Father, husband, runner, musician, and the lifestyle changes that came after thyroid cancer surgery (Patient Story)
In this interview, some of the key points include: Self-discovered thyroid nodule Diagnosed thyroid nodule FNA and biopsy 5 cm nodule Juice cleanse and no more red meat 3 hour surgery Regret about a Friday afternoon surgery Outpatient surgery Vocal cord paralysis Impact of vocal cord paralysis RAI six weeks post surgery - 176 mc RAI diet A positive and optimistic approach to the disease Surgeon did not present consequences of thyroid surgery Ran cross-country in high school
10 Jun 202116min
Broadway Performer Says No to Thyroid Cancer Surgery → Surveillance Instead
Jody Gelb is a Broadway singer and actress. Six months ago she was diagnosed with papillary thyroid cancer, during a doctor's visit for an unrelated issue. This news sparked immediate research and discovering an alternate path that does not include surgery. In this episode, the following topics are discussed: Broadway musical and tour Voice used during work as a performer, singing and acting Diagnosed with thyroid cancer while going to the doctor for a minor back strain MRI on back lead to discovery of thyroid nodules A scare, at one point being told cancer could be medullary BETHESDA scale Book by Dr. Gilbert Welch Incidental findings Watch and wait or active surveillance as an option to removing your thyroid Conflicting and inconsistent information from healthcare professionals to the patient Maximilaist or minimalist Cultivating a wherewithal to ask questions, even when being told something by a healthcare professional Dr. Atul Gawande Dr. Henry Marsh Choosing active surveillance and then feeling isolated or alienated Sharing selectively The importance of Google and Twitter and searching ‘papillary thyroid cancer’ NOTES Regarding Thyroid Cancer, Are You a Minimalist or a Maximalist? with Dr. Michael Tuttle from Sloan Kettering Diagnosed with Thyroid Cancer and You Say No to Surgery with Dr. Louise Davies Avoiding Thyroid Cancer Surgery, Depending on the Size with Dr. Miyauchi from Kuma Hospital in Kobe, Japan 1 in 3 People Die With Thyroid Cancer — Not From with Dr. Seth Landefeld from UAB Rethinking Thyroid Cancer – When Saying No to Surgery Maybe Best for You with Dr. Allen Ho from Cedars-Sinai in Los Angeles American Thyroid Association Overdiagnosed: Making People Sick in the Pursuit of Health Best Time of Day to Take Your Thyroid Medication and Other Questions for the Endocrinologist with Wendy Sacks, M.D. from Cedars Sinai Jody Gelb blog Twitter
9 Jun 202146min
Hypothyroidism⎥Weight Gain, Fatigue, and Sluggishness, with Dr. Alan Farwell from Boston Medical Center
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. NOTES Dr. Antonio Bianco Dr. Jacqueline Jonklaas American Thyroid Association
6 Jun 202138min
No Biopsy is 100% Accurate⎥Molecular Testing Gets Close, with Dr. Bridget Brady from Austin Thyroid Surgeons
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? NOTES Dr. Bridget Brady Veracyte American Thyroid Association
4 Jun 202128min
Pregnancy and Thyroid⎥Hypothyroidism and Hyperthyroidism, with Dr. Angela Leung from UCLA
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? Hypothyroidism and the fetus Brain development for the fetus Lower IQ scores and hypothyroid in pregnancy CATS study from UK and Italy Iodine and pregnancy Iodine intake prior to pregnancy Armour thyroid and pregnancy Concerns regarding animal derived thyroid replacement TSH levels NOTES Dr. Angela Leung CATS study American Thyroid Association 49: Thyroid and Pregnancy⎥Why It Matters, with Dr. Elizabeth Pearce from Boston University
30 Mai 202119min
Thyroid Cancer Is Not Going to Kill You (Papillary), with Dr. Amanda Laird from Rutgers Cancer Institute of NJ
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. NOTES Amanda Laird, MD American Thyroid Association
30 Mai 202124min
Medical Error and Addressing Patient Safety with Dr. Danielle Ofri
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. Statute of limitations. Errors that don’t cause harm. Wash your hands and stop and think. Dr. Ofri’s Links: Bellevue Literary Review www.danielleofri.com “When We Do Harm: A Doctor Confronts Medical Error” New Yorker Covid Diary Recent events - Dr. Ofri: tinyurl.com/BLRViral Covid Writing Goes Viral: How Literary and Social Media Writing Became a Lifeline during the Pandemic tinyurl.com/ReadingTheBody Reading the Body: Poetry, Dance & Disability Notes CARES Act Hardeep Singh, M.D., M.P.H. Doctor Thyroid Facebook Doctor Thyroid with Philip James Twitter philipjames@docthyroid.com
5 Apr 202149min
Thyroid and Pregnancy ⎥Why It Matters, with Dr. Elizabeth Pearce from Boston University
In this episode, topics include: Hypothyroidism and hyperthyroidism during pregnancy Pregnant and without a thyroid Avoiding T3 during pregnancy, including concerns with desiccated thyroid If being treated for hypothyroidism already, the importance of upping dose while pregnant Pregnant with auto-immunity Pregnant with Graves’ disease The dangers of pregnancy and overt hypothyroidism or hyperthyroidism Three-percent of pregnancies are affected The importance of iodine during pregnancy Dr. Pearce received her undergraduate and medical degrees from Harvard and a masters’ degree in epidemiology from the Boston University School of Public Health. She completed her residency in internal medicine at Beth Israel Deaconess Medical Center, and her fellowship in endocrinology at the Boston University Medical Center. She is currently an Associate Professor of Medicine at Boston University School of Medicine. She has served as a member of the board of directors of the American Thyroid Association and is currently on the management council of the Iodine Global Network. She recently co-chaired the ATA’s Thyroid in Pregnancy Guidelines Task Force. She was the 2011 recipient of the ATA’s Van Meter Award for outstanding contributions to research on the thyroid gland. NOTES Elizabeth Pearce American Thyroid Association
11 Mar 202120min
