Dive into the complete episode list for Doctor Thyroid. Each episode is cataloged with detailed descriptions, making it easy to find and explore specific topics. Keep track of all episodes from your favorite podcast and never miss a moment of insightful content.
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Pub. Date
Title
Duration
19 Jan 2021
78: La Palabra Cáncer es Engañosa — No Es Tan Mortal Como Antes, con el Doctor Antonio Hakim desde Bogotá
00:23:19
En esta entrevista hablamos sobre:
El nombre del cáncer ha cambiado
La tasa de supervivencia con cáncer ha cambiado para mejor
La mitad tiene nódulos, muchos de ellos tendrán cáncer
10% de esos tienen cáncer
No es necesario operar con todo el cáncer de tiroides
2.5 millones de personas en Colombia tienen cáncer de tiroides
No biopsia todos los nódulos
¿Qué es la fobia al cáncer?
Lo que no sabemos no nos perjudicará
No biopsiar pequeños nódulos tiroideos
BETHESDA IV en inconcluso
La vida sin tu tiroides cambia tu vida, para peor en la mayoría de los casos
12. Advanced Blood Testing and Cellular Biology with Dr. Mark Engelman
00:27:17
How well does your body make energy?
How does your body repair?
How well are your anti-oxidants working?
How well do you rid your body of free radicals?
Are you pre-conditioned to crisis?
The next generation of lab testing and diagnosis has arrived with resources such as Cyrex Labs and Nutreval.
Thyroid health issues mimic other ailments, such as inflammation, gluten intolerance, and increased permeability (leaky gut).
In this episode, hear from Dr. Engelman, recognized as one of the top doctors in functional integrative medicine, he has advanced degrees and certifications in functional, metabolic, anti-aging and stem cell medicine. Engelman Health Institute is advanced science, and personalized care. This "new medicine" incorporates the best of traditional practices and natural and alternative diagnostic modalities.
Avoiding Thyroid Cancer Surgery, Depending on the Size with Dr. Miyauchi from Kuma Hospital in Japan
00:40:38
You have been diagnosed with thyroid cancer, and choose no surgery. Although thyroid cancer diagnosis has spiked around the world, a trend is to pass on surgery if the cancer is identified as low risk. In doing so, mortality rate does not increase and it avoids unfavorable events sometimes related to surgery, such as vocal chord paralysis, hypothyroidsm, financial costs, and lifelong thyroid hormone treatment.
In this episode, we visit with Dr. hypothyroidism, a pioneer in prescribing active surveillance in place of immediate surgery.
Dr. Miyauchi is President and COO of Kuma Hospital, Center for Excellence in Thyroid Care, Kobe, Japan. He is an endocrine surgeon, especially interested in thyroid and parathyroid diseases. He earned his MD and PhD at Osaka University Medical School in 1970 and 1978, respectively. He was Associate Professor of Department of Surgery, Kagawa Medical University until he was appointed to Vice President of Kuma Hospital in 1998. Since 2001, he is at his present position. About 2,000 operations, including about 1,300 thyroid cancer cases, are done every year at Kuma Hospital. He is currently serving as Chairman of the Asian Association of Endocrine Surgeons. He also served as Council of the International Association of Endocrine Surgeons until August 2015.
Topics covered, include:
Incidence versus mortality
Worldwide trends related to thyroid cancer
Papillary Microcarcinoma of the Thyroid (PMCT)
Unfavorable events following immediate surgery
Results of research which began in 1993
The current trend in the incidence of thyroid cancer is expected to create an added cost of $3.5 billion by 2030, to the individual and as a society.
50: Regarding Thyroid Cancer, Are You a Minimalist or a Maximalist? with Dr. Michael Tuttle from Sloan Kettering
00:39:29
Many centers from around the world want to know how Memorial Memorial Sloan Kettering Cancer Center treats thyroid cancer. A key member of the MSKCC is Dr. Michael Tuttle.
During this interview, Dr. Tuttle discusses the following points:
Challenges of managing thyroid cancer as outlined by the guidelines
Scaling back care for insurance-challenged patients, and adopting a plan that gets the same result without needing the expensive tests
Desired outcome is survival and no recurrence, a third is for no harm that would be caused by an unnecessary surgery
Unwanted side affects of thyroid cancer include nerve damage, parathyroid damage, and infections
RAI sometimes has unwanted side affects
With technology, ultrasounds and biopsies, we know some cancers do not need to be treated, as they are now being found very early
Change in ATA guidelines, low risk cancers can be considered for observation
Two different kinds of patient profiles: Minimalist and Maximalist
1cm or 1.5cm?
Patient characteristic, ultra sound characteristics, and the medical team characteristics weighs who is the most appropriate for observation
400 active surveillance patients currently at MSKCC
Certain parts of the world are harder to offer observation as a treatment due to practicality, examples include Latina America where multi-nodular goiters are common, and Germany still is iodine deficient
I am a board-certified endocrinologist who specializes in caring for patients with advanced thyroid cancer. I work as part of a multidisciplinary team including surgeons, pathologists, radiologists, nuclear medicine specialists, and radiation oncologists that provides individualized care to patients treated at Memorial Sloan Kettering for thyroid cancer.
In addition to treating patients I am also actively researching new treatments for advanced thyroid cancer. I am a professor of medicine at the Joan and Sanford I. Weill Medical College of Cornell University and travel extensively both in the US and abroad, lecturing on the difficult issues that sometimes arise in the management of patients with thyroid cancer. My research projects in radiation-induced thyroid cancer have taken me from Kwajalein Atoll in the Marshall Islands to the Hanford Nuclear power-plant in Washington State to regions in Russia that were exposed to fallout from the Chernobyl accident.
I am an active member of the American Thyroid Association (ATA) and the Endocrine Society. In addition to serving on the ATA committee that produced the current guidelines for the management of benign and malignant nodules, I am also a Chairman of the National Comprehensive Cancer Network Thyroid Cancer Panel, a consultant to the Endocrinologic and Metabolic Drugs Advisory Committee of the FDA, and a consultant to the Chernobyl Tissue Bank.
Clinical Expertise: Thyroid Cancer
Languages Spoken: English
Education: MD, University of Louisville School of Medicine
Residencies: Dwight David Eisenhower Army Medical Center
Fellowships: Madigan Army Medical Center
Board Certifications: Endocrinology and Metabolism
28: Patient Story 2 - Kimberly Dorris - A Comprehensive Analysis of Graves' Disease
00:26:56
This episode is a thorough presentation of Graves' Disease from Kimberly Dorris, an educator and expert, and also a patient. In this episode, listeners will gain a thorough understanding of a disease that is often confused with other diagnosis.
Kimberly Dorris is the Executive Director and CEO of the Graves' Disease and Thyroid Foundation, a small nonprofit organization based in Rancho Santa Fe, CA. She began working with the GDATF as a volunteer in 2010, and took over day-to-day management of the Foundation in 2011.
Her responsibilities include organizing patient education events in various locations throughout the U.S.A., managing the Foundation's social media sites, producing print and electronic communications, seeking grant funding, and providing support for patients via phone, e-mail, and an online support forum.
She also leads a monthly patient support group meeting in Phoenix, AZ.
Ms. Dorris has a unique perspective on thyroid dysfunction, having lived with both hyperthyroidism and hypothyroidism. She was diagnosed with Graves' disease in 2007 and took methimazole for seven years.
Approximately 18 months after stopping the methimazole, she became hypothyroid and is currently taking replacement hormone.
Ms. Dorris received a B.A. from the University of Arizona in 1990 and an M.B.A. from Belmont University in Nashville in 1990.
Prior to joining the GDATF, she spent
8 years with Mercury Nashville Records, a year with KPMG Consulting, and
10 years with a community bank, including a two-year term as chairman of the company’s Charitable Giving Committee.
Patients and family members can also e-mail the Graves' Disease Foundation at info@gdatf.org or call toll-free 877-643-3123.
08 Nov 2024
This patient avoided thyroid surgery thanks to Dr Emad Kandil
00:12:22
In this interview with Dr. Emad Kandil, a leading expert in thyroid ablation, patient Elizabeth shares her journey of receiving conflicting medical advice regarding her thyroid nodule.
After consultations with multiple doctors in New York who recommended surgery, Elizabeth sought an alternative in New Orleans with Dr. Kandil, who offered a less invasive option—thyroid ablation.
This video explores the benefits of microwave ablation (MWA) as an effective treatment for thyroid nodules, avoiding the complications of surgery and long-term medication dependency.
Dr. Kandil provides in-depth insights into the procedure, its success rates, and how it preserves thyroid function, challenging the traditional approach of immediate surgical intervention. For those with suspicious thyroid nodules, this discussion highlights the importance of seeking second opinions and understanding all available treatment options before making a decision.
About Baird Medical
Baird Medical LLC, established in 2012 and headquartered in Guangzhou, China, is a leading developer and provider of minimally invasive medical devices specializing in microwave ablation (MWA) technology. In the U.S., the company continues to expand its reach, recently receiving FDA clearance to market its microwave ablation devices for thyroid treatment.
Dr. Emad Kandil is a renowned expert in endocrine and oncological surgery. He is the Chief of General, Endocrine, and Oncological Surgery at Tulane University in New Orleans, Louisiana. He holds the prestigious Elias Hanna Chair in Surgery and is celebrated for his groundbreaking work in minimally invasive thyroid treatments, including thyroid ablation. Dr. Kandil has performed over 1,000 thyroid ablation procedures, establishing himself as a leading figure in using this innovative treatment approach in the United States. www.emadkandil.com
About Philip James
Philip James hosts the Doctor Thyroid podcast, a platform that provides patients with information on alternative thyroid treatments. His work focuses specifically on minimally invasive procedures like thyroid ablation. He aims to help patients avoid unnecessary thyroid surgeries, a mission close to him after his own experience with an unneeded surgery. www.docthyroid.com
12 Jun 2021
A Summary of Radioactive Iodine Treatment for Thyroid Cancer, with Dr. Alan Waxman from Cedars Sinai
00:39:03
Not all thyroid cancer patients who receive a thyroidectomy require radioactive iodine, but for those whose cancer maybe more aggressive and spread beyond the thyroid area, often radioactive iodine (RAI) is protocol.
RAI treatment may vary depending on the hospital. For example, in this interview you hear protocol for RAI at Cedars Sinai.
In this interviews, Dr. Alan Waxman explains what occurs leading up to, during, and after RAI. Topics discussed include:
If staying at the hospital after taking RAI, how long is the stay required?
Should you go home after RAI?
What is the benefit of staying overnight at the hospital when receiving RAI?
Worldwide trends toward prescribing lower doses of RAI.
Is there risk in RAI causing leukemia?
The importance of ultrasound prior to administering RAI of done.
The need to stimulate TSH prior to administering RAI.
Withdrawal versus injections in raising TSH levels.
Damage to salivary glands.
Alan D. Waxman, MD is Director of Nuclear Medicine at the S. Mark Taper Foundation Imaging Center at Cedars Sinai. He is also a member of the Saul and Joyce Brandman Breast Center – A Project of Women’s Guild and the Thyroid Cancer Center at Cedars-Sinai Medical Center. He is a clinical professor of radiology at Los Angeles County + University of Southern California (USC) Medical Center. Dr. Waxman’s participation in research has led to the development of many new imaging techniques and equipment adaptations. A leading expert in nuclear medicine imaging, Dr. Waxman has directed efforts to develop innovations in whole-body tumor imaging using new and existing radiolable compounds. Dr. Waxman is an active member and officer of the Society of Nuclear Medicine. He has authored numerous publications and lectured extensively throughout the world. Dr. Waxman is a graduate of the USC Medical School, where he completed his postgraduate training. He also completed a clinical research fellowship at the National Institutes of Health.
16: The Parathyroid, and a Safer — Less-Scarring Thyroid Surgery with Dr. Larian from Cedars-Sinai
00:37:54
Dr. 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. Dr. Larian's Center For Head and Neck Surgery is located in Beverly Hills, California.
In this episode, Dr. Larian discusses his experience treating thyroid disorders, including his medical missions to Central America. During this interview, you will hear greater detail about the following topics:
The most recent American Thyroid Association’s guidelines and updates to treating thyroid cancer compared to past approaches
Minimally invasive thyroid surgery, which results in less scarring and less discomfort
Breaking away from the old tradition of a large incision
Testing for parathyroid imbalance
What might it mean when the patient feels anxious, has to urinate during the night, impaired mental function, and calcium imbalance?
Which blood test reveals possible parathyroid issues?
The common denominator in patients who recover post thyroid cancer surgery
A parathyroid trend in women 40 - 60 years old
The importance of staying in tune with your body and its signals
Choosing Surveillance Over Surgery 🏥 Thyroid Cancer Treatment Without Surgery
00:40:29
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.
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.
29 Sep 2023
UK Doctors Recommended Surgery for Thyroid Goiter, But Italian Doctor Offers Non-Surgical Alternative with RFA
00:26:39
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.
🔷🔷🔷🔷
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.
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.
08 Nov 2022
Radiofrequency Ablation → REMOVE Thyroid Nodules → with NO SURGERY → Dr Ralph Tufano
00:29:38
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.
✅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:
✅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
18 Apr 2017
27: Información clave sobre el hipertiroidismo con el Dr. Alejandro R. Ayala desde el Universidad de Miami
00:28:10
En este episodio explora los siguientes temas:
Opciones de tratamiento para la enfermedad de Graves.
Opciones de tratamiento para el hipertiroidismo.
Peligros de la medicación del hyperthyroidism.
Síntomas del hipertiroidismo.
Dr. Alejandro Ayala obtuvo su doctorado de la Universidad Federal Fluminense en Río de Janeiro, Brasil, en 1992, y completó su residencia en medicina interna en la Universidad Federal de Sao Paulo. Posteriormente se unió al Programa de Medicina Interna de la Universidad de Georgetown en el Centro Hospitalario de Washington, donde recibió el Premio Saul Zukerman, MD, Humanitarianism in Medicine. El Dr. Ayala obtuvo su formación clínica en Endocrinología en el Hospital Universitario Johns Hopkins, seguido de una beca de investigación en los Institutos Nacionales de Salud (NIH) en Bethesda, Maryland, donde continuó durante los siguientes cinco años como clínico del personal, investigador clínico y facultad de El programa de entrenamiento de endocrinología NIH.
Durante este tiempo, los intereses de investigación del Dr. Ayala están relacionados con los trastornos de la Neruendocrinología, la pituitaria y la adrenal. Sus intereses de investigación incluyen hiperaldosteronismo, síndrome de Cushing y feocromocitoma, áreas en las que ha sido autor de más de dos docenas de artículos revisados por pares y ha escrito varios capítulos de libros.
⦿ 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
01 Aug 2017
46: Nerve Monitoring During Thyroid Surgery, with Dr. Özer Makay from Ege University - Turkey
00:35:13
This episode is recorded from Boston at the World Congress on Thyroid Cancer, where thyroid doctors and researchers gathered to share the latest medical research and medical improvements related to thyroid disease.
Dr. Özer Makay is an expert in nerve monitoring during thyroid surgery, and has been a guest faculty member in South Korea, Italy, France, the Netherlands, Germany, Belgium and Bulgaria.
He has received 17 awards and honors for his scientific studies. He has authored a 300-page book on nerve monitoring during thyroid surgery.
This episode covers the following topics:
Protecting the recurrent laryngeal nerve (RLN) and superior laryngeal nerve during thyroid surgery.
Outcomes of damaging these nerves during surgery include no voice, hoarseness, shortness of breath, problem with drinking water or aspiration, impaired physical exertion with something as simple as climbing a flight of stairs.
Why some centers have a higher occurrence of damage during thyroid surgery and include an error rate as high as 10%
The cause of the damaged nerve include stretching or traction, and cutting or stitching.
How to reduce risk.
Is it possible to reattach a cut nerve?
Surgeons who are opponents of using a nerve monitor.
Pitfalls of using nerve monitoring.
Also discussed are thyroid cancer trends in Turkey including:
Incidence being in the top 5 in the world.
Now the number one cancer for women.
Proximity to Chernobyl.
Screening and awareness as a reason for the increase.
50% of population has a thyroid nodule.In the words of Dr. Özer Makay
Biography: In the words of Dr. Özer Makay
I was born in 1974 in the Netherlands. After finishing the primary school there, I completed my secondary and high school educations at Bornova Anatolian High School in Izmir/Turkey. I graduated from Ege University, School of Medicine and started my residency at the General Surgery Department of Ege University, School of Medicine. During my studentship, I did my surgical internship at London King’s College Hospital. During my surgical residency, in 2002, I received education regarding “Laparoscopic Surgery” at Free University Hospital, Amsterdam from Prof. Miguel Cuesta and carried out scientific studies there. I had the opportunity to meet with the robotic surgery system here and did use this system at the experimental investigation laboratory.
After being a specialist registrar in May 2005, I started to work at the division of “Endocrine Surgery” of the General Surgery Department of Ege University. During my fellowship, I worked under the supervision of Prof. Enis Yetkin, Prof. Mahir Akyıldız and Prof. Gökhan İçöz. During this period, I became the first Turkish surgeon to have the right to get the title “Fellow of European Board of Surgery – div. Endocine Surgery” by passing the “UEMS Board Examination for Endocrine Surgery”. At the Ege University, we started the “Laparoscopic Adrenalectomy Programme’ in 2008, together with Prof. Dr. Mahir Akyıldız. Besides, the “Robotic Surgery Programme’ was launched in 2012. I promoted to “Associate Professor of Surgery” in 2012. I have been invited to become a member of the European Board of Endocrine Surgery Committee. This makes me the first Turkish member of this committee. Besides, I was chosen as “the national representative” of a “European Union Health Project” concerning this area.
To date, I own more than 80 national and international publications. Furthermore, I participated in more than 30 national and international scientific meetings as speaker, instructor and guest surgeon. I served as president, scientific secretary or organization/scientific committee member for national and international congresses and meetings. I had been in South Korea, Italy, France, the Netherlands, Germany, Belgium and Bulgaria as guest faculty member. I received 17 awards and honors because of my scientific studies presented during national and international scientific congresses. I speak English, Dutch and German fluently and Spanish at elementary level.
My essential areas of interests are “endocrine surgery” and “robotic surgery”. As Ege University, we are the most experienced center of our country regarding “robotic adrenalectomy”.
Thyroid Cancer Surgery? The Single Most Important Question to Ask Your Surgeon with Dr. Gary Clayman
01:11:09
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:
95: Hypothyroidism and Combination Therapy of T3 and T4 with Dr. Martin Milner from Portland, Oregon
00:44:28
Dr. Milner is well published with texts, medical journal articles and studies in cardiology, endocrinology, pulmonology, oncology, and environmental medicine. Dr. Milner calls his practice “integrated endocrinology” balancing all the endocrine hormones using bio-identical hormone replacement and amino acid neurotransmitter precursors.
