Doctor Thyroid

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

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

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

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

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

Other Doctor Thyroid episodes referenced during this interview:

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

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

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

SHOW NOTES:

Dr. Gary Clayman

Thyroid Cancer Overview

Book: Atlas of Head and Neck Surgery

Health Grades

Zoc Doc

The American Thyroid Association

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.

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

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

Dr. Breen completed a residency with Dr. Gary Weiner at Pearl Natural Health and continues to see patients at this location. Her training and expertise in the areas of IBD/IBS, thyroid health, bio-identical hormones, gynecology, IV therapy, herbal, nutritional and lifestyle changes offers people a holistic, integrative and comprehensive model of care.

Dr. Breen is a wife and mother of two children. She enjoys living in the Pacific Northwest where she hikes, snow skis, and gardens. She has a special love for animals, including her two cats, fermented foods and Tabata workouts.

In this episode, the following topics are discussed:

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

NOTES:

Mysymotoms.com

Susanne Breen, N.D.

In this episode our guest is Dr. Martin Milner. Today's interview features information on optimizing medication with slow-release compounded thyroid replacement.

Can adding adjusting your medication from T4 to slow release with T3 really make you feel better? The answer is, yes! And, could also be the key to losing weight.

We also discuss the following topics, painful feet, dizziness, fatigue, hair loss, iron deficiency, chronic pain, fibromylagia, adrenal connection to to inflammation, sleep problems, muscle spasms, caution with your morning smoothies, and why you should stand up when taking T3.

Want to find a compounding pharmacy that will make your slow release T3 and T4? Start here: http://www.pccarx.com/

Dr. Milner has published several articles on new treatment protocols for hypothyroidism. Most recently, " Hypothyroidism: Optimizing Medication with Slow-Release Compounded Thyroid Replacement" was published in the peer review journal of compounding pharmacists, International Journal of Pharmaceutical Compounding (IJPC) Vol. 9 No. 4 July/August 2005. In 2006 and 2007 he lectured around the United States guiding physicians and compounding pharmacists in the management of hypothyroidism using his protocol of slow released compounded thyroid replacement. Also to his credit are "Wilson's Syndrome and T3 therapy – A Clinical Guide to Safe and Effective Patient Management" IJPC Vol. 3 No. 5, Sept/Oct 1999, p. 344-349 and Assessment and Management of Thermoregulation, IJPC Vol. 3 No. 5, Sept/Oct 1999, p. 350-351. Reprints of many of these and other Dr. Milner articles are available at CNMWellness.com, the medical education website of the Center for Natural Medicine. Dr. Milner co-authored chapter 14 in An Alternative Medicine Definitive Guide to Cancer by J. Diamond and W.L. Cowden, the most definitive text on alternative cancer therapies. He also served as the primary consulting physician for Judith Sach's book Natural Medicine for Heart Disease. The has authored many articles over the years in cardiology.

Dr. Milner is well published with texts, medical journal articles and studies in cardiology, endocrinology, pulmonology, oncology, and environmental medicine. Dr. Milner published in May 2005, Menopause Revolution: Smashing the HRT Myth- Alternatives to Manufactured Drug Therapy , Agora Health Books. He enjoys what he calls practicing "integrated endocrinology" balancing all the endocrine hormones using bio-identical hormone replacement and amino acid neurotransmitter precursors.

Today's guest is Wendy Sacks, M.D., endocrinologist in the Division of Endocrinology, Diabetes and Metabolism and the Thyroid Cancer Program at Cedars-Sinai in Los Angeles.

Some of the topics covered include radioactive iodine treatment, blood testing, the role of the pathologist, selecting the right hospital and medical team for your thyroid cancer treatment, monitoring thyroid cancer reoccurrence, and supplementation.

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.

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.

NOTES:

Dr. Jennifer Kuo

Afirma - Veracyte

RELATED DOCTOR THYROID EPISODES

23: You Have a Thyroid Nodule, What Happens Next? with Dr. Regina Castro from The Mayo Clinic

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!

NOTES: Elle Russ web site

http://www.elleruss.com/

Primal Blueprint Podcast

http://blog.primalblueprint.com/

Yahoo Natural Thyroid Support Group

https://beta.groups.yahoo.com/neo/groups/NaturalThyroidHormones/info

Combination Therapy of T4 and T3 as a way to combat Hypothyroidism

Thyroidectomy often leads to hypothyroidism-like symptoms. This includes brain fog, sluggishness, weight gain, unmotivated, and water accumulation.

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, as revealed by the NHANE survey

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.

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 hypothyroidism symptoms

Dr. Antonio Bianco, Rush University Medical Center as professor of medicine, senior vice chair in the Department of Internal Medicine and division chief of endocrinology at Rush University Medical Center. He has more than 30 years of experience in thyroid research.

Bianco's research interests have been in the cellular and molecular physiology of the enzymes that control thyroid hormone action in which he contributed more than 200 papers, book chapters and review articles, and lectured extensively both nationally and internationally.

Recently, he has focused on the aspects of the deiodination pathway that interfere with treatment of hypothyroid patients, a disease that affects more than 10 million Americans. He is Director of Bianco Labs.

Notes:

Bianco Lab

http://deiodinase.org/

Bianco Lab on Facebook

https://www.facebook.com/biancolab/

NHANES Survey

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.

https://www.cdc.gov/nchs/nhanes/