Kettering Cancer Center, New York, unveiled a practice that goes against traditional medical protocol: favoring active surveillance over immediate surgery in managing papillary thyroid cancer. The method has been utilized at Kuma Hospital for 30 years, and in this time, not one patient has died from this type of cancer. This groundbreaking revelation was discussed in a live interview hosted by Philip James of the Doctor Thyroid podcast.

According to Dr. Miyauchi, the original proposal for this trial of active surveillance was approved and initiated in 1993. It is based on the principle that early intervention is not always critical. Instead, the method favors regular monitoring of the patient’s condition to identify any changes in the cancer’s progression.

“The most important thing might be the unclosing safety of the active surveillance. Compared to immediate surgery, the instances of unfavorable events such as vocal cord paralysis, hypoparathyroidisms, or patients with surgical scars, patients taking Levothyroxine – these instances are significantly smaller in active surveillance” explained Dr. Miyauchi.

The focus of active surveillance is not to disregard treatment but to delay intervention until necessary, allowing for better management of the disease. This, in turn, reduces the risk of complications often associated with early and possibly unnecessary surgery.

However, surveillance does not mean the absence of treatment. Many patients are proactive in their health management, adopting healthier lifestyles, engaging in physical activities, and sometimes utilizing alternative treatments. The goal remains the same: to halt or slow the progression of the cancer.

Dr. Tuttle reiterated that the outcomes and survival rates between early and delayed intervention are largely the same. Importantly, patients who do show a small increase in the size of the cancer or the appearance of small lymph nodes in the neck can still be efficiently treated with delayed surgery. This does not compromise their chance of a full recovery or increase their risk of recurrence or distant metastasis.

In the U.S., where active surveillance has been practiced for around 12 years, Dr. Tuttle’s experience with patients who have needed to switch to surgery has been largely positive. Most were grateful for having been able to keep their thyroid for as long as they did, and many even reported feeling healthier due to the lifestyle changes they had implemented.

“Having seen a few now that are on the other side of that, I can tell you for most people they weren’t upset they weren’t sad that we had to do something but they felt like they’d given it their best” Dr. Tuttle explained.

This approach might, however, require a change in doctors’ attitudes as well. It’s not only about informing patients about their cancer but also managing their anxiety and uncertainty about the ‘wait and see’ strategy. The physicians’ warm-heartedness, their reassuring demeanor, and the trust they establish with their patients are crucial factors that may significantly affect patients’ psychological well-being.

The shift from immediate surgical intervention to active surveillance represents a revolutionary approach to managing thyroid cancer. The results from the Kuma Hospital trial are prompting the medical community to rethink its strategies and consider adopting this new method more broadly. Although active surveillance might not be the right choice for all patients, it presents an alternative and safe option for those with papillary thyroid cancer, potentially improving both their physical and psychological quality of life.

🔷🔷🔷🔷

About Philip James

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.

The word he uses to describe his work as patient advocate is, ‘tonglen’. Or, using his pain and hardship to help others.

LinkedIn

-------------

Content on the RFAMD and Doctor Thyroid with Philip James websites and podcasts is for informational purposes only and not a substitute for professional medical advice. See our full Legal Disclaimer for details.
Apr 5, 2023

You have been diagnosed with thyroid cancer, and contrary to your doctor's advice, you choose to not proceed with surgery.  Is this a patient trend, and how often are patients making this decision?

In a qualitative analysis, Dr. Louise Davies reports on the experience of US patients who self-identify as having an over-diagnosed thyroid cancer.

How likely is death as result of thyroid cancer?  In a study by H. Harach, he sites that when reviewing random autopsies, thyroid cancer was prevalent in 34% of the cadavers.  

Dr. Davies states, if diagnosed with thyroid cancer, important questions to ask, include:

  1. How big is the tumor?
  2. How was the tumor discovered?
  3. Are there any symptoms?

Dr. Davies says those who choose to opt for no surgery are sometimes called stupid by those who know them, and end up feeling isolated and anxious, with little or no support.  

Louise Davies, MD, MS, FACS is an Associate Professor at Geisel School of Medicine
and Dartmouth Institute for Health Policy & Clinical Practice (TDI).