Dr. Milner’s articles include treatment protocols for hypothyroidism, ”Hypothyroidism: Optimizing Medication with Slow-Release Compounded Thyroid Replacement” was published in the peer review journal of compounding pharmacists, International Journal of Pharmaceutical Compounding.
In this interview, the following topics are discussed:
Starving in the midst of plenty
Slow release T3 and T4
Hypothyroidism
Hyperthyroidism or Graves Disease
Often RAI leads to hypothyroidism
Visiting a naturopath while being treated by traditional endocrinologist
TSH suppression for thyroid cancer patients
Ordering blood tests of TSH, Free T4, Free T4, and reverse T3
Converting T4 into T3
Slow released T3
Manufactured T3 is not slow release
2005 article was published
150,000 pharmacist in U.S., and about 5,000 are compounding
Slow release blends are the same T4 from Synthroid and T3 from Cytomel
Slow release agent is hydroxypropyl melanose
Side effects of too much T3 or T4
The risk is compounder error or inconsistency
Binder sensitivity is another reason for compounding
Desiccated thyroid hormone compared to slow release
Auto-immune disease and desiccated treatment
Overwhelming response to slow release is when patients symptoms of hypothyroidism alleviate
A small percentage of people do not do better on slow release
Basel body temperatures
96.5 temperature in the morning, and hypothyroid symptoms is a concern in regard to treatment
Testing temperature in the morning, ideally done using mercury thermometer
How to use temperature testing as an indicator of hypothyroidism
Body temp should be over 97.8 first thing in the morning
Hypothyroidism will be overweight and difficult to lose weight, and brain fog, sluggish, dry skin, hair loss,
Eating well, active, and weight gain
Hypoglycemic or adrenal overload and low body temperature
High cortisol levels
Standard of care of Cytomel in contrast with conventional endocrinologist
T3 has a short half life
Half life — How long does it take a drug to bring blood levels to normal levels?
Half life of T3 is up to 70 days
Starving in the midst of plenty with T4
Insurance coverage of slow release T3 — T4
Cost of slow release T3 — T4 is approximately $40 monthly
Most important testing for TT patient is checking parathyroid gland status — and their role in calcium function
Important to measure calcium for TT patients
Caution about soy, broccoli, brussel sprouts, cauliflower, and calcium and thyroid hormone
When to thyroid replacement hormone — first thing in the morning, 1 hour before eating,
T4 replacement before bed — advantages to more stable levels
Slow release, combination therapy, should be taken in the morning
Estrogen deficiency
Brief summaries of the following symptoms: painful feet, dizziness, fatigue, hair loss, iron deficiency, chronic pain, tyrosine turning into dopamine and then adrenaline, sleep problems and anxiety and hypothyroidism, insomnia and cortisone and adrenaline at nigh and DHEA, cortisol measured throughout the day, muscle spasms,
Avoid refined sugar and high amounts of alcohol
Drink more water
Caution: food and its importance: smoothies and soluble fiber — fiber interacts with nutrients. Avoid this, as it effects absorption of medications
Emotional attachment to disease — fixation and complaining without making changes.
37: Adding T3 to T4 Will Make You Feel Better? For Some the Answer is ‘Yes’ with Dr. Antonio Bianco from Rush University
00:43:16
Antonio Bianco, MD, PhD, is head of the division of Endocrinology and Metabolism at Rush University Medical Center. Dr. Bianco also co-chaired an American Thyroid Association task force that updated the guidelines for treating hypothyroidism.
Dr. Bianco’s research has revealed the connection between thyroidectomy, hypothyroidism symptoms, and T4-only therapy. Although T4-only therapy works for the majority, others report serious symptoms. Listen to this segment to hear greater detail in regard to the following topics:
Combination therapy of adding T3 to T4
85% of patients on Synthroid feel fine.
Nearly 5% of the U.S. population takes T4 or Levothyroxine, as revealed by the NHANE survey. This means 10 - 15 million Americans.
Residual symptoms of thyroidectomy include depression, difficulty losing weight, poor motivation, sluggishness, and lack of motivation. For some, there is no remedy to these symptoms. For others, adding T3 to T4 shows immediate improvement.
The importance of physical activity and its benefit in treating depression
If we normalize T3 does it get rid of hypothyroid symptoms?
Overlap between menopause and hypothyroid symptoms
The National Health and Nutrition Examination Survey (NHANES) is a program of studies designed to assess the health and nutritional status of adults and children in the United States. The survey is unique in that it combines interviews and physical examinations.
06 Jun 2021
Hypothyroidism⎥Weight Gain, Fatigue, and Sluggishness, with Dr. Alan Farwell from Boston Medical Center
00:38:07
Dr. Alan Farwell is an endocrinologist, Director of the Endocrine Clinics at Boston Medical Center, and Associate Professor of Medicine at Boston University School of Medicine, in Massachusetts.
In addition to his extensive academic and clinical activities, Dr. Farwell has been extremely active and served in multiple capacities in the ATA, including as Chair of the Education Committee and the Patient Education and Advocacy Committee, and as a member of the Program Committee and the Website Task Force Publications Committee. He has served two terms on the ATA Board of Directors, is the founding and current Chair of the ATA Alliance for Patient Education.
Dr. Farwell has been an Associate Editor and member of the Editorial Board of Thyroid, and since 2009 has been Editor-in-Chief of Clinical Thyroidology for the Public.
In this interview, we discuss the following topics:
Thyroid surgery and RAI sometimes results in hypothyroidism
Most common cause is Hashimoto’s disease
Explanation of overactive and underactive thyroid
Weight gain, dry skin, constipation
Very few symptoms unique to hypothyroidism
Sleep apnea and being tired all of the time and weight gain.
Brain fog and difficulty concentrating
Blood tests diagnose hypothyroidism based on TSH levels, when elevated means it is not working too well.
Explaining TSH in laymen’s terms
Normal TSH in the U.S. is .3 to 3.5
Treating for feel rather than a number
People with elevated TSH have many of the hypothyroid symptoms, but people with normal TSH levels may also have hypothyroid symptoms
Sleep disturbances such as apnea and anemia can be disguised as hypothyroidism
Historical explanation of hypothyroidism treatment
About 10% of patients do not respond to Levothyroxin
Explanation of desiccated thyroid, including pig and cow
Dr. Jacqueline Jonklaas, PCORI Grant will look at a study, head to head, Levothyroxin versus desiccated
Adding T3 to T4 treatment
Discussing Dr. Bianco’s research and deiodinases enzyme
A discussion of celiac disease and gluten
Explanation of auto-immune disorders, where the thyroid is attacked by the bodies own antibodies
Physical symptoms of hypothyroidism are goiters, sluggishness, fatigue, dry skin, lateral eyebrows to disappear, the tongue can get thick, puffiness, swelling in legs, face, and around eyes. With proper treatment, these are reversible.
El Cambio en el Tratamiento del Tiroides: La Adopción de la Ablación Tiroidea en Argentina
00:14:24
Durante una entrevista detallada en el podcast RFAMD, el anfitrión Philip James conversó con la Dra. Ana Voogd, una distinguida cirujana de cabeza y cuello con más de 30 años de experiencia, sobre la integración gradual de la terapia de ablación tiroidea en el panorama médico de Argentina.
La Dra. Voogd, que dirige el departamento de cirugía de cabeza y cuello en uno de los hospitales más grandes de Argentina, proporcionó perspectivas valiosas sobre el enfoque evolutivo del país hacia el cuidado del tiroides.
Un Paso Hacia Procedimientos Menos Invasivos
La Dra. Voogd explicó la ablación tiroidea en términos sencillos, destacando su carácter no quirúrgico y percutáneo, que utiliza agujas para crear necrosis dentro de los nódulos tiroideos. Este proceso detiene efectivamente el crecimiento del nódulo y mejora los síntomas sin necesidad de cirugía, marcando un avance significativo en la mejora de la calidad de vida del paciente y en la preservación de la glándula tiroidea.
A la Par con los Estándares Internacionales
La adopción de técnicas de ablación tiroidea en Argentina, que han sido utilizadas durante décadas en países como Corea del Sur e Italia, es relativamente reciente. La Dra. Voogd señaló la llegada de equipos especializados para la ablación por radiofrecuencia hace dos o tres años como un punto de inflexión, lo que permitió a los proveedores de atención médica locales ofrecer este tratamiento. Aunque Argentina está poniéndose al día, la introducción de esta tecnología ha sido recibida con entusiasmo tanto por los profesionales médicos como por los pacientes, ofreciendo una opción no quirúrgica para tratar los nódulos tiroideos y, en algunos casos, el cáncer de tiroides.
Desafíos de Acceso y Asequibilidad
La conversación con la Dra. Voogd también abordó los desafíos de acceder a la ablación tiroidea en Argentina, donde la disponibilidad del procedimiento varía significativamente entre los sectores de salud pública y privada. En el sector público, la ablación tiroidea no es ampliamente aceptada, mientras que el sector privado ofrece más flexibilidad pero con costos variables. La Dra. Voogd señaló que, aunque el costo del procedimiento está influenciado por el precio de consumibles como las agujas, sigue siendo comparable a los precios internacionales, haciéndolo accesible para aquellos con seguro adecuado o los medios financieros para la atención privada.
Resultados Alentadores y Alta Satisfacción del Paciente
La Dra. Voogd compartió sus experiencias positivas con la ablación tiroidea, mencionando el tratamiento de más de 100 nódulos con reducciones notables en tamaño y alivio de síntomas. Estos resultados sugieren que la ablación tiroidea podría cambiar significativamente el paisaje del tratamiento tiroideo en Argentina, ofreciendo una alternativa efectiva a la cirugía convencional.
Una Perspectiva Más Amplia y Perspectivas Futuras
Al concluir la entrevista, la Dra. Voogd enfatizó la importancia de crear conciencia sobre la ablación tiroidea entre los pacientes con nódulos tiroideos. Animó a los pacientes a considerar esta opción de tratamiento innovadora, que permite un rápido retorno a las actividades diarias, sin cicatrices visibles y con mínimas molestias post-procedimiento. Destacó un caso particularmente memorable de un paciente que experimentó una mejora significativa después de años de sufrimiento, ilustrando el profundo impacto de la ablación tiroidea en la vida de los individuos.
En resumen, las perspectivas compartidas por la Dra. Ana Voogd en el podcast RFAMD iluminan el abrazo gradual de Argentina hacia la ablación tiroidea como opción de tratamiento. Este cambio hacia métodos menos invasivos representa un desarrollo significativo en el sistema de atención médica del país, ofreciendo resultados de tratamiento mejorados y mejorando la calidad de vida para los pacientes con condiciones tiroideas.
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.
05 Jul 2017
42: Flame Retardants Connected to Thyroid Cancer, with Dr. Julie Ann Sosa from Duke University
00:27:28
This is an in depth discussion about the connection between flame retardants and plastics, and thyroid cancer. These chemicals, also known as endocrine disruptors, have a clear connection to thyroid cancer occurrence.
The research is presented by Julie Ann Sosa, MD MA FACS is Chief of Endocrine Surgery at Duke University and leader of the endocrine neoplasia diseases group in the Duke Cancer Institute and the Duke Clinical Research Institute. She is Professor of Surgery and Medicine. Her clinical interest is in endocrine surgery, with a focus in thyroid cancer. She is widely published in outcomes analysis, as well as cost-effectiveness analysis, meta-analysis, and survey-based research, and she is director of health services research.
Medical Error and Addressing Patient Safety with Dr. Danielle Ofri
00:49:07
Dr. Danielle Ofri is a doctor at Bellevue Hospital in New York City. She is one of the foremost voices in the medical world today, shining an unflinching light on the realities of healthcare and speaking passionately about the doctor-patient relationship. Her newest book is "When We Do Harm: A Doctor Confronts Medical Error." Ofri is a regular contributor to the New York Times and is also the editor-in-chief of the Bellevue Literary Review. She lives in New York City and is determined to get through the Bach cello suites before she kicks the bucket.
In this episode:
Medical error is the third leading cause of death? After heart disease and cancer.
Intended audience for the book? A general audience; lay-public and medical professionals.
It is difficult to define a medial error. Starting medication at wrong dose? What errors cause death? This can be vague.
Hospitalized patients are different than the general public
All sorts of patient harm should be brought to light — shift the medical field to “more safe” should be our goal.
Once you are in the patient chair, one loses their strength and power.
System flaws: more common error is a qualified professional who is burdened by design flaws — including false alarms.
Collaboration and intellectual humility — recognizing we don’t know.
Patients are sicker and more chronic conditions, mean collaboration helps reduce error.
Denmark as an example to error response: acknowledge and apologize.
The U.S. malpractice system as part of the problem.
Qualifiers of malpractice: harm occurred, doctor was the cause, and consequence was big enough to make the case worthwhile.
Who is making the laws about malpractice? Could be an underlining agenda.
Recourse for patients: 1. Talk with doctor or nurse. 2. The hospital’s patient advocate. 3. Insurance patient advocates. 4. Local Board of Health. 5. Keep notes, and have a paper trail.
The system is not designed to get information easy — take advantage of CARES Act.
When transparency backfires; if a doctor is treating high risk patients, then their error will be higher.
Doctors penalized for spending more time with a patient.
The need for silence or time to think.
The problem with the “reimbursement” model.
Medical error, adverse events, and unintended consequences.
Over-treating and over-diagnosis in regard to prostate or thyroid.
The Financial Risk of Thyroid Surgery → Dr. Jonas de Souza - Oncologist, Medical Director at Humana
00:13:06
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
61: Drug Resistant Thyroid Cancer, with Dr. Carmelo Nucera from Harvard Medical School
00:39:30
Carmelo Nucera, M.D., Ph.D., is currently an Assistant Professor at Harvard Medical School, Boston, in the Division of Cancer Biology and Angiogenesis (Department of Pathology), Beth Israel Deaconess Medical Center. Dr. Nucera received his M.D. and Ph.D. in Experimental Endocrinology and Metabolism from Italy. Dr. Nucera is highly driven by an intense desire to make important contributions that will directly benefit patients. Dr. Nucera is strongly committed to make discovery aimed to immediately cure patients that are suffering with aggressive tumors and rare/orphan cancer disease. Dr. Nucera has a clinical background and intensely served patients with fatal human diseases.
In this episode, Dr. Nucera discusses a combination drug therapy using vemurafenib and palbociclib represents a novel therapeutic strategy to treat papillary thyroid carcinoma (PTC).
96: Thyroid and Prostate Cancer — Surgery Outcomes Sometimes Worse Than No Surgery — Weighing Risks and Outcomes with Dr. Allen Ho
00:38:05
Allen S. Ho MD is Associate Professor of Surgery, Director of the Head and Neck Cancer Program, and Co-Director of the Thyroid Cancer Program at Cedars-Sinai Medical Center. As a fellowship-trained head and neck surgeon. His practice focuses on the treatment of head and neck tumors, including HPV(+) throat cancers and thyroid malignancies. He leads the multidisciplinary Cedars-Sinai Head and Neck Tumor Board, which provides consensus management options for complex, advanced cases. Dr. Ho’s research interests are highly integrated into his clinical practice. His current efforts lie in cancer proteomics, HPV(+) oropharyngeal cancer pathogenesis, and thyroid cancer molecular assays. Dr. Ho has published as lead author in journals that include Nature Genetics, JCO, JAMA Oncology, and Thyroid, and is Editor of the textbook Multidisciplinary Care of the Head and Neck Cancer Patient (Springer 2018). Dr. Ho serves on national committees within the AHNS and ATA, and leads a national trial on thyroid cancer active surveillance (ClinicalTrials.gov ID: NCT02609685). He maintains expertise in transoral robotic surgery (TORS), minimally invasive thyroidectomy approaches, and nerve preservation techniques. Dr. Ho’s overarching aim is to partner with patients to optimize treatment and provide compassionate, exceptional care.
In this interview — a discussion about Dr. Ho’s research; Parallels Between Low-Risk Prostate Cancer and Thyroid Cancer: A Review. Topics include:
prostate and thyroid cancer parallels
prostate cancer and practical acceptance of active surveillance
randomized and followed patients through true active surveillance
overall survival, comparing thyroid and prostrate cancer
tolerance of risk
Older versus younger patient priorities
Younger patient thought process
Weighing quality of life and risk
Hypothyroidism, parathyroidism, laryngeal nerve risk in thyroidectomy… asymptomatic patients being made symptomatic due to treatment
Physicians have embraced active surveillance for prostate cancer more than thyroid
The patient leans on physician for guidance
The Finland study: 17M in U.S. have thyroid cancer
Extrapolation — Patients who die of other conditions, in autopsies very small thyroid cancers found in 36% of patients
A lot of small cancers that need not be diagnosed
The physicians perspective and influencing the active surveillance decision
Shared decision making process
Terminology… some people choose active surveillance even when nodule is greater than 2cm
Jury is still out on what is considered safe size
Size and lymph node spread is still being defined
Moving away from Gleason system
Some cancers are aggressive
Some cancers are slow and not lethal
Incidental cancers
The word cancer or the c word… and shifting away from fear
Radiology guidelines
The Cedars Sinai active surveillance program
50% of patients who are offered surveillance accept it… which mirrors Japan
Alienation of active surveillance patients
Anxious, calm, and risk and prioritize risks of surgery
Thyroid cancer tends to strike younger patients. Prostrate cancer tends to be older.
34: What Happens When Thyroid Cancer Travels to the Lungs? with Dr. Fabian Pitoia from the Hospital of University of Buenos Aires
00:31:17
What Happens When Thyroid Cancer Travels to the Lungs?
Fabian Pitoia, M.D., serves as the Head of the Thyroid Section of the Division of Endocrinology and Investigation Area Coordinator at the Hospital de Clinicas of the University of Buenos Aires (UBA). He works also as an Proffessor of internal medicine at the Faculty of Medicine (UBA).
Dr Pitoia serves as a Full Member of the Argentine Society of Endocrinology and Metabolism, of the Latin American Thyroid Society, the Endocrine Society and he is a Correspondent Member of the American Thyroid Association.
In this episode Dr. Pitoia addresses the following topics:
10% of thyroid cancer patients will have distant metastatic disease
The disease will travel to lungs, bones, or both
Treatment with RAI is most effective for those under 40 years old
Evaluation of metastatic thyroid cancer in the lungs is a CT scan
In 2006, there was a change in the treatment of the disease
Adverse events of medication
The coordination between the endocrinologist and the oncologist
Hospital de Clínicas de la Universidad de Buenos Aires - Ciudad Autónoma de Buenos Aires. Consultorio privado: Pte. J.E. Uriburu 754 - Piso 2. Teléfonos: 49545488/49525496 fpitoia@glandulatiroides.com.ar
31 Jan 2018
72: [Spanish] La Conexión Entre el Corazón y el Hipotiroidismo. Entrevista con la Dra. Gabriela Brenta de Buenos Aires
00:30:57
Dra. Gabriela Brenta, M.D., Ph.D.
