Doctor Thyroid

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
• Nodulos de tiroides

Doctor Thyroid

Doctor Tiroides

Doctor Tiroides con Philip James

Dr. Carlos Duque

Doctor Carlos Simón Duque Fisher

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
• Cómo localizar un buen cirujano de tiroides

Información Adicional

American Thyroid Association en español

Doctor Tiroides pagina web

Doctor Tiroides en Facebook

Doctor Tiroides Grupo de apoyo

Facebook Doctor Carlos Duque

Carlos Simón Duque Fisher

Libro ¡Uuuyyy, TENGO CÁNCER DE TIROIDES!

18 years ago Lorrie was diagnosed with Graves' disease. Then, in 2017 she received a diagnosis of thyroid cancer.

In this episode we hear Lorrie describe the following:

• Papillary thyroid cancer
• Long delayed pathology results
• Graves' disease
• Balancing Graves' disease and a thyroid cancer diagnosis
• Emotional roller coaster of feeling optimistic and other days of sadness.
• The feelings and emotions of related to a cancer diagnosis
• Being careful about the information shared on the Internet and potential negativity
• Support network and family
• Nodule size was 1.1 cm, but with history of Graves' disease, she decided to forego active surveillance

PATIENT RESOURCES

American Thyroid Association

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
• Colesterol y nivel de conexión tiroidea
• Conexión de diabetes e hipotiroidismo
• Niveles normales de TSH en pacientes mayores
• Riesgos con pacientes mayores

Recursos

Asociación Americana de Tiroides

In this episode we hear from Doug, and 37 year old, male patient of Hashimoto's. Discussed, are the following topics:

• Panic attacks
• Nervous
• Sweating
• Can't get out of bed
• Putting on weight
• Feeling coldness
• NP Thyroid®
• L-Tyrosine
• Synthroid
• WP Thyroid
• WP Thyroid and L-Tyrosine combination therapy
• High heart rate on T3
• ACTH stimulation test
• TSH as high as 60
• T3 suppressing pituitary
• Experience as a male with Hashimoto's
• Brain fog
• Body aches
• Food and diet

NOTES:

American Thyroid Association

NP Thyroid

ACTH stimulation test

PubMed

Deiodinase polymorphism testing

FACEBOOK GROUPS

All hormone deficiencies

Hypothyroid Men

In this episode, we visit with Carla. She had thyroid cancer surgery. During the interview, we discuss:

• 50 biopsies of the first nodule
• 5 cm nodule
• Biopsies
• RAI
• Weight gain
• Support from family

NOTES

American Thyroid Association

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

64: Managing Indeterminate Thyroid Nodules, with Dr. Kimberly Vanderveen from Denver Center for Endocrine Surgery

Dr. Eduardo Faure

Especialista en Endocrinología. UBA

Médico egresado de la Facultad de Medicina de la Universidad Nacional de Rosario. Especialista en Endocrinología egresado de la Facultad de Medicina de la Universidad de Buenos Aires. Especialista recertificado por AMA (Asociación Médica Argentina) / SAEM (Sociedad Argentina de Endocrinología y Metabolismo) años 2003 y 2009. Realizó su formación como Endocrinólogo en el Servicio de Endocrinología del Complejo Médico PFA Churruca-Visca. Buenos Aires. Argentina. Se sub-especializó en el área de Tiroides. Actualmente se desempeña como Médico de Planta del Servicio de Endocrinología del Complejo Médico PFA Churruca-Visca. Es Jefe de la Sección Tiroides de dicho Servicio. Sus trabajos de investigación se basan fundamentalmente en Tiroides. Fue docente de Fisiología de la Cátedra de Fisiología Humana de la Facultad de Medicina de la Universidad Nacional de Rosario. Es docente de la Carrera de Médicos Especialistas en Endocrinología de la Universidad de Buenos Aires. Es colaborador Docente de la Unidad Docente Hospitalaria "Churruca-Visca" dependiente de la Facultad de Medicina de la Universidad Nacional de Buenos Aires. Fue docente estable de la Carrera de Especialización en Endocrinología Ginecológica y de la Reproducción en la Universidad Favaloro. Es Miembro Activo de las siguientes sociedades: Sociedad Argentina de Endocrinología y Metabolismo y de la Sociedad Latinoamericana de Tiroides. Forma parte del Departamento de Tiroides de la Sociedad Argentina de Endocrinología y Metabolismo. Es invitado por Sociedades Nacionales e Internacionales como disertante en temas relacionados con Tiroides. Ex Director de la Sociedad Latinoamericana de Tiroides (LATS). Chair de la Educational Task Force de la Sociedad Latinoamericana de Tiroides (LATS).

Durante este episodio, escuchamos más detalles sobre lo siguiente:

1. Calidad de vida después de la cirugía
2. Complicaciones
3. Riesgo de obesidad
4. ¿Necesitaré quimioterapia?
5. Otros tratamientos relacionados con el cáncer de tiroides que se necesitan?

