Doctor Thyroid

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. LinkedIn 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.

27 Sep 202310min

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.   🔷🔷🔷🔷 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.  View Full Profile: Dr. Erivelto Volpi 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. LinkedIn 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.

26 Sep 20235min

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.    A recent interview from the TNT conference on thyroid ablation in Italy, Philip James of the Doctor Thyroid and RFAMD podcasts had a one-on-one discussion with Dr. Catherine Sinclair, a seasoned head and neck surgeon from Melbourne, Australia. Having served at Mount Sinai in New York for 11 years before relocating back to Melbourne in 2021, Dr. Sinclair offers a unique perspective and extensive expertise in thyroid surgery and laryngology. The Importance of Nerve Protection As a specialist who’s invested in both head and neck surgery and the voice box, Dr. Sinclair developed a keen interest in thyroid surgery due to the significant risks it presents to the vocal nerves during thyroid procedures, including during ablation. The laryngeal nerves, in particular, tend to be the patients’ greatest concern during thyroid procedures due to the potential damage they might sustain. Many patients seeking Dr. Sinclair’s services are often singers or professional voice users who want to avoid surgery out of fear for their vocal nerves. As such, they prefer ablation. However, as she explains, it is crucial that they understand the risks to the laryngeal nerves and other vital structures in the area and the strategies used to mitigate these risks during ablation. Limitations in Nerve Monitoring In surgery, nerve monitoring is employed to keep track of and protect the nerves. But with ablation, patients are usually awake, which means the conventional nerve monitoring technology can’t be used. This presents a significant area of research on how to protect the nerves when the patient is conscious. Dr. Sinclair emphasizes that though the risk is slightly lessened with surgery, it still exists. To counter this, specific strategies are used to minimize potential damage, but it’s never a guarantee that no injuries will occur. Patients’ Preparedness and Awareness Patients must ask about the surgeon’s experience, the number of ablations performed, and any potential complications that they should worry about. The more experienced the surgeon, the less likely there are to be complications of any kind, nerve injury included. Contrary to some patients’ assumptions, nerve monitoring isn’t used in ablation since it requires general anesthesia. Early in her ablation experience, Dr. Sinclair used nerve monitoring on patients under general anesthesia. This procedure showed that nerve potentials remain stable as long as lower energy is used at the back of the thyroid gland where the nerves run. Furthermore, by minimizing time spent in the critical zones, nerve injury can be mostly prevented. Real-time Vocal Assessment During ablation, Dr. Sinclair often asks her patients to count in a monotone. This simple technique allows her to detect any changes in the voice, a potential indicator of nerve damage due to heat during the procedure. According to her, this method has helped prevent nerve issues. State of Thyroid Ablation in Australia Until recently, Dr. Sinclair was the only one performing thyroid ablations in Australia. Now, a colleague has started doing them in Western Australia. However, given the demand and the country’s size, she anticipates more physicians will adopt this procedure. Her main concern is ensuring that it’s done safely, with physicians possessing good ultrasound skills, interventional biopsy skills, and comprehensive knowledge of neck anatomy. Final Thoughts Dr. Sinclair’s parting advice to those considering thyroid ablation or thyroidectomy is to have realistic expectations. They should understand that injuries can happen despite the best precautions. However, the experience of the proceduralist can help lessen complications, and there are strategies to reduce the likelihood of nerve damage. Patients should also be well-informed and know what questions to ask their proceduralist before opting for ablation. Interested parties can reach Dr. Sinclair by email at Catherine@melbournethyroidsurgery.com. She encourages inquiries from both domestic and international individuals. 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. LinkedIn 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.