Docente de post grado de la Universidad Favaloro y de las carreras de Especialista en Endocrinología así como de Bioquímica Clínica dependientes de Universidad de Buenos Aires. Médica adscripta en el Servicio de Endocrinología y Metabolismo de la Unidad Asistencial Dr. César Milstein de Buenos Aires, Sector Tiroides. Presidente del Comité Científico de la Sociedad Latinoamericana de Tiroides. Miembro del Dpto. de Tiroides de la Sociedad Argentina de Endocrinología y Metabolismo. Su área de investigación clínica abarca el efecto cardiovascular y metabólico de las hormonas tiroides.
En esta entrevista, discutimos los siguientes temas:
Menos función cardiovascular
Hipertensión
La conexión entre el funcionamiento del corazón menos y el hipotiroidismo
El riesgo cardiovascular
Resistencia cardiovascular
Mayor colesterol LDL e hipotiroidismo
Hipotiroidismo subclínico y riesgo
Niveles de TSH
Niveles de TSH por encima de 10
Colesterol e hipotiroidismo
Riesgo residual y estatinas
Mejorando la absorción de T4
Levotiroxina y buen cumplimiento
Osteoporosis
Niveles altos de colesterol, tomar estatinas y dolores musculares
Mujeres que toman estatinas y un mayor riesgo cardiovascular y altos niveles de TSH
Altos niveles de TSH, uso de estatinas e inflamación
66: Five Important Things Your Thyroid Surgeon Maybe Not Telling You, with Dr. Akira Miyauchi
00:13:29
Professor Akira Miyauchi (Figure 1) is President and COO of Kuma Hospital, Center of Excellence in Thyroid Care, Kobe, Japan. He is a Japanese endocrine surgeon, and a pioneer in active surveillance, and visionary in regard to treatment of thyroid cancer. World renowned researcher, and lecturer. As the associate professor of the Department of Surgery, Kagawa Medical University, he proposed and initiated a clinical trial of active surveillance for low-risk papillary micro cancer in collaboration with Kuma Hospital in 1993. In 2001, he was appointed the President of Kuma Hospital. Since then, he has been keen on the study of evaluating treatments for papillary micro cancer, observation versus surgery.
During this episode, the following topics are discussed:
Financial burden of surgery versus total cost of active surveillance over ten years.
Setting patient expectations prior to FNA to manage anxiety
When the laryngeal nerve is severed during thyroid surgery, it can and should be repaired, with proper surgeon skill and training.
Rather than being stationery and immobile, patients should practice neck stretching exercise within 24 hours proceeding surgery. There should be no fear about separating the incision.
The most common question asked to Dr. Miyauchi by surgeons from around the world.
Total cost of surgery is 4.1x the cost compared to the cost of active surveillance. In the U.S., the cost is higher.
By providing patient an active surveillance brochure prior to FNA, they are more open to not proceeding with surgery for small thyroid cancer management.
Patient voice restores to near normal when repair of laryngeal nerve is done correctly. All surgeons should be executing this to perfection.
When doing next stretches one-day post surgery, patients report feeling much better and less pain, even one year after surgery.
Protocol for delaying surgery depends on the patient’s age. Older patients are less likely to require surgery. 75% of patients will not require surgery for their lifetime.
90: The Results of 30 Years of Patients Receiving Active Surveillance Instead of Surgery → Dr. Akira Miyauchi from Kuma Hospital in Kobe, Japan
00:43:09
Dr. Akira Miyauchi
Professor Akira Miyauchi (Figure 1) is President and COO of Kuma Hospital, Center of Excellence in Thyroid Care, Kobe, Japan. He is a Japanese endocrine surgeon, and a pioneer in active surveillance, and visionary in regard to treatment of thyroid cancer. World renowned researcher, and lecturer. As the associate professor of the Department of Surgery, Kagawa Medical University, he proposed and initiated a clinical trial of active surveillance for low-risk papillary micro cancer in collaboration with Kuma Hospital in 1993. In 2001, he was appointed the President of Kuma Hospital. Since then, he has been keen on the study of evaluating treatments for papillary micro cancer, observation versus surgery.
During this episode, the following topics are discussed:
Financial burden of surgery versus total cost of active surveillance over ten years.
Stretching Exercises for Neck Setting patient expectations prior to FNA to manage anxiety
When the laryngeal nerve is severed during thyroid surgery, it can and should be repaired, with proper surgeon skill and training.
Rather than being stationery and immobile, patients should practice neck stretching exercise within 24 hours proceeding surgery. There should be no fear about separating the incision.
Total cost of surgery is 4.1x the cost compared to the cost of active surveillance. In the U.S., the cost is higher.
Incidence versus mortality
Worldwide trends related to thyroid cancer
Papillary Microcarcinoma of the Thyroid (PMCT)
Unfavorable events following immediate surgery
Results of research which began in 1993
The current trend in the incidence of thyroid cancer is expected to create an added cost of $3.5 billion by 2030, to the individual and as a society.
By providing patient an active surveillance brochure prior to FNA, they are more open to not proceeding with surgery for small thyroid cancer management.
Patient voice restores to near normal when repair of laryngeal nerve is done correctly. All surgeons should be executing this to perfection.
When doing next stretches one-day post surgery, patients report feeling much better and less pain, even one year after surgery.
Protocol for delaying surgery depends on the patient’s age. Older patients are less likely to require surgery. 75% of patients will not require surgery for their lifetime.
Molecular Profiling and Unnecessary Thyroid Surgeries with Jennifer Kuo from Columbia University
00:35:37
One-third of all thyroid nodule fine needle aspirations come back indeterminate. When surgery is performed on these cases, pathology of the thyroid reveals that many times the nodule is benign. Through molecular profiling, patients with indeterminate thyroid nodules, can now avoid unnecessary surgery and get more accurate pathology results from the fine needle aspiration.
Are you a patient and your doctor has said your thyroid nodule is indeterminate and is recommending surgery as an option? The key is, to confirm that molecular profiling was performed.
Jennifer Kuo, MD is Director of the Thyroid Biopsy Program, Director of the Endocrine Surgery Research Program, and Instructor in Surgery, at the Columbia University Medical Center. Dr. Kuo received her medical degree from the College of Physicians and Surgeons at Columbia University and completed surgical training at the University of California, Davis Medical Center, in Sacramento. Her new position follows completion of her clinical fellowship in the Department of Surgery, Division of Endocrine Surgery. Dr. Kuo has clinical expertise in minimally invasive endocrine surgery and fine-needle thyroid biopsy and is dedicated to the advancement of the field of endocrine surgery.
39: Thyroid Cancer Web Sites Confuse Patients with Dr. Rashika Bansal from St. Joseph's Regional Medical Center
00:26:15
Dr. Rashika Bansal is a PGY-2 resident in Internal Medicine at St. Joseph's Regional Medical Center in Paterson, NJ. Her major research has been with diabetes prevalence and awareness in rural India, with special interest in thyroid disease.
In this episode Dr. Bansal shares the research she presented at AACE 2017 and ENDO 2017, regarding the poor readability scores for thyroid cancer web sites.
The challenge for these web sites and health institutions is to translate thyroid education from complex to simple and easy to understand. Currently, many patients are not following with treatment, citing confusion after being exposed to the various thyroid cancer education resources.
In this episode hear from Dr. Greg Nigh, a Naturopath in Portland, OR.
Dr. Nigh will discuss the following topics:
Dangers of garlic and soy
Overcoming sugar cravings
Hashimotos and hypothyroidism
Specialty laboratories
The dangers of using TSH as the sole yardstick
29 Aug 2017
52: Cancer Phobia?⎥Don't Sacrifice Your Thyroid, with Dr. José A. Hakim - Hospital Universitario Santa Fe de Bogotá
00:22:00
Dr. José A. Hakim realiza más de 400 cirugías al año. Es cirujano general. Especialista en cirugía de cabeza y cuello en relación con el cáncer.
En este entrevista, hablamos sobre:
No todos los cánceres de tiroides deben ser operados.
No todos los nódulos tiroideos deben ser biopsiados.
La mitad de la población tiene nódulos tiroideos. El 10% de esos nódulos tienen cáncer. En Colombia, 2,5 millones de personas tienen cáncer de tiroides. 15 millones de personas tienen cáncer de tiroides en los Estados Unidos, y lo más probable es que no lo sepan.
Los estudios muestran que el 30% de los cadáveres tienen nódulos tiroideos con cáncer.
Comprender las repercusiones de hacer una biopsia. Si se trata de un nódulo que no requiere cirugía, incluso si es cáncer, decirle a un paciente esto a veces hace más daño en la forma de estrés emocional que lo que es necesario.
No sacrificar una tiroides debido a la fobia.
La carga es en el médico para no desencadenar paranoia y estrés en el paciente diciéndoles que "podría" tener cáncer, en el caso de llevar a cabo una biopsia en un nódulo cuando no es necesario.
Una tiroidectomía cambia una vida, incluyendo la piel seca, aumento de peso, calcio, pérdida de voz o cambio de voz - estos pueden ser peores que vivir con cáncer de tiroides papilar.
¿Qué necesita ocurrir en la comunidad médica para cambiar el paradigma que no necesitamos para operar en todo el cáncer de tiroides?
La patología es la clave para cambiar el paradigma.
El cáncer no es igual en todos los casos. Piense en el cáncer de tiroides similar a la vista sobre el cáncer de próstata en los hombres.
15 Jun 2021
Thyroid Cancer and Children with Dr. Andrew Bauer from the Perelman School of Medicine, U of Pennsylvania
00:52:20
Andrew J. Bauer, MD is an Associate Professor of Pediatrics at the Perelman School of Medicine, University of Pennsylvania and serves as the Director of the Thyroid Center in the Division of Endocrinology and Diabetes at The Children’s Hospital of Philadelphia. Dr. Bauer maintains active membership as a fellow in the American Academy of Pediatrics (FAAP), the Endocrine Society, the Pediatric Endocrine Society, and the American Thyroid Association. He also volunteers as a consultant for the Thyroid Cancer Survivors Association and the Graves’ Disease and Thyroid Foundation. In the American Thyroid Association Dr. Bauer has recently served as a member of the pre-operative staging committee, the thyroid hormone replacement committee, and as a co-chair for the task force charged to author guidelines on the evaluation and treatment of pediatric thyroid nodules and differentiated thyroid cancer. His clinical and research areas of interest are focused on the study of pediatric thyroid disease, to include hyperthyroidism, thyroid nodular disease, thyroid cancer, and inherited syndromes associated with an increased risk of developing thyroid nodules and thyroid cancer.
In this episode Dr. Bauer shares the complexities of managing children with thyroid nodules, and differentiated thyroid cancer. This is a must listen interview for parents whose child has a thyroid nodule or thyroid cancer diagnosis.
There are a several important differences in how pediatric thyroid nodules and differentiated thyroid cancer (DTC) present and respond to therapy. Kids are less frequently diagnosed with a thyroid nodule; however, the risk for malignancy is four- to fivefold higher compared with an adult thyroid nodule. For DTC (specifically papillary thyroid cancer), more than 50% of pediatric-aged patients will have metastases to cervical lymph nodes at the time of diagnosis, but because the tumors typically retain the ability to absorb iodine (retain differentiation), disease-specific mortality is very low, with > 95% of pediatric patients surviving from the disease. This is true even for children with pulmonary metastases, which occur in approximately 15% of patients who present with lateral neck disease.
With the high risk for malignancy and the invasive potential of the cancer, there has been a stronger tendency to take kids with thyroid nodules to the operating room (OR) and to administer RAI to those found to have DTC. With a greater realization of the increased risk for surgical complications as well as the short- and long-term complications of RAI treatment, the guidelines emphasize the need for appropriate preoperative assessment of nodules, and the approach to surgical resection, and they provide a stratification system and guidance for surveillance to identify which patients may benefit from RAI. The stratification system, called the "ATA pediatric risk classification," is not designed to identify patients at risk of dying of disease; it is designed to identify patients at increased likelihood of having persistent disease.
We have known about these differences for years, but the approach to evaluation and care has never been summarized into a pediatric-specific guideline. The adult guidelines aren't organized to address the differences in presentation, and the adult staging systems are targeted to identify patients at increased risk for disease-specific mortality. So, the adult guidelines are not transferable to the pediatric population.
Médico de la Universidad Pontificia Bolivariana y Otorrinolaringólogo de la Universidad de Antioquia en Medellín, Colombia. Residencia en Otorrinolaringología en la Universidad de Antioquia.
Fellowship , Entrenamiento exclusivo en Cirugía de Cabeza y Cuello (1996 a 1998) y posteriormente un Fellowship en Rinología y Cirugía Endoscópica de Senos para nasales (2004 a 2005) ambos en el Departamento de Otorrinolaringología de la Universidad de Miami, USA.
En esta entrevista escuchamos del autor y cirujano, Dr. Carlos Duque, que explica los siguientes temas sobre el cáncer de tiroides:
Tendencias con cáncer de tiroides
La aparición más frecuente de cáncer de tiroides.
150 - 200 cirugías tiroideas cada año.
Lo que un paciente con cáncer de tiroides debe esperar si es diagnosticado.
Antes de la cirugía, el paciente debe conocer los riesgos, incluida la voz y el calcio
Aumento de peso y cirugía de tiroides
Después de la cirugía, un paciente a veces tiene síntomas hipotiroideos
La mejor hora del día para tomar medicamentos para la tiroides
Espere una hora antes de comer después de tomar
Levothyroxine
Precaución al consumir calcio después de tomar la hormona de reemplazo tiroidal
Cómo detectar a un cirujano
Cómo recuperarse mejor después de una cirugía de tiroides
Radiación después de la cirugía de tiroides
Diferencias de tratamiento de un país a otro
Cambios en el tratamiento en los últimos años con respecto a la radiación y la cirugía
Thyroid Surgery? Be Careful, Not All Surgeons Are Equal and Here is Why with Dr. Ralph P. Tufano from The Johns Hopkins School of Medicine
00:32:35
In this interview, items discussed include:
the emotional burden of being diagnosed with cancer and the haste that sometimes follows
the unnecessary damage of thyroid surgery, including the cutting of the laryngeal nerve resulting in vocal cord paralysis, low calcium levels and a need to supplement calcium and Vitamin D for life, and leaving residual disease behind
knowing your risk factor and finding the right medical team to address it
Dr. Ralph P. Tufano is the Director of the Division of Head and Neck Endocrine Surgery at The Johns Hopkins School of Medicine, and conducts thyroid and parathyroid surgery with a focus on optimizing outcomes. He is a recognized world authority on the management of thyroid cancer, thyroid nodules, benign thyroid diseases and parathyroid disease. He has expertise in the management of thyroid cancer nodal metastases, advanced and invasive thyroid cancers as well as recurrent thyroid cancers. His work in molecular markers, improving surgical outcomes, nerve monitoring and exploring novel treatment techniques for thyroid and parathyroid diseases has helped the medical field tailor and personalize treatment for patients with these conditions. He is a Charles W. Cummings Professor, sits on the American Thyroid Association Board of Directors, is Director of the Division of Head and Neck Endocrine Surgery, and is a part of the Department of Otolaryngology-Head and Neck Surgery. He conducts approximately 450 thyroid surgeries annually.
86: Que hago si tengo cancer de tiroides? → Dr. Carlos Simon Duque
01:11:19
El Dr. Duque es un Cirujano de Cabeza y Cuello, formado en la Universidad de Miami, actualmente trabaja en el Hospital Pablo Tobon Uribe de Medellin.
Al años opera unos 220 pacientes con problemas de tiroides, de estos la mayoría con cancer de tiroides.
El Dr. Duque ha escrito un libro titulado !Uuuyy. TENGO CANCER DE TIROIDES¡
(Antes de inciar esta entrevista , me gustaria dejar claro que el fin de esta entrevista es informativo. Muy respetuosamente le solicitaria todos los que se unen a esta entrevista, No hacer preguntas sobre casos personales, o mencionar nombres de personas o medicos tratantes , el fin de estas y otras entrevistas que hago es informar.)
Temas de este entrevista uncluye:
Que tan común es el cancer de tiroides, de estos cual es el mas común?
Cuéntenos un poco sobre el tratamiento con Yodo radioactivo.
Como y porque decido escribir un libro sobre cancer de tiroides
Cuando se publicara este libro, donde se puede conseguir
Quien es un buen cirujano de tiroides, donde puedo buscar un cirujano con experiencia
84: Diagnosed With Thyroid Cancer? — Stop — Do Not Rush Into Surgery → Dr. Bryan McIver - Moffitt Cancer Center
00:37:27
Bryan McIver, MD, PhD
Dr. McIver contributes to Moffitt Cancer Center almost 20 years of clinical experience in the care of patients with endocrine diseases, specializing in the evaluation of patients with thyroid nodules and thyroid cancer. He has a particular interest in the management of patients with advanced and aggressive forms of cancer and the role of genetic and molecular techniques to improve the accuracy of diagnosis; to tailor appropriate treatment to a patientdisease. Dr. McIver has a long-standing basic research interest in the genetic regulation of growth, invasion and spread of thyroid tumors of all types. His primary research focus is the use of molecular and genetic information to more accurately diagnose thyroid cancer and to predict outcomes in the disease. Dr. McIver received his MB ChB degree from the University of Edinburgh Medical School in Scotland. He completed an Internal Medicine residency at the Royal Infirmary of Edinburgh, followed by a clinical fellowship and clinical investigator fellowship in Endocrinology at the School of Graduate Medical Education at Mayo Clinic in Rochester, MN. Prior to joining Moffitt, he was employed as Professor and Consultant at the Mayo Clinic and Foundation in the Division of Endocrinology & Metabolism. Amongst his most proud accomplishments, Dr. McIver counts his two commitment to education of medical students, residents and fellows; his involvement as a founding member of the World Congress on Thyroid Cancer, an international conference held every four years; and his appointment as a member of the Endowed and Master Clinician Program at the Mayo Clinic, recognizing excellence in patient care.
In this episode, the follwoiung
By sixty years old, more common to have nodule than not
Most nodules are benign
When to do a biopsy
How to interpret the results of biopsy
Advances in thyroid cancer
Ultrasound technology advancements
Molecular markers
Cytopathology categorizations
Molecular marker technologies
Gene expression classifier
Afirma
Identifying aggressive cancer
Types and sub-types of thyroid cancers
Invasive and aggressive thyroid cancers
Papillary versus anapestic thyroid cancer
Biopsy results in 2 - 3 hours
Clinical studies that have transformed thyroid treatment
Less aggressive surgery and less radioactive iodine
Targeted chemotherapies
Immunotherapy
The importance of clinical trial environments, or thoughtful philosophy
64: Managing Indeterminate Thyroid Nodules, with Dr. Kimberly Vanderveen from Denver Center for Endocrine Surgery
00:32:59
Kimberly Vanderveen, MD is a Colorado native and graduate of Bear Creek High School in Lakewood, CO. She received her bachelor’s degree with honors from Muhlenberg College in Allentown, PA. She then earned her medical degree from Northwestern University in Chicago, IL in 2001. Dr. Vanderveen completed her surgical residency at UC-Davis in Sacramento, CA. During her residency, she also obtained a master's degree in Clinical Research and was actively involved in cancer research and education. After her surgical training, Dr. Vanderveen completed a fellowship in Endocrine Surgery at the Mayo Clinic in Rochester, MN. She is knowledgeable in both medical and surgical aspects of endocrine diseases. She specializes in surgery for diseases of the thyroid, parathyroid, adrenal glands and is a high volume neck and adrenal surgeon.