She is Chief, Otolaryngology at Veterans Administration, White River Jct., VT
Dr. Davies is an otolaryngologist - head & neck surgeon whose thyroid related research is aimed at defining and documenting the problem of rising thyroid cancer incidence and developing management approaches to the problem in ways that are safe and effective. Clinically, Dr. Davies cares for patients with both head and neck and thyroid cancer and general otolaryngology problems primarily at the VA hospital, with a limited practice at Dartmouth Hitchcock Medical Center. Her career is defined by her goal of helping patients and physicians make good decisions for their cancer care by providing clear, helpful data in useful formats at the needed time and place.

NOTES:

JAMA Abstract: Dr. Davies

Thyroid Stories Project

Dr. Michael Tuttle, from Sloan Kettering

Yasuhiro Itoa and Akira Miyauchi 

Nonoperative management of low-risk differentiated thyroid carcinoma

 

Apr 2, 2023
Jonas de Souza participates in both clinical and outcomes research studies on malignancies of the upper aerodigestive tract, especially head and neck cancers. His research focuses on the use of novel therapeutic agents along with measurements of financial burden, patients’ preferences, and the trade-offs between the risks and benefits of cancer therapies. His research has sought to integrate outcomes research, patient preferences, health policy, and economics into clinical practice. His ultimate goal is to increase access to essential cancer therapies by providing policy makers and scientific communities with the required information on patient preferences and on barriers that lie between cancer patients and access to care.
 
De Souza has authored and presented papers and given lectures on head and neck malignancies, reimbursement methods in oncology, and evidence-based care. He is the principal investigator for a trial examining the role of SPECT-CT in the follow-up of patients with locally advanced head and neck cancers.
 
De Souza earned his MD from the University of Rio de Janeiro State. He completed his residency specializing in internal medicine at the University of Texas Health Science Center in 2008 and a fellowship focusing on hematology/oncology at the University of Chicago in 2011.
 
During this episode the following topics are discussed:
“Financial toxicity,” or the financial burdens that some patients suffer as a result of the cost of their treatments can cause damage to their physical and emotional well-being. 
Financial impact of thyroid cancer
Lost income or high out-of-pocket costs for treatment, medication or related care.
Like any other side effect, financial toxicity should be disclosed and discussed with the patients.
Patients with thyroid cancer had a 41% increased risk for unemployment at 2 years 
 
 
 
 
Mar 7, 2023
Dr. Jeremy Freeman was born in Hamilton, Ontario and grew up in Toronto. He attended medical school at the University of Toronto, graduating with highest honours. He completed his otolaryngology residency at the University of Toronto.

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

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

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

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

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

In this episode the following topics are discussed:

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

NOTES

Dr. Jeremy Freeman

Jeremy Freeman's scientific contributions

LinkedIn

 

Dec 31, 2022

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

Dec 30, 2022

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.hyperparathyroidmd.com/doctor-larian/ 

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:

www.rfamd.com

Dec 30, 2022

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 🔹🔹🔹

Dec 30, 2022

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

 

Nov 8, 2022

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

Nov 8, 2022

🔹 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



 

 

 

 

 

Jun 12, 2022

This is a candid interview with Dr. Gary Clayman about thyroid cancer surgery and making sure a patient receives the best available care. 

Dr. Clayman has performed more than four hundred thyroid cancer operations per year for over twenty years among patients ranging from 6 months to 100+ years of age. Nearly half of Dr. Clayman’s patients have undergone failed initial surgery for their thyroid cancer by another surgeon or have recurrent, persistent, or aggressive thyroid cancer. If it pertains to thyroid surgery or thyroid cancer, there is likely nothing that he hasn’t seen.