NOTES

American Thyroid Association (en Español)

14: When Your Medical Professional Gets Thyroid Cancer with Dr. Aime Franco from University of Arkansas

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:

1. Financial burden of surgery versus total cost of active surveillance over ten years.
2. Setting patient expectations prior to FNA to manage anxiety
3. When the laryngeal nerve is severed during thyroid surgery, it can and should be repaired, with proper surgeon skill and training.
4. 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.
5. 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.

NOTES

Akira Miyauchi, MD

American Thyroid Association

35: Rethinking Thyroid Cancer – When Saying No to Surgery Maybe Best for You with Dr. Allen Ho from Cedars-Sinai in Los Angeles

21: Diagnosed with Thyroid Cancer and You Say No to Surgery with Dr. Louise Davies

50: Regarding Thyroid Cancer, Are You a Minimalist or a Maximalist? with Dr. Michael Tuttle from Sloan Kettering

PAPERS and RESEARCH

Estimation of the lifetime probability of disease progression of papillary microcarcinoma of the thyroid during active surveillance

Comparison of the costs of active surveillance and immediate surgery in the management of low-risk papillary microcarcinoma of the thyroid.

Incidences of Unfavorable Events in the Management of Low-Risk Papillary Microcarcinoma of the Thyroid by Active Surveillance Versus Immediate Surgery

TSH-suppressive doses of levothyroxine are required to achieve preoperative native serum triiodothyronine levels in patients who have undergone total thyroidectomy.

Stretching exercises to reduce symptoms of postoperative neck discomfort after thyroid surgery: prospective randomized study.

Improvement in phonation after reconstruction of the recurrent laryngeal nerve in patients with thyroid cancer invading the nerve.

Ezra Cohen, MD, is a board-certified oncologist and cancer researcher. He cares for patients with all types of head and neck cancers, including esophageal, thyroid and salivary gland cancers.

Dr. Cohen is also an internationally recognized expert on novel cancer therapies and heads the Solid Tumor Therapeutics program at Moores Cancer Center. Much of his work has focused on squamous cell carcinomas and cancers of the thyroid, salivary gland, and HPV-related oropharyngeal cancers. As a physician-scientist, he is especially interested in developing novel therapies and understanding mechanisms of sensitivity or resistance; cancer screening; and using medication and other agents to delay or prevent cancer (chemoprevention). He was recently appointed chair of the National Cancer Institute Head and Neck Cancer Steering Committee, which oversees NCI-funded clinical research in this disease.

Dr. Cohen is editor-in-chief of Oral Oncology, the most respected specialty journal in head and neck cancer. A frequent speaker at national and international meetings, he has authored more than 120 peer-reviewed papers and has been the principal investigator of multiple clinical trials of new drugs in all phases of development.

In this episode, topics include:

• Drug therapy for patients that fail standard therapy; including surgery and RAI
• Not all patients have same behavior for their cancer
• Some cancers are aggressive
• Not many thyroid cancer patients are affected by this; maybe a few thousand in the U.S., but not tens of thousands
• What is the treatment protocol for therapy?
• Lenvatinib or Sorafenib is the treatment for refectory thyroid cancer
• Lenvatinib tends to be more effective
• Sorafenib is tolerated by the patient better
• Other options to consider include, molecular profiling or some thyroid cancers carry mutation that is targetable, or BRAF
• BRAF inhibitors used with thyroid cancer patients
• Molecular profiling
• DNA sequencing
• Side effects include, what patient will feel and those that appear in blood tests
• Side effects include fatigue in 60% patients, hand or foot blisters, nausea and vomiting
• Side effects in blood tests include high blood pressure, increase in liver enzymes, and a reduction in blood counts
• VEGF receptor
• CT scans and ultra sounds or thyroglobulin as an indicator that thyroid cancer not responsive to traditional therapy
• We don't want to make the patient feel worse; the question is when to treat the patient with drug therapy
• Drug treatment does no cure the disease
• Holidays from the drug and be rid of side effects
• When restarting drug, disease responds again
• Pediatric care
• Immunotherapy

NOTES

Ezra Cohen, MD

American Thyroid Association

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.
• Price of molecular test is $3000 - $6000

NOTES

Kimberly Vanderveen, MD

American Thyroid Association

PAST EPISODES

50: Regarding Thyroid Cancer, Are You a Minimalist or a Maximalist? with Dr. Michael Tuttle from Sloan Kettering

35: Rethinking Thyroid Cancer – When Saying No to Surgery Maybe Best for You with Dr. Allen Ho from Cedars-Sinai in Los Angeles

22: Avoiding Thyroid Cancer Surgery, Depending on the Size with Dr. Miyauchi from Kuma Hospital in Kobe, Japan

09: Thyroid Cancer Patients Experience Quality of Life Downgrade with Dr. Raymon Grogan and Dr. Briseis Aschebrook from the University of Chicago Medicine

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