In this episode, the following topics are discussed:
Two roads of tests: rule out and malignant markers
Rule-out tests picks up innocent behavior pattern. Most common is Afirma
Malignant markers, or rule-in tests, are useful at determining extent of surgery, and help avoid a second or third surgery. ThyroSeq, ThyraMIR, Rosetta
Do patients get both tests? Rule out and behavior?
Approximately 15% of FNA’s come back indeterminate. Some centers as high as 30%
Managing indeterminate nodules when a patient chooses no surgery.
Taking into account emotional, financial, and lifestyle goals of the patient.
Addressing priorities and goals of the patients should come first.
Additional molecular testing, surgery, or active surveillance.
Profiling a patient who choose to remove thyroid even if indeterminate — is usually due to fear and the C word.
93: Has anything changed in the past 50 years of treating thyroid disease? (including thyroid cancer) The answer is yes. → Dr. Leonard Wartofsky from MedStar
00:35:32
Dr. Leonard Wartofsky is Professor of Medicine, Georgetown University School of Medicine and Chairman Emeritus, Department of Medicine, MedStar Washington Hospital Center. He trained in internal medicine at Barnes Hospital, Washington University and in endocrinology with Dr. Sidney Ingbar, Harvard University Service, Thorndike Memorial Laboratory, Boston. Dr. Wartofsky is past President of both the American Thyroid Association and The Endocrine Society. He is the editor of books on thyroid cancer for both physicians and for patients, and thyroid cancer is his primary clinical focus. He is the author or coauthor of over 350 articles and book chapters in the medical literature, is recent past Editor-in-Chief of the Journal of Clinical Endocrinology & Metabolism, and is the current Editor-in-Chief of Endocrine Reviews.
In this episode, Dr. Wartofsky discusses the following:
Bioavailability versus content of a thyroid replacement tablet, and how it is absorbed.
Hypothyroidism causes
When is replacement thyroid replacement hormone necessary?
The history of replacement thyroid hormone going back to 1891
The early treatment included a chopped up sheep thyroid and served as a ‘tartar’, often resulting in vomiting
Myxedema coma
The danger of taking generic T4; are cheaper, larger profit margin, but the content varies.
Synthroid versus generic
Manufacturing plants in Italy, India, Puerto Rico are known to produce generics
Content versus absorption when taking generic T4
An explanation of TSH
1.39 is a healthy TSH level for women in the U.S.
Symptoms of hypothyroidism, such as a slow mind, poor memory, dry skin, brittle hair, slow heart rate, problems with pregnancy, miscarriage, and hypertension.
Screening TSH levels if contemplating pregnancy T4 is the most prescribed drug in the U.S.
Hypothyroidism is common when there is a family history
Auto-immune disease is often associated with hypothyroidism
An explanation of T3
An explanation of desiccated thyroid
The T3 ‘buzz’
Muhammed Ali’s overdose of T3
Dangers of too much T3
When to take T4 medication, and caution toward taking mediations that interfere with absorption
Coffee and thyroid hormone absorption
Losing muscle and bone by taking too much thyroid hormone
31: Información Importante Sobre los Nódulos Tiroideos con la Dra Regina Castro de la Clínica Mayo
00:42:01
El término nódulo tiroideo se refiere a cualquier crecimiento anormal de las células tiroideas formando un tumor dentro de la tiroides. Aunque la gran mayoría de los nódulos tiroideos son benignos (no cancerosos), una pequeña proporción de estos nódulos sí contienen cáncer de tiroides. Es por esta posibilidad que la evaluación de un nódulo tiroideo está dirigida a descubrir un potencial cáncer de tiroides.
En esta entrevista, el Dr. Castro explica los siguientes temas:
¿Qué es un nódulo tiroideo?
¿Cuáles son los síntomas de un nódulo tiroideo?
¿Cómo se diagnostica el nódulo tiroideo?
Punción de la tiroides con aguja fina
Ecografía de la tiroides
¿Cómo se tratan los nódulos de la tiroides?
Cuando la observación activa es la opción de tratamiento en lugar de una tiroidectomía
Niños con nódulos tiroideos
M. Regina Castro, MD es consultante en la División de Endocrinología de la Clínica Mayo de Rochester, MN. Es Profesora Asociada de Medicina. Es Directora Asociada del Programa de entrenamiento en la especialidad de Endocrinología, y Directora de la rotación de Endocrinología para la Residencia de Medicina Interna. También es miembro del Grupo de Tiroides de la Clínica Mayo. Ella sirvió de 2009 a 2015 como Editor de Sección de la Tiroides para el Programa de Autoevaluación de AACE y ha sido autora de varios capítulos sobre Hipertiroidismo, Nódulos de Tiroides y cáncer
33: ¿Qué Sucede Cuando el Cáncer de Tiroides va a los Pulmones? con el Doctor Fabian Pitoia del Hospital de Clínicas de la Universidad de Buenos Aires
00:21:11
Bienvenido al episodio 33 de Doctor Thyroid con Philip James.
El invitado de hoy es Dr. Fabian Pitoia. El Dr. Pitoia es un experto endocrino mundial, que aparece en muchas publicaciones y conferencias mundiales, donde habla de cáncer de tiroides. El Dr Pitoia es médico endocrinólogo, está encargado de la Sección Tiroides de la División Endocrinología del Hospital de Clínicas de la Universidad de Buenos Aires.
En este episodio, el Dr. Pitoia responde las siguientes preguntas:
¿Qué es la enfermedad metastásica en relación con el cáncer de tiroides?
Hay una tendencia de este enfermedad?
¿cómo se descubre la enfermedad metastásica?
cuando se trata de cáncer de tiroides es un procedimiento típico para los médicos para detectar la enfermedad metastásica?
si un paciente no responde a RAI (radioactiva), ¿qué es una opción de tratamiento? ¿Podemos hacer vigilancia activa
cuando hay metástasis en los pulmones, ¿es lo mismo que el cáncer de pulmón?
600 milicurios de RAI .... ¿Hay peligro para este alto de una dosis?
¿hay efectos secundarios o peligros a los medicamentos usados para tratar la enfermedad metastásica que no responde a la radiación?
se le informa a un paciente de la enfermedad metastásica, y este es un área de estrés para los pacientes con cáncer de tiroides, ¿puede decirle a un paciente algo para reducir la ansiedad relacionada con la enfermedad metastásica?
si un paciente tiene enfermedad metastásica, ¿es necesario un médico especial para el tratamiento?
¿cómo sabemos si un médico se especializa en la enfermedad metastásica?
¿hay una página web o recursos adicionales para aprender más sobre la enfermedad metastásica?
Hospital de Clínicas de la Universidad de Buenos Aires - Ciudad Autónoma de Buenos Aires. Consultorio privado: Pte. J.E. Uriburu 754 - Piso 2. Teléfonos: 49545488/49525496 fpitoia@glandulatiroides.com.ar
27 Jul 2017
45: Hipotiroidismo - Causas, Síntomas, y Pruebas y Exámenes. Con la Dra. Gabriela Brenta desde Buenos Aires
00:33:51
La glándula tiroides es un órgano importante del sistema endocrino. Está ubicada en la parte anterior del cuello, justo por encima de donde se encuentran las clavículas. La tiroides produce hormonas que controlan la forma como cada célula en el cuerpo usa la energía. Este proceso se denomina metabolismo.
Hipotiroidismo es una afección en la cual la glándula tiroides no produce suficiente hormona tiroidea. Esta afección a menudo se llama tiroides hipoactiva.
Este episodio Dra. Gabriela Brenta discute sobre hipotiroidismo, las causas, los síntomas, pruebas y exámenes, el tratamiento, pronóstico, posibles complicaciones, y cuándo contactar a un médico.
Dra. Gabriela Brenta, M.D., Ph.D.
Docente de post grado de la Universidad Favaloro y de las carreras de Especialista en Endocrinología así como de Bioquímica Clínica dependientes de Universidad de Buenos Aires. Médica adscripta en el Servicio de Endocrinología y Metabolismo de la Unidad Asistencial Dr. César Milstein de Buenos Aires, Sector Tiroides. Presidente del Comité Científico de la Sociedad Latinoamericana de Tiroides. Miembro del Dpto. de Tiroides de la Sociedad Argentina de Endocrinología y Metabolismo. Su área de investigación clínica abarca el efecto cardiovascular y metabólico de las hormonas tiroides.
03 Apr 2017
24: Patient Story 1 - Judy O'Reilly - Thyroid Cancer and Hypothyroidism
00:17:05
In this episode, we hear from Judy O'Reilly. Judy was diagnosed with thyroid cancer in 2011. Following surgery, Judy speaks about the frequent challenges, including adjusting medication dosages, hypothyroidism, and her energy levels hitting the wall during daily activities.
For Judy, the cancer diagnosis forced the conversation of talking about death with her children and husband. A singer and musician, the thyroid cancer and resulting surgery has caused vocal challenges.
In this episode, we hear from Judy O'Reilly. Judy was diagnosed with thyroid cancer in 2011. Following surgery, Judy speaks about the frequent challenges, including adjusting medication dosages, hypothyroidism, and her energy levels hitting the wall during daily activities.
For Judy, the cancer diagnosis forced the conversation of talking about death with her children and husband. A singer and musician, the thyroid cancer and resulting surgery has caused vocal challenges.
She is the founder and former facilitator of THYCA Atlanta. Prior to starting the once/month support group held at Emory University’s Winship Cancer Institute, Judy O'Reilly offered email and phone support. Judy began her involvement/volunteering with THYCA one year after diagnosis/surgery/RAI. Prior to thyroid cancer, Judy O’Reilly had been a music educator and an entertainer. She was the female vocalist for the Atlanta Blue Notes Big Band, as well as their Combo. As a solo performer (piano/vocals), Judy specialized in senior care facilities offering up an extensive selection of the great American songbook. Ms. O’Reilly resigned/retired from performing soon after a second surgery - a completion of a previous partial thyroidectomy - due to complications. In 2015 Judy began a return to entertaining as a volunteer in the grand piano lobby of the Winship Cancer Institute, Atlanta.
19 Oct 2016
02: The Role of the Naturopath in Relation to Conventional Medicine with Dr. Shawn Soszka
00:39:25
This episode features Dr. Shawn Soszka.
Topics covered in today’s interview include, starting your day right, tendon issues due to thyroid disease, insomnia, dizziness, painful feet, temperature testing, hypothyroidism, low dose Naltrexone, selenomethionine, and why some people feel worse when exercising. Also, discussed is adrenal function and optimal time of day for body temperature testing as related to the thyroid disease.
Dr. Soszka strives to integrate both systems of medicine. a focus on functional medicine, with emphasis on treating gastrointestinal, chronic disease, and endocrine based conditions. He specializes in: fatigue/adrenal exhaustion, thyroid disorders, digestion/gut health, autoimmune diseases.
29 Jun 2021
Hypothyroidism — Moving From Fat, Foggy & Fatigued to Feeling Fit & Focused with Elle Russ
00:36:37
In this episode, we hear from Elle Russ, Author of The Paleo Thyroid Solution, and former hypothyroidism sufferer. Elle discusses:
Hypothyroidism symptoms — including physical, mental, and emotional.
How to find the right health professional.
Hypothyroidism treatment with T3.
The importance of iron and ferritin.
The emotional toll of hypothyroidism.
Nutrition strategies.
Basal body temperature method for testing hypothyroidism.
Elle Russ is a writer, health/life coach, and host of the Primal Blueprint Podcast. She is becoming the leading voice of thyroid health in the burgeoning Evolutionary Health Movement (also referred to as Paleo, Primal, or Ancestral Health). Elle has a B.A in Philosophy from The University of California at Santa Cruz and is a certified Primal Health Coach. She sits on the advisory board of The Primal Health Coach Program created by Mark Sisson, bestselling author of The Primal Blueprint. Exasperated and desperate, Elle took control of her own health and resolved two severe bouts of hypothyroidism on her own – including an acute Reverse T3 problem. Through a devoted paleo/primal lifestyle, intensive personal experimentation, and a radically modified approach to thyroid hormone replacement therapy…Elle went from fat, foggy, and fatigued – to fit, focused, and full of life!
No Biopsy is 100% Accurate⎥Molecular Testing Gets Close, with Dr. Bridget Brady from Austin Thyroid Surgeons
00:28:16
Dr. Bridget Brady is Austin’s first fellowship trained endocrine surgeon. She has a passion for and expertise in disease of the thyroid, parathyroid, and adrenal glands. Since completing her endocrine surgery fellowship in 2006 under Matthias Rothmund, MD, an internationally acclaimed endocrine surgeon, she has performed thousands of thyroidectomies and parathyroidectomies here in Austin. Dr. Brady focuses on a variety of minimally invasive techniques to optimize patients’ medical and cosmetic outcomes. Her fellowship training in Germany and experience in Austin have enabled her to specialize in patients with recurrent or persistent disease of the thyroid and parathyroid, including thyroid cancer. She offers complete diagnostic workups including in-office ultrasounds and FNA biopsies of thyroid nodules and lymph nodes.
Dr. Brady was named director of endocrine surgery for the new medical school in Austin. She was also recently chosen to teach general surgeons seeking additional training in endocrine surgery. Dr. Brady instructs these endocrine surgeons from the Baylor Scott and White fellowship program.
In this episode the following topics are discussed:
Austin Thyroid Surgeons sees 30 patients per week with thyroid nodules
Up to 80% of US population could have a thyroid nodule(s)
less than 5% of Dr Brady's thyroid nodule patients test positive for cancer
How relevant is what I don’t know won’t hurt me in thyroid cancer and biopsies of nodules?
BETHESDA system or the middle category, also known as indeterminate
For thyroid nodules that are indeterminate, historically a surgery would be performed
With molecular testing, surgery can be decreased by up to 50%
Afirma molecular testing uses messenger RNA
If Afirma comes back suspicious it does NOT necessarily mean it is cancer
Insurance covers molecular testing
Nest steps for a doctor who would like to incorporate molecular testing
Suspicious results with molecular testing can still be benign on final pathology
How do you calmly tell a patient they have cancer?
6-Steps for RFA-procedure success! → for doctors & patients → Dr. Roberto Valcavi
00:16:49
🔹 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:
✅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
15 Mar 2017
20: Información Clave Sobre el Hipotiroidismo con Dra. Alicia Gauna del Hospital Ramos Mejía, Buenos Aires
00:28:05
En este episodio, estamos con la Dra. Alicia Gauna, Jefa División Endocrinología del Hospital Ramos Mejía, Buenos Aires. Ella es Coordinadora del Comité de Recertificación de Endocrinología y Metabolismo (CREM), Directora de Beca de Dra. Florencia Rodriguez, Ministerio de Salud Pública, 2012-2013, Integrante del Comité Científico del XV Congreso Latinoamericano de Tiroides. Brasil, 2013.
En esta entrevista, Dra Gauna comparte información clave sobre hipotiroidismo y cáncer de tiroides.
Revolutionizing Thyroid Treatment: Dr. Emad Kandil Advocates for Thyroid Ablation Over Surgery
00:44:34
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.
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.
10 Aug 2017
48: Innovaciones en el Tratamiento del Cáncer de Tiroides, con el Dr. Hernán Tala desde Santiago, Chile
00:47:46
Dr. Hernán Tala es endocrinólogo de la Clinica Alemana en Santiago, Chile. Su area especialidad incluye cáncer de tiroides avanzado, endocrinologia general, y enfermedades tiroides.
Los temas presentados incluyen:
Una mejor comprensión de la biología del cáncer de tiroides, y que no todo el cáncer de tiroides es igual. La enfermedad es única en cada paciente.
La importancia de entender el perfil del cáncer en cada paciente.
Diagnóstico del nódulo.
Perfil molecular del nódulo tiroideo.
Una pausa en la exploración universal del cáncer de tiroides.
Vigilancia activa
Menos radiación, o ningún tratamiento de radiación en los casos que anteriormente recibirían radiación
La importancia para los médicos de compartir una comprensión universal de la vigilancia activa, por lo que los pacientes obtener una recomendación coherente.
Hipotiroidismo en pacientes con tiroidectomía total.
El cáncer de tiroides es lento en comparación con otros tipos de cáncer.
Qué se requiere para la adopción adicional de la innovación del tratamiento del cáncer de tiroides.
Navigating Health Information in the Digital Age: Insights from WebMD’s John Whyte
00:29:31
In a world where misinformation can spread as rapidly as legitimate data, discerning the truth becomes a critical skill—especially when it comes to our health. Dr. John Whyte, Chief Medical Officer at WebMD, shares his insights on how patients can navigate the sea of health information online to find trustworthy resources and take control of their personal health.
The Power of Information
Dr. Whyte begins by emphasizing the importance of quality information, which he argues is more accessible than ever thanks to digital advancements. “Better information leads to better health,” he says, echoing WebMD’s philosophy. In the era of the internet, the adage “knowledge is power” holds particularly true in the realm of healthcare. Quality information equips patients with the power to make informed decisions about their health, turning them into advocates for their own care.
Sorting Fact from Fiction
The challenge for many, Dr. Whyte notes, is the overwhelming amount of information available—an issue compounded by the rapid pace at which medical knowledge evolves. “Medical knowledge doubles about every 73 days,” he states, highlighting the difficulty for even the most diligent professionals to stay current. In this environment, patients must become their own advocates and learn to differentiate between reliable information and misleading data.
Whyte is concerned about the rise of misinformation, which can equate unverified opinions with scientific evidence. He stresses the importance of scrutinizing health information with the same rigor one might apply to financial decisions. This means considering the source’s credibility, transparency, and the replicability of the data. Reliable sites like WebMD help users navigate this by providing clearly dated and expert-reviewed content.
The Role of Technology in Personal Health
Dr. Whyte is a strong proponent of using technology to enhance personal health management. From wearables that track physical activity to apps that monitor sleep and dietary habits, digital tools offer a wealth of personalized data that can lead to healthier lifestyle choices. He shares his personal experiences with biohacking gadgets like Lumen, a device that measures metabolic fuel use, to illustrate how specific tools can help tailor health strategies to individual needs.
DIY Health: A Blessing and a Curse
The abundance of health-related information and tools can empower patients but also overwhelm them. Dr. Whyte calls this the “DIY approach” to health, where individuals take on the role of managing their own care without sufficient medical guidance. While he champions the use of technology, he cautions against its pitfalls, particularly when individuals rely too heavily on unvalidated sources or misinterpret the data.
