Doctor Thyroid

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.

NOTES

Dr. Maria Papaleontiou

Complications from thyroid cancer surgery more common than believed, study finds

National Cancer Institute (NCI)

RELATED DOCTOR THYROID INTERVIEWS

Dr. Ralph Tufano: Be Careful, Not All Surgeons Are Equal and Here is Why

Dr. Gary Clayman: The Single Most Important Question to Ask Your Surgeon

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

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.

NOTES

Thyroid Education Scores Low for Readability

Thyroid patient education materials not adequately targeted to patient reading level

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.

NOTES

American Thyroid Association

Cedars-Sinai clinical trial

MSKCC thyroid cancer active surveillance

THYCA Support Group

Active Surveillance of Thyroid Cancer Under Study

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

RESOURCES

ResearchGate

Dr. Pitoia - Facebook

Dr. Pitoia - web site

Dr. Pitoia - Twitter

Thyroid Cancer Alliance

American Thyroid Association

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 [email protected]

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?

Recursos:

Dr. Pitoia - Facebook

Dr. Pitoia - pagina web

Dr. Pitoia - Twitter

ResearchGate

Thyroid Cancer Alliance

American Thyroid Association - Español

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 [email protected]

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

Notas

Nódulos Tiroideos

Regina Castro Publications

American Thyroid Association en Español

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.

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.

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. ​A​pproximately 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. ​P​rior 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. NOTES & RESOURCES: GDATFWebsite: http://gdatf.org/ GDATF Online Support Forum: http://gdatf.org/forum/ Reading List: http://gdatf.org/about/about-graves-disease/reading-list-for-patients/ Recommended Links: http://gdatf.org/about/about-graves-disease/links/ GDATF YouTube Site (includes free videos on Graves' disease, autoimmunity, and thyroid eye disease): https://www.youtube.com/user/GravesAndThyroid Facebook: https://www.facebook.com/gdatf Twitter: @GDATF Patients and family members can also e-mail the Graves' Disease Foundation at [email protected] or call toll-free 877-643-3123.

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.

NOTAS:

The Hormone Foundation

Dr. Alejandro Ayala

GDATFWebsite: http://gdatf.org/ GDATF Online Support Forum: http://gdatf.org/forum/ Reading List: http://gdatf.org/about/about-graves-disease/reading-list-for-patients/ Recommended Links: http://gdatf.org/about/about-graves-disease/links/ GDATF YouTube Site (includes free videos on Graves' disease, autoimmunity, and thyroid eye disease): https://www.youtube.com/user/GravesAndThyroid Facebook: https://www.facebook.com/gdatf Twitter: @GDATF