63: Take a Step Back⎢Thyroid Surgery with a Clear Mind, with Dr. Bryan McIver from Moffitt Cancer Center
Bryan McIver, MD, PhD
Dr. McIver contributes to Moffitt Cancer Center almost 20 years of clinical experience in the care of patients with endocrine diseases, specializing in the evaluation of patients with thyroid nodules and thyroid cancer. He has a particular interest in the management of patients with advanced and aggressive forms of cancer and the role of genetic and molecular techniques to improve the accuracy of diagnosis.
Most nodules are benign
When to do a biopsy
How to interpret the results of biopsy
Advances in thyroid cancer
Ultrasound technology advancements
Molecular marker technologies
Gene expression classifier
58: 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.
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
* Imaging has increased thyroid nodule discovery.
* Following patients with small thyroid cancer ? analogous to prostate cancer. Better followed than treated.
* Tiny thyroid cancers can be defined by those nodules less than 1/4 inch in size.
* Less RAI is being used as a part of thyroid cancer treatment. This means, less need to do total thyroidectomy or thyroid lobectomy.
* Dry mouth and dry eyes are risks to doing RAI. Also, there is risk to developing a second malignancy. Most of the secondary cancers are leukemia.
* Risks to operation include changes to voice and calcium levels. Thyroid surgery is a safe operation but not risk free.
* Best question for a patient to ask is, who is my treatment team?
52: Cancer Phobia?⎥Don’t Sacrifice Your Thyroid, with Dr. José A. Hakim – Hospital Universitario Santa Fe de Bogotá
No todos los cánceres de tiroides deben ser operados.
No todos los nódulos tiroideos deben ser biopsiados.
La mitad de la población tiene nódulos tiroideos. El 10% de esos nódulos tienen cáncer. En Colombia, 2,5 millones de personas tienen cáncer de tiroides. 15 millones de personas tienen cáncer de tiroides en los Estados Unidos, y lo más probable es que no lo sepan.
Los estudios muestran que el 30% de los cadáveres tienen nódulos tiroideos con cáncer.
Comprender las repercusiones de hacer una biopsia. Si se trata de un nódulo que no requiere cirugía, incluso si es cáncer, decirle a un paciente esto a veces hace más daño en la forma de estrés emocional que lo que es necesario.
Dr. Shaha specializes in head and neck surgery, with a particular interest in thyroid and parathyroid surgery. He uses an algorithm of selective thyroid tumor criteria (the size, location, stage and type of cancer, along with the patient’s age), to tailor therapy to each individual’s circumstances.
In this interview, topics include:
* The first question a surgeon should ask and why.
* When talking active surveillance or observation, changing the language to deferred intervention, ‘we are going to defer’.
* Understanding the biology of the cancer
* The biology of thyroid cancer is a friendly cancer.
50: Regarding Thyroid Cancer, Are You a Minimalist or a Maximalist? with Dr. Michael Tuttle from Sloan Kettering
Regarding Thyroid Cancer, Are You a Minimalist or a Maximalist?
Often, surgery is not necessary to treat thyroid cancer, but much of the decision will depend on the patient characteristic.
During this interview, Dr. Tuttle discusses the following points:
Challenges of managing thyroid cancer as outlined by the guidelines
Scaling back care for insurance-challenged patients, and adopting a plan that gets the same result without needing the expensive tests
Desired outcome is survival and no recurrence, a third is for no harm that would be caused by an unnecessary surgery
Unwanted side affects of thyroid cancer include nerve damage, parathyroid damage, and infections