The Future of Health Information
Looking ahead, Dr. Whyte is optimistic about the potential of AI and machine learning to transform healthcare. He envisions a future where AI can provide empathetic, accurate support that complements traditional healthcare services. However, he acknowledges that the technology is not yet perfect and emphasizes the importance of continuing to refine these tools to avoid the spread of “hallucinated” misinformation.
Empowering Patients Through Trustworthy Resources
In conclusion, Dr. John Whyte advocates for a balanced approach to digital health information. By critically evaluating sources, utilizing technological tools judiciously, and always seeking professional advice when necessary, patients can take charge of their health confidently and safely. In an age where information is both a resource and a hazard, being a discerning consumer is perhaps the most important skill of all.
Dr. John Whyte is the Chief Medical Officer at WebMD, where he leverages his extensive background in both medicine and public health policy to enhance healthcare information accessibility and accuracy for the public. A passionate advocate for consumer-centered healthcare, Dr. Whyte is dedicated to empowering individuals with reliable and actionable health data. With a medical degree from the University of Pennsylvania School of Medicine and a master’s degree in public health from Harvard, he has served in leadership roles at the Food and Drug Administration and Discovery Channel Global Education Partnership, among others. Dr. Whyte is a prolific author and speaker, focused on improving patient education and health outcomes through innovation in digital health and media.
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.
21 Jun 2021
Hashimoto's Disease and the Thyroid Change Petition for Change
00:34:38
In this interview, the following topics are discussed:
Better treatment options for thyroid disease
Better testing for thyroid disease
Mental challenges
Juggling career and Hashimoto's
The word insignificant
The role of T3 and biological connections
Diagnosed at twelve years old
Disappearing eyebrows
You can’t have thyroid disease because you’re not overweight
76: Is Your Thyroid Surgeon Skilled? 4 Mistakes Resulting from Inexperience, with Dr. James Netterville from Vanderbilt
00:48:53
James L. Netterville, M.D. Mark C. Smith Professor of Head and Neck Surgery, Professor of Otolaryngology Director, Head & Neck Oncologic Surgery Associate Director, Bill Wilkerson Center for Otolaryngology and Communication Sciences
Dr. Netterville is the Director of Head and Neck Surgery at Vanderbilt and is an international leading authority of treating head and neck cancer. He is one of the world's experts in the treatment of skull base tumors and has a vast clinical experience.
Todays topic's include:
Reoccurrence thyroid disease patients in paratracheal, thyroid bed, and cervical lymph nodes
Papillary thyroid cancer and subtypes: tall cell, columnar, oncocytic, clear cell, hobnail
The extreme importance of the pathologist
Facebook is one of the number one sources of referrals
The changing landscape of researching physicians
PubMed and Index Medicus have replaced the library and medical literature
In past 5 years patients are seeking advice from peers and experiences from others
Patients have become the bets marketers for physicians versus the institution
performing thyroid surgery on professional singers
Patients are attached to a doctor and care team, which is often driven by social media
Paratracheal region, and difficulty in ultrasound
Selective neck dissection
The evil remnant: when a surgeon inadvertently leaves thyroid cancer behind
Three areas where thyroid cancer reoccurs: where remnant is left behind, hidden paratracheal lymph nodes,
Lymph nodes in levels II, III, IV
Some surgeons’ misperceptions about the effectiveness of RAI as a means to cleaning up poor surgery
Doing a thyroid surgery is easy. Doing it right is hard. The importance of finding a surgeon who knows how to do it right
Damage to RLN and leaving cancer behind or remnant, is due to inexperience
Working around larynx and voice box during thyroid surgery
Challenges with the trachea during thyroid surgery
Grafting the RLN
Grafting the RLN, in line graft, ends of motor nerves and sewing them back to the RLN
Thyroid marketing and the term minimally invasive
Superior RLN protection
Preserving the cricothyroid muscle, especially singers
The importance of being a good listener
Vetting a surgeon by searching social media or reputation, publications, and volume
Is thyroid cancer a cancer or just a nuisance. Chances are it is not going to kill you.
Doctors managing their reputation online
RAI and killing gross disease fallacy
A surgeon's personal brand versus institution branding
55: Thyroid Cancer Treatment and Surgery Explained⎥Dr. Gerard Doherty from Harvard Medical School
00:27:21
Dr. Gerard Doherty, an acclaimed endocrine surgeon, is a graduate of Holy Cross and the Yale School of Medicine. He completed residency training at UCSF, including Medical Staff Fellowship at the National Cancer Institute. Dr. Doherty joined Washington University School of Medicine in 1993, and became Professor of Surgery in 2001. In 2002 he became Head of General Surgery and the Norman W. Thompson Professor of Surgery at the University of Michigan, where he also served as the General Surgery Program Director and Vice Chair of the Department of Surgery. From 2012 to 2016, Dr. Doherty was the Utley Professor and Chair of Surgery at Boston University and Surgeon-in-Chief at Boston Medical Center before becoming Moseley Professor of Surgery at Harvard Medical School, and Surgeon-in-Chief at Brigham and Women’s Hospital and Dana-Farber Cancer Institute.
Dr. Doherty was trained in Surgical Oncology, and has practiced the breadth of that specialty, including as founder and co-director of the Breast Health Center at Barnes-Jewish Hospital. His clinical and administrative work was integral in the establishment of the Siteman Cancer Center at Washington University. Since joining the University of Michigan in 2002, he has focused mainly on surgical diseases of the thyroid, parathyroid, endocrine pancreas and adrenal glands as well as the surgical management of Multiple Endocrine Neoplasia syndromes. He has devoted substantial effort to medical student and resident education policy. His bibliography includes over 300 peer-reviewed articles, reviews and book chapters, and several edited books.
He currently serves as President of the International Association of Endocrine Surgeons, Past-President of the American Association of Endocrine Surgeons, Editor-in-Chief of VideoEndocrinology and Reviews Editor of JAMA Surgery. He is a director of the Surgical Oncology Board of the American Board of Surgery.
In this episode, the following topics are discussed:
Imaging has increased thyroid nodule discovery.
Following patients with small thyroid cancer — analogous to prostate cancer. Better followed than treated.
Tiny thyroid cancers can be defined by those nodules less than 1/4 inch in size.
Less RAI is being used as a part of thyroid cancer treatment. This means, less need to do total thyroidectomy or thyroid lobectomy.
Dry mouth and dry eyes are risks to doing RAI. Also, there is risk to developing a second malignancy. Most of the secondary cancers are leukemia.
Risks to operation include changes to voice and calcium levels. Thyroid surgery is a safe operation but not risk free.
Best question for a patient to ask is, who is my treatment team?
The quarterback of treatment team is often the endocrinologist .
Cluster of issues can happen after RAI, such as the need to carry water and eye drops for life.
For some patients taking thyroid hormone replacement, their blood levels are correct, but still does not feel well on standard treatment protocol.
By the end of two weeks, most people go back to what they were doing before surgery with a relatively normal state.
25: Información importante sobre el hipotiroidismo con Dra. Sandra Daniela Licht de INEBA ( Instituto de Neurociencias de Buenos Aires)
00:18:48
¿Cómo sabemos si usted tiene hipotiroidismo?
¿Qué significa si es difícil concentrarse o enfocar la mente?
¿Qué significa si usted tiene altos niveles de TSH?
¿Cómo se diagnostica el hipotiroidismo?
¿Qué es Hashimotos?
¿Cuál es el tratamiento para el hipotiroidismo?
¿Puede la dieta ayudar con el hipotiroidismo?
¿Cuándo es el mejor momento del día para tomar su medicina de hipotiroidismo?
¿Dónde puede encontrar un médico para tratar el hipotiroidismo?
Dra. Sandra Daniela Licht de Hospital General de consultorio particular y en INEBA ( Instituto de Neurociencias de Buenos Aires) Endocrinologia
ESPECIALIDAD Establecimiento: General de Agudos J. M. Ramos Mejía. Título: Clinica Medica. Establecimiento: Hospital General de Agudos Carlos G. Durand. Titulo: Endocrinologia
ACTIVIDAD ACADEMICA Y DOCENTE Instructora de Residentes de Endocrinología, Htal Durand (1993-1995) Docente de la Diplomatura en Enfermedades Tiroideas de la Facultad de Medicina de la Universidad Nacional de Tucumán
SOCIEDADES CIENTIFICAS • Miembro Titular, Sociedad Argentina de Endocrinología y Metabolismo. • Miembro Titular, Sociedad Latinoamericana de Tiroides. • Miembro Titular, The Endocrine Society. • Miembro Titular, American Thyroid Asociation. • Miembro del Comité de Asuntos Internacionales, The Endocrine Society (2005-2006). • Miembro del Comité Hormone Foundation, The Endocrine Society (2007-2010). • Miembro del Comité Patient Education and Advocacy Committee, American Thyroid Association (2008). • Miembro del Comité Clinical Affaires, American Thyroid Association. • Miembro del Comité Working Group on Disparities in Clinical Trials, The Endocrine Society. • Miembro del Comité de Publicaciones, The Endocrine Society. • Miembro del Comité Clinical Guidelines, The Endocrine Society. • Asesora médica de ACTIRA. • Asociación de Pacientes con Cáncer de Tiroides de la República Argentina. • Miembro del Medical Advisory Panel of Thyroid Cancer Alliance (desde el año 2011).
63: Slow Down and Do Not Rush⎢Thyroid Surgery with a Clear Mind, with Dr. Bryan McIver from Moffitt Cancer Center
00:35:17
Bryan McIver, MD, PhD
Dr. McIver contributes to Moffitt Cancer Center almost 20 years of clinical experience in the care of patients with endocrine diseases, specializing in the evaluation of patients with thyroid nodules and thyroid cancer. He has a particular interest in the management of patients with advanced and aggressive forms of cancer and the role of genetic and molecular techniques to improve the accuracy of diagnosis; to tailor appropriate treatment to a patientdisease. Dr. McIver has a long-standing basic research interest in the genetic regulation of growth, invasion and spread of thyroid tumors of all types. His primary research focus is the use of molecular and genetic information to more accurately diagnose thyroid cancer and to predict outcomes in the disease. Dr. McIver received his MB ChB degree from the University of Edinburgh Medical School in Scotland. He completed an Internal Medicine residency at the Royal Infirmary of Edinburgh, followed by a clinical fellowship and clinical investigator fellowship in Endocrinology at the School of Graduate Medical Education at Mayo Clinic in Rochester, MN. Prior to joining Moffitt, he was employed as Professor and Consultant at the Mayo Clinic and Foundation in the Division of Endocrinology & Metabolism. Amongst his most proud accomplishments, Dr. McIver counts his two commitment to education of medical students, residents and fellows; his involvement as a founding member of the World Congress on Thyroid Cancer, an international conference held every four years; and his appointment as a member of the Endowed and Master Clinician Program at the Mayo Clinic, recognizing excellence in patient care.
In this episode, the follwoiung
By sixty years old, more common to have nodule than not
Most nodules are benign
When to do a biopsy
How to interpret the results of biopsy
Advances in thyroid cancer
Ultrasound technology advancements
Molecular markers
Cytopathology categorizations
Molecular marker technologies
Gene expression classifier
Afirma
Identifying aggressive cancer
Types and sub-types of thyroid cancers
Invasive and aggressive thyroid cancers
Papillary versus anapestic thyroid cancer
Biopsy results in 2 - 3 hours
Clinical studies that have transformed thyroid treatment
Less aggressive surgery and less radioactive iodine
Targeted chemotherapies
Immunotherapy
The importance of clinical trial environments, or thoughtful philosophy
Treating Thyroid Cancer with No Surgery → RFA → Radiofrequency Ablation for Malignant Thyroid Nodules
00:28:38
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:
✅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
25 Feb 2021
36: 1 in 3 People Die With Thyroid Cancer — Not From with Dr. Seth Landefeld from UAB
00:23:10
The USPSTF upholds its 1996 recommendation against screening for thyroid cancer among asymptomatic adults.
The USPSTF commissioned the systematic review due to the rising incidence of thyroid cancers against a background of stable mortality, which is suggestive of over-treatment. And in view of the results, the task force concluded with “moderate certainty” that the harms outweigh the benefits of screening.
The USPSTF emphasizes, however, that this recommendation pertains only to the general asymptomatic adult population, and not to individuals who present with throat symptoms, lumps or swelling, or those at high risk for thyroid cancer.
A global problem
The over-diagnosis of thyroid cancer is worldwide.
South Korean doctors treated these newly diagnosed thyroid cancers by completely removing the thyroid—a thyroidectomy. People who undergo these surgeries require thyroid replacement hormones for the rest of their lives. And adjusting the dose can be difficult. Patients suffer from too much thyroid replacement hormone (sweating, heart palpitations, and weight loss) or too little (sleepiness, depression, constipation, and weight gain). Worse, because of nerves that travel close to the thyroid, some patients suffer vocal-cord paralysis, which affects speech.
Over-diagnosis and over-treatment of thyroid cancer hasn’t been limited to South Korea. In France, Italy, Croatia, Israel, China, Australia, Canada, and the Czech Republic, the rates of thyroid cancer have more than doubled. In the United States, they’ve tripled. In all of these countries, as had been the case in South Korea, the incidence of death from thyroid cancer has remained the same.
A SURGEON Warns Against Thyroid Surgery: Preserving QUALITY of LIFE with Dr. Emad Kandil
00:22:21
Join us as Dr. Emad Kandil, a leading expert in thyroid ablation, sits down with Philip James in the heart of New Orleans. In this candid and insightful conversation, Dr. Kandil shares his journey from aspiring engineer to becoming a renowned thyroid surgeon, influenced by a life-changing event involving his younger brother.
Against the backdrop of the city's iconic Café du Monde and a rigorous CrossFit session, the two explore the complexities of thyroid surgery, discussing why Dr. Kandil often advocates for ablation over traditional thyroidectomies to preserve patients' quality of life.
As the conversation unfolds, viewers examine Dr. Kandil’s commitment to research, patient care, and innovation. They venture from the cafe to the gym and finally to Dr. Kandil's clinic, where modern technology meets compassionate healthcare. For anyone considering thyroid surgery or seeking alternatives, this episode explores non-surgical options and the science behind thyroid ablation.
Discover how one surgeon’s philosophy and approach redefine patient outcomes—one thyroid at a time.
About Dr. Emad Kandil Dr. Emad Kandil is a renowned expert in endocrine and oncological surgery. He is the Chief of General, Endocrine, and Oncological Surgery at Tulane University in New Orleans, Louisiana. He holds the prestigious Elias Hanna Chair in Surgery and is celebrated for his groundbreaking work in minimally invasive thyroid treatments, including thyroid ablation. Dr. Kandil has performed over 1,000 thyroid ablation procedures, establishing himself as a leading figure in using this innovative treatment approach in the United States. www.emadkandil.com
About Philip James Philip James hosts the Doctor Thyroid podcast, a platform that provides patients with information on alternative thyroid treatments. His work focuses specifically on minimally invasive procedures like thyroid ablation. He aims to help patients avoid unnecessary thyroid surgeries, a mission close to him after his own experience with an unneeded surgery. www.docthyroid.com
03 Feb 2021
92: Treinta años después y más de 5000 pacientes con cáncer papilar de tiroides → y solo dos murieron, con el Dr. Jorge Calvo desde Panama
00:28:11
Dr. Jorge Calvo Lugar de estudio: U. de Panamà, Hospital de la Caja de Seguro Social, Fundaciòn Santa Fe (Colombia) U. Del Norte (Argentina), Sistema Integrado de Salud (Veraguas) Otros estudios: Laparoscopía, Curso de postgrado de Cirugía Gastrointestinal, Curso de postgrado de Cirugía de Cabeza y Cuello
En este episodio, se tratan los siguientes temas:
¿Cómo será la vida después de la cirugía?
Embarazo después del cáncer de tiroides
Parálisis de las cuerdas vocales
Las complicaciones incluyen voz e hipo-calcio
Sangrado durante la cirugía
Tratamiento para hypo-calcium
Vitamina D
Embarazo y radiación
TSH elevada después de la cirugía
Problemas de TSH suprimido
Número uno de miedo del paciente cuando se le diagnostica cáncer de tiroides y antes de la cirugía
32 años como cirujano tiroideo - cáncer papilar de tiroides
Vigilancia activa
Tasas de mortalidad del cáncer papilar de tiroides
Recurrencia
La mejor hora del día para tomar un reemplazo de tiroides
Más información: www.doctiroides.com
06 Mar 2021
89: Your Patient ‘Type’ May Determine Your Thyroid Cancer Treatment → Dr. Michael Tuttle from Sloan Kettering
00:39:03
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
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.
Thyroid Cancer Patients and Quality of Life Issues with Dr. Grogan and Dr. Aschebrook
00:46:42
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.
06 Nov 2024
Thyroid Ablation Case Study: MWA (microwave) Outperforms RFA (radiofrequency)
00:23:20
In this expert-level analysis, we compare the clinical effectiveness of Microwave Ablation (MWA) and Radiofrequency Ablation (RFA) for the treatment of thyroid nodules, with a focus on key decision-making criteria for selecting the optimal minimally invasive treatment. This detailed case study, featuring Dr. Emad Kandil and patient testimony, offers a comprehensive exploration of advanced thyroid nodule management techniques.
We begin with the patient’s journey, documenting her initial treatments with RFA, which resulted in limited success and the eventual regrowth of the thyroid nodule. Dr. Kandil then introduced MWA, leading to a remarkable 80% volume reduction in just three months. This transition illustrates the pivotal differences between RFA and MWA, such as the heat sink effect, and why MWA provides more precise and effective energy delivery, particularly for nodules with significant vascularization.
Dr. Kandil, having performed over 1,200 thyroid ablation procedures.