Dr. Clayman left the M. D. Anderson Cancer Center in the fall of 2016 to form the Clayman Thyroid Cancer Center in Tampa, Florida

If someone is considering surgery, Dr. Clayman discusses important topics, including:

  • Do not let a doctor operate on you unless the surgeon can prove to you that he/she has done a minimum of 150 annual thyroid surgeries, and for a minimum of ten years.  This means, do not see a surgeon unless he/she has completed a minimum of 1500 thyroid surgeries. 
  • Damage to voice box nerves is preventable, when surgery is done right.
  • 90% of thyroid surgeries done in the U.S. are by doctors doing fewer than fifteen thyroid surgeries per year
  • There is a growing trend of patients being more informed compared to years past
  • Do not rush into a surgery.  Vet your doctor and hospital.  Talk to people and make sure you have selected a skilled surgeon 
  • Surgery is not franchisable, use caution when
  • If a case is too complex, important that a less experienced surgeon seek help from a more experienced surgeon
  • Incomplete surgery is completely unacceptable (persistence of disease)
  • Advice to surgeons, especially less-experienced ones

Other Doctor Thyroid episodes referenced during this interview:

The Financial Burden of Thyroid Cancer with Dr. Jonas de Souza from The University of Chicago Medicine

The Parathyroid, and a Safer — Less-Scarring Thyroid Surgery with Dr. Babak Larian from Cedars-Sinai

A Must Listen Episode Before Getting Surgery – Do Not Do It Alone, with Douglas Van Nostrand from MedStar Washington Hospital

SHOW NOTES:

Dr. Gary Clayman

Thyroid Cancer Overview

Book: Atlas of Head and Neck Surgery

 

Health Grades

Zoc Doc

The American Thyroid Association

Jun 7, 2022

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.

Mar 22, 2022
In this episode, Dr. Spencer, Professor of Medicine at University of Southern California, discusses the importance of testing for thyroglobulin-antibodies and thyroglobulin.   Important notes from this interview include:
  • only 10% of nodules are malignant.
  • when getting blood panels each six months, it is very the important to of measure TgAb every time.  
  • consistency is important in blood tests, meaning, use the same laboratory and manufacturer's method every time.
  • the most reliable method of testing TgAb is the machine manufactured by Kronus (RSR) or Roche.  When getting blood tests, be sure to request either of these manufacturers for TgAb results, each of these manufacturers are 100% sensitive.
  • Beckman is  the most commonly used manufacturer, but only is 79% sensitive to TgAb results.
  • always use the same Tg and TgAb methods and the same laboratory.  

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

Mar 14, 2022
Dr. Susanne Breen is a board certified naturopathic physician. She completed her medical training at the National University of Natural Medicine (NUNM) after initial medical studies at the Oregon Health Sciences University in conventional medicine.  Healing, she discovered, required more than medication or even natural remedies. Her inspiration came from her advanced studies at NUNM in gastroenterology, including Small Intestinal Bacterial Overgrowth (SIBO), where she learned about the root causes of her personal health challenges. She read Breaking the Vicious Cycle, changed her diet, found direction from practitioners and started her path to health. She brings her personal experience and training to help others do the same.

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:

  • Fatigue, hair loss, weight gain, anxiety, and depression.
  • Sub-clinical hypothyroidism
  • Standard range for TSH has changed over the years, .5 - 1.5 TSH is optimal
  • Armour Thyroid vs Levothyroxine
  • If antibodies are involved than it is most likely related to the gut
  • Getting off thyroid medication
  • Testing: TSH, free T3 T4, TPO antibodies, reverse T3
  • Getting motivated and inspired by fixing thyroid
  • Selenium
  • Iodine
  • Thyroid supplements
  • Treating fertility
  • Hair loss and levothyoxine
  • Joint pain and levothyroxine 
  • Nature vs Armour
  • Magnesium interfering with T4
  • Analysis of gut and assessment: bad breath, burping, etc.
  • Stool testing for SIBO
  • Progesterone and testosterone
  • Testing for adrenal fatigue through saliva throughout the day
  • Cortisol secretion related to grief or stress
  • Desiccated bovine adrenal
  • Graves’ disease and testosterone fix
  • Breath tests and pathogens
  • Microflora
  • Digestive and thyroid health are connected
  • Bowel movement frequency and constipation
  • Whole foods and unprocessed foods
  • Sugar, inflammation, and heart disease
  • Homemade yogurt and cow’s milk and removing lactose, fixing bloating
  • Food allergy testing
  • Achy joints, painful feet, anemia, cramping, testosterone and estrogen, neuro-therapy, ozone therapy, acupuncture, blood flow, dizziness, hydration, lyme disease, and muscle spasms.

NOTES:

Mysymotoms.com

Susanne Breen, N.D.

Dec 22, 2021

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.

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