Doctor Interviews

Surgery

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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.

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Podcast

51: What Do You Do For a Living?⎥Why It Matters, with Dr. Ashok R. Shaha from MSKCC

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.

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Endocrine

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

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Endocrine

48: Innovaciones en el Tratamiento del Cáncer de Tiroides, con el Dr. Hernán Tala desde Santiago, Chile

Dr. Hernán Tala es endocrinólogo de la Clinica Alemana en Santiago, Chile. Su area especialidad incluye cáncer de tiroides avanzado, endocrinologia general, y enfermedades tiroides.
Los temas presentados incluyen:
* Una mejor comprensión de la biología del cáncer de tiroides, y que no todo el cáncer de tiroides es igual. La enfermedad es única en cada paciente.
* La importancia de entender el perfil del cáncer en cada paciente.
* Diagnóstico del nódulo.
* Perfil molecular del nódulo tiroideo.
* Una pausa en la exploración universal del cáncer de tiroides.
* Vigilancia activa

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Podcast

47: Treatment of Thyroid Cancer in Japan, with Dr. Takahiro Okamoto from Tokyo Women’s Medical University

A different approach to treating thyroid cancer compared to the U.S.

Dr. Takahiro Okamoto helped write the Japanese guidelines on thyroid cancer.  He is Professor & Chair of the Department of Surgery at Tokyo Women’s Medical University. 
Key points from this episode include:
* Most Western countries carry out total thyroidectomies, whereas in Japan, the approach is more conservative with a fundamental practice of hemithyroidectomy whenever possible.
* By not doing a total thyroidectomy, this allows the patient to not avoid taking thyroid replacement medication.
* Complete thyroidectomy is conducted when 80-90% of lymph nodes have metastasis.
* I-131 treatment is decreasing despite cases of cancer increasing
* For I-131 treatment, patients wait more than 6 months post surgery.
* When receving I-131 treatment, patients be admitted to hospital for several days.
* TSH suppression therapy is common in Western countries, whereas in Japan, measures are taken to avoid TSH suppression by not removing all of the thyroid.
* Normal TSH in Japan is 4.3 or less.

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Podcast

46: Nerve Monitoring During Thyroid Surgery, with Dr. Özer Makay from Ege University – Turkey

Dr. Özer Makay is an expert in nerve monitoring during thyroid surgery, and has been a guest faculty member in South Korea, Italy, France, the Netherlands, Germany, Belgium and Bulgaria. 

This episode covers the following topics:
* Protecting the recurrent laryngeal nerve (RLN) and superior laryngeal nerve during thyroid surgery.
* Outcomes of damaging these nerves during surgery include no voice, hoarseness, shortness of breath, problem with drinking water or aspiration, impaired physical exertion with something as simple as climbing a flight of stairs.
* Why some centers have a higher occurrence of damage during thyroid surgery and include an error rate as high as 10%
* The cause of the damaged nerve include stretching or traction, and cutting or stitching.
* How to reduce risk.
* Is it possible to reattach a cut nerve?

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