Key Moments:
00:10— Explanation of the heat sink effect with MWA leading to 80% shrinkage 01:05— Failure of RFA to induce significant nodule shrinkage 01:30— Patient discusses the lack of pain during MWA 01:45— Paradigm shift in the medical community regarding new ablation technologies 02:20— Philip James introduces MWA's success where RFA failed 03:14— The first surgeon recommended surgery, which was ultimately unnecessary 04:00— Discovery of the thyroid nodule during a routine health check 04:55— The emotional impact of discovering a thyroid nodule 06:10— The patient’s positive experience with Dr. Kandil 06:45— Is it cancer? Genetic markers and biopsy results 07:50— Dr. Kandil explains biopsy issues, suspicious cells, and genetic markers 09:00— One surgery versus multiple surgeries: using the best available information to decide 09:40— The large, vascular nodule and implications for treatment 10:00— Measuring tumor volume: a shift from centimeters to milliliters (100 ml) 10:30— The importance of seeking a second opinion 10:50— RFA failed to provide a satisfactory response 11:10— Detailed comparison of MWA vs. RFA, including technical and clinical differences 12:00— Heat sink effect with RFA vs. sustained energy delivery with MWA 12:20— MWA's ultimate success in reducing nodule size 12:50— Dr. Kandil’s experience of performing over 5,000 thyroid surgeries 13:00— Emphasizing quality of life and preserving the thyroid, as explained by Dr. Kandil 14:30— The importance of having MWA as a treatment option 15:50— Treating out-of-state patients and the widespread demand for ablation technologies16:15— The patient reacts to the decision to avoid surgery 16:50— Failure of RFA highlighted again, reinforcing the shift to MWA 17:50— Not every surgeon is equal: the importance of experience and options 18:30— Discussing the “toolbox” of available treatments offered by different healthcare providers 19:30— The sterile hospital experience vs. the warmer, more personalized care at Dr. Kandil’s office 19:54— Dr. Kandil’s bedside manner: kindness, patience, and detailed explanations 20:40— Encouragement for patients to explore all available options; the medical community's resistance to adopting new technologies like ablation 21:30— Dr. Kandil’s experience with over 1,200 cases of thyroid ablation, establishing him as one of America's top doctors in the field
About Baird Medical
Baird Medical LLC, established in 2012 and headquartered in Guangzhou, China, is a leading developer and provider of minimally invasive medical devices specializing in microwave ablation (MWA) technology. In the U.S., the company continues to expand its reach, recently receiving FDA clearance to market its microwave ablation devices for thyroid treatment. @BairdMedical www.bairdmed.com
About Dr. Emad Kandil Dr. Emad Kandil is a renowned expert in endocrine and oncological surgery. He is the Chief of General, Endocrine, and Oncological Surgery at Tulane University in New Orleans, Louisiana. He holds the prestigious Elias Hanna Chair in Surgery and is celebrated for his groundbreaking work in minimally invasive thyroid treatments, including thyroid ablation. Dr. Kandil has performed over 1,000 thyroid ablation procedures, establishing himself as a leading figure in using this innovative treatment approach in the United States. @EmadKandilMD-z3dwww.emadkandil.com
About Philip James Philip James hosts the Doctor Thyroid podcast, a platform that provides patients with information on alternative thyroid treatments. His work focuses specifically on minimally invasive procedures like thyroid ablation. He aims to help patients avoid unnecessary thyroid surgeries, a mission close to him after his own experience with an unneeded surgery. @DoctorThyroid www.docthyroid.com
21 Oct 2017
62: Treating Thyroid Patients For 40 Years ⇒ Lessons Learned from Two Patients, with Dr. Elaine Kaptein from USC
00:24:51
A native of Saskatchewan, Canada, Dr. Kaptein began teaching at the Keck School of Medicine in the Endocrinology Division in 1977. She became a tenured Professor of Medicine in 1990, a position she currently holds. Dr. Kaptein is a distinguished member of the Western Society for Clinical Investigation, American Society of Nephrology, the Endocrine Society and the American Thyroid Association. An accomplished researcher and lecturer, Dr. Kaptein has been invited to speak on the topics of Endocrinology and Nephrology in such cities as Montreal, Milan, Tel Aviv, Jerusalem, Vienna and Rotterdam, to name a few.
In this interview, Dr. Kaptein discusses the need to consider each patient before making treatment decisions. In some cases, this may mean foregoing the removal of cancerous lymph nodes.
Pregnancy and Thyroid⎥Hypothyroidism and Hyperthyroidism, with Dr. Angela Leung from UCLA
00:19:42
Dr. Angela M. Leung is an Assistant Professor of Medicine at the UCLA David Geffen School of Medicine and an endocrinologist at both UCLA and the VA Greater Los Angeles Healthcare System.
After pursuing her undergraduate studies at Occidental College, Dr. Leung completed her internal medicine residency and endocrinology fellowship training at Boston University School of Medicine. She also studied at the Boston University School of Public Health and obtained a master's degree in Epidemiology.
Dr. Leung has particular clinical and research interests in thyroid disorders, and she also sees patients regarding parathyroid and adrenal disorders. She has published widely and lectures frequently on thyroid disease, including hyperthyroidism, hypothyroidism, thyroid nodules, thyroid cancer, and thyroid disease during pregnancy.
In this episode, the following topics are explained:
Optimizing thyroid health prior to conception
Thyroid issues that affect pregnancy
Hypothyroid as result of surgery or Hashimotos
Hyperthyroidism and pregnancy
Adjusting current thyroid treatment, meaning optimizing thyroid levels by adjusting dosage of thyroid medication
TSH levels in light of pregnancy
Planned pregnancy usually means a dose increase
What happens if someone does not get treatment during pregnancy?
Professional Triathlete, Ironman Champion, and Facing Thyroid Cancer with Karen Smyers
01:00:44
Karen Smyers has competed as a professional triathlete for 30 years. In her lengthy career, she has won seven National and four World Championship titles, including a dramatic come-from-behind victory in the Hawaiian Ironman World Championships in 1995. Her victory at the short-course ITU Triathlon World Championship just 5 weeks later still earns her the distinction of being the only woman ever to win triathlon’s two most prestigious races in the same year.
In this episode, we hear Karen describe what the calls, ‘character building’ moments, including how she approached thyroid cancer in the midst of of preparing for the 2000 Olympics.
Other obstacles included a torn hamstring, being hit by a 18-wheeler, and a broken collar bone. Regardless of the obstacle, Karen was able to stay focused on and win the Pro National Ironman Championship.
At 42 and post thyroid cancer, Karen gave birth to her second child.
Listen to this episode and you will be inspired by Karen’s determination, perseverance, and approach to living life to the fullest. And, in some cases pushing boundaries and achieving what some would say not possible.
Currently, Karen shares her experience, optimism, and passion for racing as a coach, motivational speaker and co-director of the Lincoln Kids Triathlon. She is a 1983 graduate of Princeton University and lives in Lincoln, MA with daughter Jenna, son Casey, and husband and frequent training partner Michael King.
Contact: 11 Giles Rd, Lincoln, MA 01773 mkandks@comcast.net www.karensmyers.com
19 Mar 2024
The Dangers of Thyroid Ablation and its Rapid Adoption
00:20:01
As the medical community swiftly embraces thyroid ablation, a groundbreaking non-surgical treatment for thyroid nodules, concerns arise about the potential risks associated with its rapid adoption. Key among these concerns is the lack of ultrasound expertise among practitioners and the contentious decision to treat nodules that may be too small to warrant intervention. This article delves into the insights of Dr. Jagdish Dhingra, a seasoned thyroid surgeon, who highlights the crucial balance between leveraging medical innovations and ensuring patient safety through skilled application and judicious treatment decisions.
In the rapidly evolving field of medical treatments, thyroid ablation stands out as a significant advancement, offering a non-surgical option for patients with thyroid nodules. However, the quick adoption of this technique across the United States has raised concerns among experts about its application and the potential risks involved. In a recent interview on the RFAMD podcast, hosted by Philip James, Dr. Jagdish Dhingra, a seasoned thyroid surgeon with over 25 years of experience, shared his insights on the dangers of the rapid embrace of thyroid ablation and the critical importance of skilled ultrasound technique in its success.
Goodwill missions to Africa
Dr. Dhingra, known for his extensive work and goodwill missions in Africa, particularly Rwanda, where he volunteers to perform surgeries on women affected by large goiters, emphasizes the need for caution. His annual trips to Africa highlight his commitment to addressing thyroid-related conditions and his expertise in managing complex cases.
Goiter in Colombia
The conversation also touched upon the impressive work of Dr. Juan Pablo Dueñas in Medellín, Colombia, who successfully treated a patient with a very large goiter using ablation. This case exemplifies the potential of thyroid ablation when applied correctly and with the requisite skill.
Dangers of thyroid ablation and ultrasound
However, Dr. Dhingra pointed out the significant risks associated with the procedure, especially when used for nodules that are too small or by practitioners lacking in precise ultrasound-guided techniques. He warned against the treatment of small, benign thyroid nodules with ablation, arguing that observation rather than intervention is often the best approach in such cases. The risks, including major vessel and nerve injury, are heightened in the absence of expertise in ultrasound guidance.
The expertise required for safe and effective thyroid ablation extends beyond surgical skills, involving proficiency in ultrasound to avoid damaging vital neck structures. This underscores the importance of comprehensive training and experience in both ultrasound and surgery for those performing thyroid ablations.
Thyroid ablation guidelines
As thyroid ablation gains popularity, Dr. Dhingra advocates for establishing and adhering to strict guidelines to ensure patient safety. These guidelines would ideally include rigorous training and qualification criteria for practitioners, akin to the well-defined protocols followed in countries like South Korea, which has successfully integrated thyroid ablation into their healthcare system.
How to find a thyroid ablation doctor?
For patients considering thyroid ablation, finding a qualified and experienced practitioner is crucial. Dr. Dhingra suggests visiting www.rfamd.com, a resource that can help patients connect with skilled ablation doctors. This platform provides an avenue for patients to seek treatment from professionals who are not only proficient in ultrasound-guided procedures but also have a thorough understanding of when ablation is appropriate.
The rapid adoption of thyroid ablation in the United States represents a double-edged sword; it’s a promising treatment that can significantly benefit patients when applied judiciously and with the proper expertise. However, without careful consideration of the risks and strict adherence to guidelines, its potential benefits could be overshadowed by adverse outcomes. As the medical community continues to embrace this innovative treatment, the emphasis must remain on patient safety, thorough practitioner training, and the judicious application of thyroid ablation.
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.
08 Dec 2020
88: For Some Thyroid Cancer Patients, No Surgery is the Best Treatment → Dr. Allen Ho from Cedars Sinai
00:43:13
Dr. Allen Ho is a fellowship-trained head and neck surgeon who focuses on head and neck tumors, including HPV(+) throat cancers and thyroid malignancies. As director of the Head and Neck Cancer Program and co-director of the Thyroid Cancer Program, he leads the multidisciplinary Cedars-Sinai Head and Neck Tumor Board, which provides consensus management options for complex, advanced cases. Ho’s research interests are highly integrated into his clinical practice. His current efforts lie in cancer proteomics, HPV(+) oropharyngeal cancer pathogenesis, and thyroid cancer molecular assays. He has presented his research at AACR, ASCO, AHNS, and ATA, and has published extensively as lead author in journals that include Nature Genetics, Journal of Clinical Oncology, Cancer, and Thyroid. Ho serves on national committees within the ATA and AHNS, and is principal investigator of a national trial on micropapillary thyroid cancer active surveillance (ClinicalTrials.gov ID: NCT02609685). He maintains expertise in transoral robotic surgery (TORS), minimally invasive thyroidectomy approaches, and nerve preservation techniques. Ho’s overarching mission is to partner with patients to optimize treatment and provide compassionate, exceptional care.
Weighing treatment options for thyroid cancer, with deep consideration for the patient’s lifestyle, could become the new norm in assessing whether surgery is the best path.
Dr. Allen Ho states, “if a patient is a ballerina or an opera singer, or any other profession that could be jeopardized due to undesired consequences of thyroid cancer surgery, then the best treatment path maybe active surveillance.” Undesired consequences of thyroid cancer surgery could be vocal cord paralysis, damage to the parathyroid glands resulting in calcium deficiencies, excessive bleeding or formation of a major blood clot in the neck, shoulder nerve damage, numbness, wound infection, and mental impairment due to hypothyroid-like symptoms. Or in the case of a ballerina, undesired scarring could jeopardize a career.
The above risks occur in approximately 10% of thyroid cancer surgeries. Although, some thyroid cancer treatment centers have a much more reduced incidence of undesired consequences, while others much higher.
In order to address the above and remove the risk of thyroid cancer surgery, Cedars-Sinai has become the first west coast hospital to launch an active surveillance study as optional treatment for thyroid cancer. The study includes 200 patients from across the country who have chosen the wait and see approach rather than hurry into a surgery that could result in undesired, major life changes. By waiting, this means these patients will dodge the need to take daily hormone replacement medication for the rest of their lives as the result of a thyroidectomy.
Other active surveillance research
Although this is the first study for active surveillance on the west coast, other studies are ongoing, including Sloan Kettering as directed by Dr. Tuttle, Kuma Hospital in Kobe as directed by Dr. Miyauchi, and the Dartmouth Institute as directed by Dr. Louise Davies.
The team
Dr. Ho says the “de-escalating” of treatment for thyroid cancer will become the new trend. The active surveillance thyroid cancer team at Cedars-Sinai is orchestrated to the patient’s needs, and includes the pathologist, endocrinologist, and surgeon.
87: Is There a Stigma when Choosing Active Surveillance? → Dr. Louise Davies from The Dartmouth Institute
00:30:40
The past year has been fascinating and highly fruitful year for Dartmouth Institute Associate Professor Louise Davies, MD, MS. A 2017-2018 Fulbright Global Scholar, Davis spent several months in Japan at the Kuma Hospital in Kobe, Japan, studying the hospital's pioneering surveillance program for thyroid cancer. Davies, the chief of otolaryngology-head & neck surgery-at the Veterans Affairs Medical Center in White River Junction, Vermont, has researched U.S. patients' experiences of monitoring thyroid cancers they self-identify as overdiagnosed, and has found that such patients often feel unsupported, even ostracized. Following her stay in Japan, Davies, who also develops and teaches courses in qualitative research methods in Dartmouth Institute's MPH programs, spent several months in the U.K. at the Health Experiences Research Group (HERG) at Oxford University. There, she learned skills that will help her develop web-based materials to raise public awareness about surveillance, surveillance programs, and overdiagnosis in general.
As if the year wasn't packed enough, Davies also visited the site of the Fukushima Daiichi nuclear power plant, site of the 2011 nuclear accident in Japan. Unrelated to her Fulbright work, Davies is a member of an international task force organized through the International Agency for Research on Cancer, a branch of the World Health Organization. The task force will make recommendations on the monitoring of the thyroid gland after nuclear accidents. Learn more about her incredible year and what's next for her research in overdiagnosis!
Q: As a practicing physician, how did your interest in overdiagnosis develop?
A: My interest in over diagnosis grew from my work with Dr. Gil Welch, dating back to 2004. He was and is a mentor to me, and we developed the work on thyroid cancer together. I have always had an interest in making sure that patients receive care that aligned with their values. The problem of overdiagnosis is particularly intriguing because if people do not understand the concept, they may undergo treatment that, had they understood more about their risks, they might not have elected. Finding ways to solve that problem has been a fascinating focus for me.
Q: Is overdiagnosis and/or overtreatment in thyroid cancer on the rise, if so what accounts for this increase?
A: Thyroid cancer incidence has more than tripled in the U.S. over the past 30 years. The majority of the increase has been due to the detection of small cancers, which we know exist as a subclinical reservoir in otherwise asymptomatic people. As more attention has been drawn to the problem of overdiagnosis, the rate of increase has slowed, which has been gratifying to see; although it has not stopped completely or reversed. In the most recent national guidelines on the treatment of thyroid cancer (from the American Thyroid Association), there has been a clear suggestion that treatment should be more conservative for the small cancers that are so commonly detected now. It is not yet clear how much of an impact these new guidelines have had on practice patterns.
Q: You've studied the experiences of patients who are diagnosed with thyroid cancer but choose not to intervene. What are some of the commonalities you've found? A: The patients who were the first to understand that their small, asymptomatic thyroid cancers picked up incidentally might not need immediate intervention, but instead could be monitored through regular checkups and active surveillance did not receive a lot of support from the medical community. Many managed their cancer by keeping it a secret, which can be stressful in itself, and several stopped getting follow ups-the recommended care if surveillance rather than interventions chosen for a small thyroid cancer. This was a unique group of patients who represented the first people to undertake what is a new and incompletely understood treatment option in the U.S. As such, they are probably more representative of people going against medical convention than thyroid cancer patients who elect to undertake surveillance, per se. Q: What will/have you been looking for when evaluating the surveillance program at Kuma Hospital? How will you combine this with your own U.S. pilot data? My goal in going to Kuma Hospital last fall was to understand more about the active surveillance program they have there. They were the first in the world to run such program and collect data on it, and have been doing so since 1993. I wanted to understand their data on active surveillance in more detail. I wanted to understand the patient experience of being on surveillance, and how the program worked operationally. I was able to do all those things and gathered patient experience data through a survey as well as interviews. I also was lucky to get to spend a fair amount of time in the operating room, where I learned a number of new surgical techniques that will advance my own practice in thyroid surgery. My goal is to report what I learned at Kuma Hospital as broadly as possible, so that people in the U.S. begin to feel comfortable adopting active surveillance as a method of managing the early thyroid cancers that are appropriate candidates for surveillance.
What's next for you in overdiagnosis research? My work on the task force about thyroid monitoring after nuclear power plant accidents has given me a new appreciation for the complexity of public health communication about risk, emergency preparedness, and the problem of over diagnosis when it comes to policy setting. I hope to be able to continue to contribute in other ways to the broader public health discussion about over diagnosis. In my next steps looking at the epidemiology of thyroid cancer, I plan to focus on understanding more about why we see such variation in thyroid cancer incidence across geography, age groups, and gender.
Dr. Volpi on Thyroid Ablation: Future of Cancer Treatment
00:05:35
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.
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.
30 May 2021
Thyroid Cancer Is Not Going to Kill You (Papillary), with Dr. Amanda Laird from Rutgers Cancer Institute of NJ
00:24:44
Dr. Amanda Laird, MD is an endocrine surgeon and Chief of Endocrine Surgery at the Rutgers Cancer Institute of New Jersey in New Brunswick, New Jersey. She is currently licensed to practice medicine in New Jersey and New York. She is affiliated with Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Hospital.
In this interview, Dr. Laird reflects on a decade of treating papillary thyroid cancer patients and reports none have died. In this interview we also explore these questions:
Prognosis and what will happen in the long run and quality of life.
Surgery complications.
Levothyroxine side-effects, including weight gain.
Life after surgery and RAI.
What causes thyroid cancer.
What time of day to take thyroid replacement medication.
What blood tests should be ordered and is fasting necessary prior to thyroid lab work.
The Evolving Landscape of Thyroid Ablation in 2024 with Dr. Mauri
00:27:17
Innovations and Issues: from the RFAMD podcast hosted by Philip James
In recent years, a medical revolution has been quietly taking place in the treatment of thyroid conditions. Thyroid ablation, a procedure that offers an alternative to traditional surgery, is gaining popularity across the globe, particularly in the United States following its FDA approval. Dr. Giovanni Mauri , a leading interventional radiologist from Milan and recognized as one of the top 2% scientists by Stanford University, shares insights into the advancements and challenges of this transformative treatment.
The concept of thyroid ablation isn't new; Italy saw its inception 25 years ago with experimental treatments beginning in the year 2000. However, the last three years have marked a significant turn with rapid expansion and adoption of the technique worldwide. According to Dr. Mauri, this surge is largely thanks to procedural innovations and international collaborations, notably from South Korea, where specialized devices have propelled the practice forward.
Thyroid ablation works by using heat (or other methods) to destroy thyroid tissue, thus alleviating various thyroid-related conditions without the need for invasive surgery. This method preserves thyroid function and enhances patients' quality of life, a point Dr. Mauri emphasizes with great passion. The procedure is particularly appealing because it offers a quick recovery and significant reduction in health risks compared to traditional surgeries.