25 Sep 202311min

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 recent episode of the Doctor Thyroid and RFAMD podcasts, Dr. Vaninder Dhillon, an esteemed laryngologist and ENT surgeon from Johns Hopkins, highlighted the critical issue of voice and swallow risks associated with thyroidectomy and thyroid ablation. SUBSCRIBE @DoctorThyroid AVOID SURGERY www.rfamd.com @JohnsHopkinsMedicine The interview sheds light on the importance of preserving the voice and offered insights into innovative approaches to avoid surgery. Dr. Dhillon, who has extensive experience in both laryngology and endocrine head and neck surgery, underscored the significance of the voice and swallow outcomes in patients undergoing these procedures. Her research and clinical practice focus on improving outcomes and quality of life for patients who may face post-operative issues with their voice and swallow, as well as those with general voice and swallow complaints. One of the most common complications after thyroid surgery is vocal cord paralysis, which can have a significant impact on a patient's voice. While the overall percentage of patients experiencing voice issues after thyroidectomy varies, it can be as high as 30 to 50 percent, with temporary paralysis affecting up to 15 percent. Although permanent paralysis is rarer (1-2 percent), it remains a concern for patients. During the interview, Dr. Dhillon emphasized the importance of differentiating between voice and swallowing outcomes, as the latter is often overlooked. Swallowing complaints are higher than voice complaints, with some studies showing up to 60 percent of patients experiencing temporary swallowing issues post-operatively. Voice and swallow assessments are crucial before and after surgery. Dr. Dhillon stressed the need for a comprehensive evaluation, including endoscopy and video stroboscopy, to examine the larynx more closely during speech. These assessments help in identifying potential issues with the recurrent laryngeal nerve and the superior laryngeal nerve. Dr. Dhillon's team has implemented voice and swallow tests before surgery, and they continue to monitor patients post-operatively to ensure any issues are addressed promptly. This proactive approach helps patients feel more confident and informed about the potential risks to their voice and swallow function. The conversation also discussed the rise of radiofrequency ablation (RFA) as an alternative to surgery. RFA is a minimally invasive technology for treating thyroid nodules and thyroid cancers. While RFA has a lower risk of voice and swallow complications than surgery, Dr. Dhillon stressed the importance of a thorough pre-RFA laryngeal exam to ensure optimal outcomes. However, Dr. Dhillon acknowledged that more research is needed to fully understand the potential voice and swallow risks associated with RFA. Standardized protocols and patient-reported outcomes can be vital in evaluating these risks and ensuring patient safety during the procedure. Dr. Vaninder Dhillon highlighted the importance of safeguarding the voice and swallow function in thyroid surgery and ablation. By proactively evaluating and addressing potential complications, patients can make informed decisions and seek appropriate interventions to protect their vocal and swallowing abilities. The ongoing research and innovative approaches in this field offer hope for improved outcomes and a better quality of life for those affected by thyroid conditions. About Dr. Vaninder Dhillon Assistant Professor of Otolaryngology – Head and Neck Surgery Vaninder “Vinny” K. Dhillon, M.D., is an assistant professor of otolaryngology – head and neck surgery at Johns Hopkins University School of Medicine, specializing in both children and adults. She practices out of Johns Hopkins Otolaryngology – Head and Neck Surgery in Bethesda, Maryland. Dr. Dhillon is also affiliated with Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center in Baltimore, Maryland, as well as Sibley Memorial Hospital in Washington, D.C. Dr. Dhillon has an expertise in endocrine surgery, laryngology, otolaryngology, parathyroid diseases and surgery, swallowing disorders, thyroid diseases and surgery, and voice problems. Dr. Dhillon earned her medical degree from Keck School of Medicine of University of Southern California. She completed a residency in otolaryngology at Los Angeles County and University of Southern California Medical Center. View Full Profile: https://www.rfamd.com/vaninder-dhillon/ 🔷🔷🔷🔷 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. LinkedIn ------------- 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.

25 Sep 202355min

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. LinkedIn ------------- 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.

22 Sep 202340min

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. NOTES: JAMA Abstract: Dr. Davies Thyroid Stories Project Dr. Michael Tuttle, from Sloan Kettering Yasuhiro Itoa and Akira Miyauchi  Nonoperative management of low-risk differentiated thyroid carcinoma

5 Apr 202328min

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      Jonas de Souza MD, MBA   The High Cost of Cancer Care May Take Physical and Emotional Toll on Patients   Thyroid Cancer Diagnosis Affects Employment, Income

2 Apr 202313min

Dr. Jeremy Freeman was born in Hamilton, Ontario and grew up in Toronto. He attended medical school at the University of Toronto, graduating with highest honours. He completed his otolaryngology residency at the University of Toronto. After receiving his Fellowship from the Royal College of Surgeons of Canada in 1978, he spent two further years of advanced training, one as a Gordon Richards Fellow at the Princess Margaret Hospital in Toronto in Radiation and Medical Oncology and a second year as a McLaughlin Fellow, training in Head and Neck Oncology at the Royal Marsden Hospital in London, UK. He was the first fellow of the Advanced Training Council sponsored by the two head and neck societies. A Full Professor, he occupies the Temmy Latner/Dynacare Chair in Head and Neck Oncology at the University of Toronto, Faculty of Medicine. He is former Otolaryngologist-in-Chief at the Mount Sinai Hospital stepping down after fulfilling his 10 year appointment. He has an active practice focusing on head and neck oncology with a primary interest in endocrine surgery of the head and neck. He has given over 500 scholarly presentations, has been invited as a visiting professor and surgeon internationally, and has published over 280 articles in the scientific literature. He has been involved in a number of administrative roles in the American Head and Neck Society and is also on the editorial board of a number of high impact journals focusing on head and neck oncology. He has recently been appointed to the National Institute of Health (in Washington DC) task force on the management of thyroid cancer. He is the Director of the University of Toronto Head and Neck Oncology Fellowship, considered to be one of the top three such fellowships in North America. He was the program chair and congress chair of the First and Second World Congresses on Thyroid Cancer held in 2009 and 2013 in Toronto. He was the Keynote speaker at the Congress held in Boston in 2017. He has been invited worldwide to deliver keynotes in the management of thyroid malignancies. In this episode the following topics are discussed: Cost of thyroid surgery in varies depending on jurisdiction Surgery and active surveillance is a fixed cost Costs after surgery TG tests, ultrasound, thyroid hormone costs Contrary to some proponents, surgery is not more cost effective than active surveillance Hypo parathyroidism leads to daily doses of calcium and vitamin D If there is RLN damage, then there could be more surgery and voice therapy There are more costs than solely the surgical fee Levothyroxine costs Ramifications of degree of thyroid cancer Thyroid cancer is a low risk of death Many people die with thyroid cancer but don’t die from it Possibility versus probability Emotional expense of malignancy and being labeled survivor Lead a normal life or the survivor label Lifetime cost of thryoidectomy Medical costs and cost of travel, time of work, baby-sitters, and all expenses that go into managing thryoidectomy for ancillary items How long can someone live without thyroid replacement hormone post thyroidectomy? Quality of life post thyroidectomy Psychological wellbeing Do not do a FNA for nodule under 1 cm NOTES Dr. Jeremy Freeman Jeremy Freeman's scientific contributions LinkedIn

7 Mars 202327min