The technique's adoption has seen a parallel rise in educational initiatives, with training programs proliferating globally to ensure that practitioners can safely and effectively perform ablations. Dr. Mauri himself is involved in such programs, including the MIT group and the Savior Thyroid School, highlighting the importance of proper training and the use of high-quality simulation tools.
However, this rapid expansion is not without its problems. Dr. Mauri voices concerns about the steep learning curve associated with the procedure. He notes that many practitioners eager to incorporate thyroid ablation into their practice might not fully appreciate the complexities involved, particularly the critical role of ultrasound in guiding the ablation process. This can lead to suboptimal outcomes, making thorough training and patient selection paramount.
Moreover, the innovation in thyroid ablation tools has broadened, spanning from radiofrequency devices to newer, potentially more effective technologies like microwave ablation and non-thermal methods, which promise to treat without thermal damage. Such advancements underscore a dynamic field set on improving and refining therapeutic options for patients with thyroid conditions.
Yet, the allure of new technology also brings challenges. The push for rapid adoption can overshadow the necessity for comprehensive training and understanding of the intricacies involved. Stories of complications and inadequate patient selection serve as cautionary tales highlighting the need for regulatory frameworks and better educational resources for healthcare providers.
As thyroid ablation continues to grow, so does the dialogue around its practice. Dr. Mauri calls for more open discussions to explore the limits and possibilities of this technique, ensuring that it remains a safe and beneficial treatment option. Through these conversations, the medical community hopes to navigate the complexities of innovation while maintaining the highest standards of patient care.
While thyroid ablation stands as a beacon of progress in medical treatments for thyroid conditions, it requires a balanced approach of innovation, education, and ethical practice. As we look to the future, the contributions of pioneers like Dr. Mauri and ongoing global collaboration will be crucial in shaping the path forward for this promising medical advancement.
35: Rethinking Thyroid Cancer - When Saying No to Surgery Maybe Best for You with Dr. Allen Ho from Cedars-Sinai in Los Angeles
00:43:12
Weighing treatment options for thyroid cancer, with deep consideration for the patient’s lifestyle, could become the new norm in assessing whether surgery is the best path.
Dr. Allen Ho states, “if a patient is a ballerina or an opera singer, or any other profession that could be jeopardized due to undesired consequences of thyroid cancer surgery, then the best treatment path maybe active surveillance.” Undesired consequences of thyroid cancer surgery could be vocal cord paralysis, damage to the parathyroid glands resulting in calcium deficiencies, excessive bleeding or formation of a major blood clot in the neck, shoulder nerve damage, numbness, wound infection, and mental impairment due to hypothyroid-like symptoms. Or in the case of a ballerina, undesired scarring could jeopardize a career.
The above risks occur in approximately 10% of thyroid cancer surgeries. Although, some thyroid cancer treatment centers have a much more reduced incidence of undesired consequences, while others much higher.
In order to address the above and remove the risk of thyroid cancer surgery, Cedars-Sinai has become the first west coast hospital to launch an active surveillance study as optional treatment for thyroid cancer. The study includes 200 patients from across the country who have chosen the wait and see approach rather than hurry into a surgery that could result in undesired, major life changes. By waiting, this means these patients will dodge the need to take daily hormone replacement medication for the rest of their lives as the result of a thyroidectomy.
Other active surveillance research
Although this is the first study for active surveillance on the west coast, other studies are ongoing, including Sloan Kettering as directed by Dr. Tuttle, Kuma Hospital in Kobe as directed by Dr. Miyauchi, and the Dartmouth Institute as directed by Dr. Louise Davies.
The team
Dr. Ho says the “de-escalating” of treatment for thyroid cancer will become the new trend. The active surveillance thyroid cancer team at Cedars-Sinai is orchestrated to the patient’s needs, and includes the pathologist, endocrinologist, and surgeon.
About Dr. Allen Ho
Allen Ho, MD, is a fellowship-trained head and neck surgeon who focuses on head and neck tumors, including HPV(+) throat cancers and thyroid malignancies. As director of the Head and Neck Cancer Program and co-director of the Thyroid Cancer Program, he leads the multidisciplinary Cedars-Sinai Head and Neck Tumor Board, which provides consensus management options for complex, advanced cases. Ho's research interests are highly integrated into his clinical practice. His current efforts lie in cancer proteomics, HPV(+) oropharyngeal cancer pathogenesis, and thyroid cancer molecular assays. He has presented his research at AACR, ASCO, AHNS, and ATA, and has published extensively as lead author in journals that include Nature Genetics, Journal of Clinical Oncology, Cancer, and Thyroid. Ho serves on national committees within the ATA and AHNS, and is principal investigator of a national trial on micropapillary thyroid cancer active surveillance (ClinicalTrials.gov ID: NCT02609685). He maintains expertise in transoral robotic surgery (TORS), minimally invasive thyroidectomy approaches, and nerve preservation techniques. Ho’s overarching mission is to partner with patients to optimize treatment and provide compassionate, exceptional care.
47: Treatment of Thyroid Cancer in Japan, with Dr. Takahiro Okamoto from Tokyo Women’s Medical University
00:30:12
This episode is recorded from Boston and the World Congress on Thyroid Cancer, where leading doctors and researchers have gathered to share the latest medical research and trends related to thyroid disease.
At the Congress, Dr. Okamoto presented on Thyroid Cancer Guidelines Around the World
He helped write the Japanese guidelines on thyroid cancer. He is Professor & Chair of the Department of Surgery at Tokyo Women’s Medical University.
Key points from this episode include:
Most Western countries carry out total thyroidectomies, whereas in Japan, the approach is more conservative with a fundamental practice of hemithyroidectomy whenever possible.
By not doing a total thyroidectomy, this allows the patient to not avoid taking thyroid replacement medication.
Complete thyroidectomy is conducted when 80-90% of lymph nodes have metastasis.
I-131 treatment is decreasing despite cases of cancer increasing
For I-131 treatment, patients wait more than 6 months post surgery.
When receving I-131 treatment, patients be admitted to hospital for several days.
TSH suppression therapy is common in Western countries, whereas in Japan, measures are taken to avoid TSH suppression by not removing all of the thyroid.
Normal TSH in Japan is 4.3 or less.
Culturally, Japanese patients are typically conservative compared to Western countries. Even high risk patients opt for no TT.
In Japan people are less aggressive and more patient as a culture, and this is reflected in their approach to treating thyroid cancer.
For medullary thyroid cancer, treatment management differs in japan. In Westerm countries, they receive TT. But, in Japan, if its not familial it is treated with hemithyrodectmy. Only when familial, is it treated with TT.
Calcitonin
Follicular diagnosis is difficult, benign and malignant is a big issue.
Active surveillance is spreading now, the question is why? We must consider the patient’s view. Research from Japan focuses on the size of tumor, but must consider patient’s view.
Levothyroxine and Hair Loss ⎥Thyroid Health, with Dr. Susanne Breen
01:01:53
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
Dr. Greg Randolph on Patient-Centered Approaches to Thyroid Nodule Treatment
00:10:12
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.
30 Sep 2021
A Must Listen Episode Before Getting Surgery - Do Not Do It Alone, with Dr. VanNostrand
00:33:56
Dr. Douglas Van Nostrand, MD is the Director of Nuclear Medicine and the Program Director of the Nuclear Medicine Residency Program at Washington Hospital Center and Professor of Medicine, Georgetown University Hospital Center.
His specialty is nuclear medicine, and his primary area of interest and expertise is the nuclear medicine diagnosis and treatment of thyroid cancer. He has held numerous academic and medical society positions including Clinical Professor of Radiology and Nuclear Medicine, Uniformed Services University of Health Sciences; past President, Mid-Eastern Society of Nuclear Medicine, Director of Continuing Medical Education Department, and other elected positions of the Medical Staff of Good Samaritan Hospital. He has over 150 articles published and has been the co-editor of seven medical books including the medical textbook entitled Thyroid Cancer, A Comprehensive Guide to Clinical Management.
In this episode, get the critical questions to ask prior to committing to a surgeon. And, other useful strategies to make sure a patient gets the best outcome possible.
29 Sep 2017
59: No Biopsia es 100% Exacta⎥Exámenes Moleculares son los Mejores, con Dr. Paul Y. Casanova
00:34:46
Dr. Paul Y. Casanova-Romero, M.D., M.P.H., F.A.C.P., F.A.C.E, E.C.N.U, que se unió a Palm Beach Diabetes y Endocrine Specialists en 2012, recibió su grado médico con honores (Summa Cum Laude) y Doctor en Ciencias Médicas (DMSc), de la Universidad de Zulia, la Escuela de Medicina en Venezuela. Posteriormente se unió a la facultad de su Alma Mater y en 1998, el Grupo de Investigación del Programa de Prevención de la Diabetes (D.P.P.) en el Instituto de Investigación de la Diabetes-Universidad de Miami. Completó su posgrado en Medicina Interna y Endocrinología (Jackson Memorial Hospital) y estudios de postgrado en Salud Pública (M.P.H.) con el Premio de Mérito Académico en la Universidad de Miami.
Un consultor privado endocrinólogo y orador nacional desde 2006, el Dr. Paul Y. Casanova-Romero de investigación extensa sobre la prevención de la diabetes, trastornos de la tiroides, síndrome metabólico y otros trastornos endocrinos han sido ampliamente publicadas. Sigue colaborando en estudios de investigación en Estados Unidos y Latinoamérica, el más reciente en pruebas moleculares de tiroides. El Dr. Casanova-Romero está certificado por la Junta en Medicina Interna, así como en Endocrinología, Diabetes y Metabolismo. Es miembro del Colegio Americano de Endocrinología (F.A.C.E.) y miembro del Colegio Americano de Médicos (F.A.C.P.). Actualmente es profesor voluntario de medicina en la Universidad de Miami.
Dr. Paul Y. Casanova-Romero se especializa en el tratamiento de la enfermedad de la tiroides incluyendo nódulos tiroideos, hipotiroidismo, hipertiroidismo y cáncer de tiroides, enfermedad paratiroidea, diabetes, pre-diabetes, trastornos lipídicos y otros trastornos endocrinos. Él ha estado usando la prueba molecular para la caracterización de los nódulos de la tiroides desde 2010. Él ha satisfecho con éxito los requisitos para la certificación endocrina en el ultrasonido del cuello (ECNU) para realizar la biopsia internamente guiada por ultrasonido de la aspiración de la aguja fina de nódulos de tiroides, de la paratiroides, nodos.
Es miembro del panel de membresía de la American Thyroid Association, miembro activo de la Endocrine Society, la Asociación Americana de Endocrinólogos Clínicos, la American Diabetes Association, el American College of Physicians y la National Lipid Association.
En esta entrevista hablamos sobre esta temas:
¿Cómo se identifican los nódulos y por qué ocurren? autoexamen o en la oficina del médico
La mayoría de los nódulos son benignos pero ocurren porque en mas de 70% de la población
¿Qué tests puede realizar un médico para evaluar el nódulo?
Ninguna test es 100%
Ultrasonido - qué están buscando en general
Que es ojo fina y el proceso general
Tests moleculares
¿Qué tipos de resultados se pueden obtener de la citología y qué significan?
La mayoria de ojo finas son benigno
Maligno o sospechoso de malignidad, todavía tiene la posibilidad de no ser cáncer
Los arco iris - 3,4,5 - indeterminate categoria
Systema BETHESDA
¿Qué tests adicionales se pueden realizar para resolver los nódulos indeterminados? - Tests moleculares
Que son todas los tests moleculares? Y son las mismas?
Dr. Casanova prefiere usar test de Afirma, este es por que
97: What You Must Know About Hashimoto's Disease with Dr. Brittany Henderson
00:55:41
Brittany Henderson, MD, ECNU is board-certified in internal medicine and endocrinology, with advanced training in thyroid disorders, including Hashimoto’s thyroiditis, Graves Disease, thyroid nodules, and thyroid cancer. Originally from Cleveland, Ohio, she graduated in the top 10% of at her class at Northeastern Ohio Medical University, where she received the honor of Alpha Omega Alpha (AOA). She completed her endocrinology fellowship training under a National Institutes of Health (NIH) research-training grant at Duke University Medical Center. She then served as Medical Director for the Thyroid and Endocrine Tumor Board at Duke University Medical Center and as Clinical Director for the Thyroid and Endocrine Neoplasia Clinic at Wake Forest University Baptist Medical Center.
Topics discussed in this episode include:
How to interpret my thyroid results?
Why did I get this? Is it something I did?
Thyroid controls nearly all body systems: heart, weight, brain, bowel.
Testing and diagnosis: beyond blood-work
TSH is the most common check
TSH is like the reading of your electric meter: it tells you big picture for a month, not daily — it is not a fluid system, it changes by the hour
TSH is not the cure all for reading thyroid health
Full thyroid panel: Free T4 and Free T3 is important — highest in morning, lowest around 2p or 3p in the afternoon
There is no one size fits all to Hashimoto’s — there are different types
Blood tests: preparing for lab tests
‘Normal’ TSH but a patient does not feel normal
Normal TSH range is controversial — .5 to 3 TSH is normal — if on thyroid replacement target 1.5
Suppressed TSH
Dangers of suppressed TSH for thyroid cancer replacement or those on too much on thyroid replacement — heart failure, osteoporosis
T3 symptoms of TSH is kept too low for too long
The T4 — T3 relationship
T4 is money in savings account — but you cant use it now — T3 is money in your pocket and available now
Preferred thyroid replacement — but, issues with synthetic and desiccated
The goal — T4 and T3 as stable as possible throughout the day — in light of absorption and interfering food
Compounded medications
A doctor must listen to the patient
Generic levothyroxine and fillers — who is the manufacturer
What is better, Nature or Armour?
Why do some people do better on various thyroid replacement formulations?
Gut biome
The environment and thyroid disease
Defining leaky gut
Avoid foods that gut inflammation thereby worsening auto-immune disease
Three food foes: processed foods, sugar, and iodine disruptors
Is adrenal fatigue real?
Supplements: vitamins and Hashimoto’s
Nutrients needed to produce thyroid hormone, such as optimizing iron and selenium
Anti-inflammatory vitamins and Vitamin A and Vitamin D
Anti-oxidant vitamins — Vitamin B1, Vitamin C, and Glutathione
What time of day to take to thyroid replacement medication
What happens if you miss a day of thyroid replacement hormone?
What does an endocrinologist feel about a patient seeing a Naturopath or an integrative medicine specialist?
17: Información Clave Para Saber Sobre el Cáncer de Tiroides y La Cirugía con el Doctor Fabián Pitoia
00:25:53
El Dr Fabián Pitoia es Médico Endocrinólogo, es Jefe de la Sección Tiroides y Coordinador del Área Investigación de la División Endocrinología del Hospital de Clínicas - Universidad de Buenos Aires, es Docente adscripto de la Facultad de Medicina - Jefe de Trabajos prácticos de Medicina B (Facultad de Medicina - UBA) y Docente de la Carrera de Especialistas en Endocrinología y Metabolismo de la UBA.
Especialidad recertificada en Diciembre de 2013.
El Dr Pitoia tiene más de 200 publicaciones de sus investigaciones, más de 50 listadas en Pubmed, ha sido primer autor de las Guías Latinoamericanas para el diagnóstico y tratamiento del cáncer de tiroides, también el primer autor de las Guías Intersocietarias Argentinas para manejo de pacientes con cáncer de tiroides 2014.
En esta entrevista, discutiremos:
Los síntomas que una experiencia del paciente puede saber que tienen un problema
Si cirugía siempre es una necesidad
Cuándo se quita sólo la mitad de la tiroides?
Cómo ayuda la patología en el diagnóstico?
Cuál es la mejor manera de encontrar un buen cirujano?
Los análisis de sangre relacionados con los pacientes con tiroides?
40: New Research Reveals Thyroid Surgery Errors 5x More Frequent Than Reported with Dr. Maria Papaleontiou from Michigan Medicine
00:30:26
I sometimes get asked, why am I doing this podcast?
What started out as a pet project is now being listened to in over 30 countries and with as many as 20000 downloads per episode. So far, thyroid patients are embracing the opportunity to hear from the world’s leading thyroid doctors, and gaining the information needed to make better decisions related to health.
So why did I start Doctor Thyroid?
My motivation for doing this podcast is to help patients avoid bad experiences related to thyroid cancer and thyroid disease, including bad surgery. And, provide resources to help make better health decisions and improve quality of life.
My thyroid surgery resulted in errors, which have downgraded my quality of life significantly. Knowing what I know now, I would have picked a different surgeon, or chosen no surgery at all. Because, as this interview will discuss, although perceived as safe, thyroid surgery is not without risks.
To be published next month, new research reveals thyroid surgery errors are five times more likely than previously reported.
The study was conducted by Dr. Maria Papaleontiou. She is an Assistant Professor of Internal Medicine with an appointment in the Division of Metabolism, Endocrinology and Diabetes. She graduated medical school from the prestigious Charles University in the Czech Republic and subsequently spent several years conducting research at the Geriatrics Division at Weill Cornell Medical College. She then completed her internal medicine residency at Saint Peter’s University Hospital in New Jersey and her endocrinology fellowship at the University of Michigan. She joined the faculty at the University of Michigan in 2013. She is a recipient of Fulbright and Howard Hughes Medical Institute scholarships. Dr. Papaleontiou’s practice focuses on thyroid disorders and thyroid cancer. She is especially interested in the treatment of endocrine disorders in older adults. She also conducts health services research in the field of thyroidology and aging.
03: Diagnosis - Identifying Thyroid Cancer More Quickly and with Greater Accuracy with Dr. Joseph Sniezek
00:38:28
Hear about the advances in thyroid ultra sound technology, along with the patient process from diagnosis to surgery. Key topics in this episode include how to research a surgeon, requesting a second opinion, selecting the best hospital, and the challenges faced when operating on the neck.
This episode features Dr. Joseph Sniezek, who is the Medical Director of Head & Neck Endocrine Surgery for Swedish Health Services.
Too often, the time between being told by your doctor to get an ultrasound to biopsy, often results in anxiety and a disconnect between surgeon - radiologist - pathologist. Now, with better technology, especially in the area of ultra sound, the multiple trips to specialists can be eliminated.
13 Dec 2016
10: Recovering From Thyroid Cancer Surgery, Faster, Better, and Stronger
00:46:14
This interview is a part of the lifestyle stories featured on the Doctor Thyroid podcast, an opportunity to hear from athletes and overachievers, and how they approach their diagnosis, surgery, and recovery.
In this case, we hear from Evan Simon, Head Strength and Conditioning Coach at Oregon State University. Evan was diagnosed with advanced Stage IV thyroid cancer, which resulted a 13 hour surgery. At the end of his surgery, Evan was told he would not be able to lift his hands overhead for 3 months, instead he broke the odds, taking him only 3 weeks.
Evan shares with us, his approach to first hearing the news, how he chose to share the news with his family, including his two young daughters, and what he did to speed his recovery. Evan will offer you tips to improve better your recovery, including physical rehabilitation and having an optimistic mindset.
During the interview, we also hear from special guest, Stasi Kasianchuk, MS, RD, Sports Dietitian at Oregon State University. Staci shares her experience in treating Evan through nutrition as a means to a better recovery, and improved lifestyle post-surgery.
25 Feb 2024
Revolutionizing Thyroid Care: Dr. Julia Noel Discusses Ablation and Innovation on The RFAMD Podcast
00:30:36
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 Jameswelcomed a trailblazer in the field of thyroid treatment, Dr. Julia Noelof 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.
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.
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
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 🔹🔹🔹
01 Dec 2016
08: The Financial Burden of Thyroid Cancer with Dr. Jonas de Souza
00:10:42
Dr. Jonas de Souza, Assistant Professor of Medicine, specializes in the treatment of head and neck cancer, including thyroid cancer at the University of Chicago.
Talking points of this episode:
Financial toxicity
What is the COST tool?
Patient-Centered Outcomes Research?
When is the best time to discuss costs with the thyroid cancer patient?
Who is most at risk of the increased financial burden of thyroid cancer?
How can a patient best prepare for the costs of thyroid cancer?
Dr. Emad Kandil EXPOSES the TRUTH About MWA v RFA for Thyroid Ablation
00:15:13
In this in-depth interview, Dr. Emad Kandil, a leading expert in thyroid ablation at Tulane University, discusses the advanced technique of Microwave Ablation (MWA) for treating thyroid nodules. Dr. Kandil explains the science behind MWA, how it compares to Radiofrequency Ablation (RFA), and addresses common misconceptions such as concerns over excessive heat. He also explores the benefits of MWA over traditional thyroid surgery, including the preservation of thyroid function and the minimization of complications.
This discussion is precious for medical professionals, researchers, and individuals interested in innovative, minimally invasive treatments for thyroid conditions. Dr. Kandil emphasizes the importance of practitioner expertise in ensuring successful outcomes and offers insight into the decision-making process for selecting the most appropriate treatment method.
This video offers expert-level insights if you're seeking an advanced, technical understanding of the latest thyroid ablation technologies and treatment options.
About Baird Medical
Baird Medical LLC, established in 2012 and headquartered in Guangzhou, China, is a leading developer and provider of minimally invasive medical devices specializing in microwave ablation (MWA) technology. In the U.S., the company continues to expand its reach, recently receiving FDA clearance to market its microwave ablation devices for thyroid treatment.
Dr. Emad Kandil is a renowned expert in endocrine and oncological surgery. He is the Chief of General, Endocrine, and Oncological Surgery at Tulane University in New Orleans, Louisiana. He holds the prestigious Elias Hanna Chair in Surgery and is celebrated for his groundbreaking work in minimally invasive thyroid treatments, including thyroid ablation. Dr. Kandil has performed over 1,000 thyroid ablation procedures, establishing himself as a leading figure in using this innovative treatment approach in the United States.
Philip James hosts the Doctor Thyroid podcast, a platform that provides patients with information on alternative thyroid treatments. His work focuses specifically on minimally invasive procedures like thyroid ablation. He aims to help patients avoid unnecessary thyroid surgeries, a mission close to him after his own experience with an unneeded surgery.
@DoctorThyroid www.docthyroid.com
16 Jun 2021
Hypothyroidism — Diagnosis, Treatment, and Medication with Dr. Leonard Wartofsky from MedStar
00:35:06
Dr. Wartofsky is Professor of Medicine, Georgetown University School of Medicine and Chairman Emeritus, Department of Medicine, MedStar Washington Hospital Center. He trained in internal medicine at Barnes Hospital, Washington University and in endocrinology with Dr. Sidney Ingbar, Harvard University Service, Thorndike Memorial Laboratory, Boston. Dr. Wartofsky is past President of both the American Thyroid Association and The Endocrine Society. He is the editor of books on thyroid cancer for both physicians and for patients, and thyroid cancer is his primary clinical focus. He is the author or coauthor of over 350 articles and book chapters in the medical literature, is recent past Editor-in-Chief of the Journal of Clinical Endocrinology & Metabolism, and is the current Editor-in-Chief of Endocrine Reviews.
In this episode, Dr. Wartofsky discusses the following:
Hypothyroidism causes
When is replacement thyroid hormone necessary?
The history of replacement thyroid hormone going back to 1891
The early treatment included a chopped up sheep thyroid and served as a ‘tartar’, often resulting in vomiting
Myxedema coma
The danger of taking generic T4; are cheaper, larger profit margin, but the content varies.
Synthroid versus generic
Manufacturing plants in Italy, India, Puerto Rico are known to produce generics
Content versus absorption when taking generic T4
An explanation of TSH
1.39 is a healthy TSH level for women in the U.S.
Symptoms of hypothyroidism, such as a slow mind, poor memory, dry skin, brittle hair, slow heart rate, problems with pregnancy, miscarriage, and hypertension.
Screening TSH levels if contemplating pregnancy
T4 is the most prescribed drug in the U.S.
Hypothyroidism is common when there is a family history
Auto-immune disease is often associated with hypothyroidism
An explanation of T3
An explanation of desiccated thyroid
The T3 ‘buzz’
Muhammed Ali’s overdose of T3
Dangers of too much T3
When to take T4 medication, and caution toward taking mediations that interfere with absorption
Coffee and thyroid hormone absorption
Losing muscle and bone by taking too much thyroid hormone
What Do You Do For a Living?⎥Why It Matters, with Dr. Ashok R. Shaha from MSKCC
00:50:56
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.
Diagnosed with Thyroid Cancer and You Say No to Surgery with Dr. Louise Davies
00:28:33
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:
How big is the tumor?
How was the tumor discovered?
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.
91: Thyroid Cancer Patients Report Poor Quality of Life After Diagnosis and Treatment → Dr. Aschebrook and Dr. Grogan from UChicago Medicine
00:46:33
The 5-year survival rate for invasive thyroid cancer is 97.9%, and the 10-year survival rate is more than 95%, according to the National Cancer Institute. This leads some people to refer to it as a "good cancer."
“The idea behind that ‘good cancer’ statement is a positive one,” said study co-author Raymon Grogan, MD, Assistant Professor of Surgery at the University of Chicago Medicine, in Chicago, IL. “It is physicians trying to make people feel better. But, I think it’s had the opposite effect over time.”
The number of thyroid cancer survivors is rising rapidly due to the combination of an increasing incidence, high survival rates, and a young age at diagnosis, according to Dr. Grogan and co-author Briseis Aschebrook-Kilfoy, PhD, Assistant Research Professor in Epidemiology at the University of Chicago Medicine, who lead the North American Thyroid Cancer Survivorship Study (NATCSS).
The incidence of thyroid cancer will double by 2019 and thyroid cancer survivors could soon represent up to 10% of all cancer survivors in the United States, the researchers predicted.
But there’s a difference between surviving and living happily ever after. Once treatment is over, thyroid cancer survivors then face a high rate of recurrence and an anxiety-filled lifetime of cancer surveillance. When the researchers heard clinic patients express these survival concerns firsthand, they sought to study this poorly investigated area.
The investigators recruited 1,174 thyroid cancer survivors whose mean time from diagnosis was 5 years (89.9% were female, average age was 48), and evaluated their quality of life using a questionnaire that assessed physical, psychological, social, and spiritual wellbeing on a 0-10 scale, with 0 being the worst.
Survivors of thyroid cancer reported worse quality of life—with an average overall score of 5.56 out of 10—than the mean quality of life score of 6.75 reported by survivors of other cancer types (including colorectal and breast) that have poorer prognoses and more invasive treatments.
“I think we all have this fear of cancer that has been ingrained in our society,” Dr. Grogan said. “So, no matter what the prognosis is, we’re just terrified that we have a cancer. And, I think this [finding] shows that.”
Thyroid cancer survivors who were younger, female, less educated, and those who participated in survivorship groups all reported even worse quality of life than other study participants. However, after 5 years of survival, quality of life gradually began to increase over time in both women and men, the researchers found.
In order to further understand the psychological wellbeing of the growing number of thyroid cancer survivors, the researchers plan to continue to follow this cohort for the long term.
73: The Aggressive Mission to Find Cancer is Going Too Far? with Dr. Gilbert Welch from The Dartmouth Institute
00:37:34
H. Gilbert Welch, MD, MPH
An internationally recognized expert on the effects of medical screening and over-diagnosis
Dr. Gilbert Welch’s work is leading many patients and physicians think carefully about what leads to good health. For Welch, the answer is often “less testing” and “less medicine” with more emphasis on non-medical factors, such as diet, exercise, and finding purpose in life.
Welch’s research examines the problems created by medicine’s efforts to detect disease early: physicians test too often, treat too aggressively, and tell too many people that they are sick. Most of his work has focused on overdiagnosis in cancer screening: in particular, screening for melanoma, thyroid, breast, and prostate cancer. He is the author of three books: Less Medicine, More Health: 7 Assumptions That Drive Too Much Health Care (2015), Overdiagnosed: Making People Sick in the Pursuit of Health(2012), and Should I Be Tested for Cancer? (2006). His op-eds on health care have appeared in numerous national media outlets, including the Los Angeles Times, The New York Times, the Washington Post, and the Wall Street Journal.
Welch is a professor of medicine at the Geisel School of Medicine, an adjunct professor of business administration at the Tuck School of Business, and an adjunct professor of public policy at Dartmouth College. He has initiated and taught courses on health policy, biostatistics, and the science of inference.
In this episode, the following topics are discussed:
overdiagnosis is about how its found, and is a side effect of screening
when screening for early forms of cancer
some cancer is never going to cause the patient problems
some cancer never becomes clinically evident
we are looking so hard for cancer, that there is more than is possible
birds, rabbits, turtles
can’t fence in birds or aggressive cancers
rabbits you can catch if you build enough fences
turtles aren’t going anywhere anyway
certain organs have a lot of turtles, prostate, lung, thyroid, breast
ovedrdiagniosis only occurs when we are trying to look for early forms
screening can benefit, but also cause harm
breasts, prostate, and thyroid carry a lot of cancers.
overcoming cancer phobia, and reducing patient anxiety.
the best test is not the one that finds the most cancers, the best test is to find the ones that matter
Monitoring Recurrence of Thyroid Cancer by Measuring Thyroglobulin (Tg) and TgAb with Dr. Spencer
00:18:52
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
19 Jun 2021
You Have a Thyroid Nodule? This is what happens next - with Dr. Regina Castro from The Mayo Clinic
00:20:38
This episode details the medical approach to thyroid nodules. Topics include:
• 60% of the U.S. population has thyroid nodules
• Discovered when evaluating other neck issues such as an unrelated pain
• What happens when you are told you have a thyroid nodule?
• How to know if your thyroid nodule is cancerous?
• When is surgery done despite the nodule being benign?
• Decreasing patient anxiety with quick biopsy results
• The American Thyroid Association as a resource for patients and physicians
• A word of caution about sourcing medical information from online resources
Dr. M Regina Castro is an endocrinologist in Rochester, Minnesota and is affiliated with Mayo Clinic. She received her medical degree from Central University of Venezuela and has been in practice for more than 20 years. Dr. Castro accepts several types of health insurance, listed below. She is one of 78 doctors at Mayo Clinic who specialize in Endocrinology, Diabetes & Metabolism. She also speaks multiple languages, including Spanish and French.
Thyroid Cancer Disappears WITHOUT SURGERY: Dr. Emad Kandil from Tulane University
00:12:34
Dr. Emad Kandil, one of the leading thyroid surgeons in the U.S. and a pioneer in non-surgical thyroid cancer treatment, is featured in this video discussing the benefits of thyroid ablation as an alternative to surgery.#thyroidnodule#thyroidcancer#thyroidsurgery
Based at Tulane University, Dr. Kandil has successfully treated numerous patients using this minimally invasive procedure, which allows for the targeted destruction of cancerous thyroid nodules without removing the thyroid gland.
00:01-08:03The patient story told by Vanessa: "you have thyroid cancer" 08:04-12:38Dr. Kandil discusses treating thyroid cancer without surgery
In this case, Dr. Kandil treated Vanessa, who was initially diagnosed with a 1.5 cm thyroid nodule and advised by her first doctor to undergo a total thyroidectomy. Concerned about the lifelong consequences of surgery, including the need for thyroid hormone replacement, Vanessa sought out Dr. Kandil, who recommended thyroid ablation.
🛑 Three months after the procedure, her follow-up ultrasound revealed no detectable cancer, highlighting the effectiveness of ablation.
The video thoroughly discusses the thyroid ablation process, including Dr. Kandil’s patient-centered approach, the technical aspects of the procedure, and the post-ablation outcomes. Thyroid ablation is a promising option for patients with small, early-stage thyroid cancers who wish to avoid surgery and its associated complications. Dr. Kandil shares insights into why ablation may be a preferred treatment for preserving the thyroid while achieving cancer-free results.
Key points covered:
🔹 Dr. Kandil’s expertise in thyroid ablation and patient care
🔹 The non-surgical alternative for treating thyroid cancer
🔹 Patient outcomes following thyroid ablation
🔹 Comparison of thyroidectomy and ablation techniques
This video is intended for viewers seeking an evidence-based understanding of thyroid ablation as a viable alternative to surgery.
About Baird Medical
Baird Medical LLC, established in 2012 and headquartered in Guangzhou, China, is a leading developer and provider of minimally invasive medical devices specializing in microwave ablation (MWA) technology. The company focuses on advanced treatments for thyroid nodules, offering patients a non-surgical alternative to traditional procedures. Baird Medical's MWA devices are used globally for the treatment of both benign and malignant tumors, including thyroid, liver, and lung cancers.
With a solid commitment to innovation and improving patient outcomes, Baird Medical has become the first company in China to receive a Class III medical device registration certificate for MWA systems. In the U.S., the company continues to expand its reach, recently receiving FDA clearance to market its microwave ablation devices for thyroid treatment.
About Dr. Emad Kandil Dr. Emad Kandil is a renowned expert in endocrine and oncological surgery. He is the Chief of General, Endocrine, and Oncological Surgery at Tulane University in New Orleans, Louisiana. He holds the prestigious Elias Hanna Chair in Surgery and is celebrated for his groundbreaking work in minimally invasive thyroid treatments, including thyroid ablation. Dr. Kandil has performed over 1,000 thyroid ablation procedures, establishing himself as a leading figure in using this innovative treatment approach in the United States.
Dr. Kandil’s commitment to advancing thyroid care focuses on offering patients non-surgical alternatives, such as ablation, to avoid traditional surgery. This allows for reduced recovery times and better preservation of thyroid function. His contributions to the field include over 400 research publications and numerous lectures worldwide. His research interests include endocrine tumor genetics and the development of targeted therapies for thyroid cancer.
About Philip James Philip James hosts the Doctor Thyroid podcast, a platform that provides patients with information on alternative thyroid treatments. His work focuses specifically on minimally invasive procedures like thyroid ablation. He aims to help patients avoid unnecessary thyroid surgeries, a mission close to him after his own experience with an unneeded surgery.
In addition to his podcast, Philip is the author of Say No to Thyroid Surgery, a book that advocates for patients to explore non-surgical options. He educates and empowers thyroid patients globally through his websites and social media, offering them access to cutting-edge treatment information and expert interviews with leading medical professionals.
His passion stems from a desire to help others make informed health decisions and to provide a resource for those seeking alternatives to conventional thyroid surgery.
@DoctorThyroid www.docthyroid.com
22 Apr 2017
29: Hypothyroidism — an A to Z Summary and Important Things to Know with Dr. Victor J. Bernet from the Mayo Clinic
00:35:28
In this episode Dr. Bernet describes that Hashimoto’s thyroiditis is an autoimmune condition that usually progresses slowly and often leads to low thyroid hormone levels — a condition called hypothyroidism. The best therapy for Hashimoto’s thyroiditis is to normalize thyroid hormone levels with medication. A balanced diet and other healthy lifestyle choices may help when you have Hashimoto’s, but a specific diet alone is unlikely to reverse the changes caused by the disease.
Hashimoto’s thyroiditis develops when your body’s immune system mistakenly attacks your thyroid. It’s not clear why this happens. Some research seems to indicate that a virus or bacterium might trigger the immune response. It’s possible that a genetic predisposition also may be involved in the development of this autoimmune disorder.
A chronic condition that develops over time, Hashimoto’s thyroiditis damages the thyroid and eventually can cause hypothyroidism. That means your thyroid no longer produces enough of the hormones it usually makes. If that happens, it can lead to symptoms such as fatigue, sluggishness, constipation, unexplained weight gain, increased sensitivity to cold, joint pain or stiffness, and muscle weakness.
If you have symptoms of hypothyroidism, the most effective way to control them is to take a hormone replacement. That typically involves daily use of a synthetic thyroid hormone called levothyroxine that you take as an oral medication. It is identical to thyroxine, the natural version of a hormone made by your thyroid gland. The medication restores your hormone levels to normal and eliminates hypothyroidism symptoms.
You may hear about products that contain a form of thyroid hormones derived from animals. They often are marketed as being natural. Because they are from animals, however, they aren’t natural to the human body, and they potentially can cause health problems. The American Thyroid Association’s hypothyroidism guidelines recommend against using these products as a first-line treatment for hypothyroidism.
Although hormone replacement therapy is effective at controlling symptoms of Hashimoto’s thyroiditis, it is not a cure. You need to keep taking the medication to keep symptoms at bay. Treatment is usually lifelong. To make sure you get the right amount of hormone replacement for your body, you must have your hormone levels checked with a blood test once or twice a year.
If symptoms linger despite hormone replacement therapy, you may need to have the dose of medication you take each day adjusted. If symptoms persist despite evidence of adequate hormone replacement therapy, it’s possible those symptoms could be a result of something other than Hashimoto’s thyroiditis. Talk to your health care provider about any bothersome symptoms you have while taking hormone replacement therapy.
Victor J. Bernet, MD, is Chair of the Endocrinology Division at the Mayo Clinic in Jacksonville, Florida and is an Associate Professor in the Mayo Clinic College of Medicine. Dr. Bernet served 21+ years in the Army Medical Corps retiring as a Colonel. He served as Consultant in Endocrinology to the Army Surgeon General, Program Director for the National Capitol Consortium Endocrinology Fellowship and as an Associate Professor of Medicine at the Uniformed Services University of Health Sciences. Dr. Bernet has received numerous military awards, was awarded the “A” Proficiency Designator for professional excellence by the Army Surgeon General and the Peter Forsham Award for Academic Excellence by the Tri-Service Endocrine Society. Dr. Bernet graduated from the Virginia Military Institute and the University of Virginia School of Medicine. Dr. Bernet completed residency at Tripler Army Medical Center and his endocrinology fellowship at Walter Reed Army Medical Center. Dr. Bernet’s research interests include: improved diagnostics for thyroid cancer, thyroidectomy related hypocalcemia, thyroid hormone content within supplements as well as management of patient’s with thyroid cancer. He is the current Secretary and CEO of the American Thyroid Association.
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