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
During this episode, the following topics are discussed:
1. Financial burden of surgery versus total cost of active surveillance over ten years.
2. Stretching Exercises for Neck
3. Setting patient expectations prior to FNA to manage anxiety
4. When the laryngeal nerve is severed during thyroid surgery, it can and should be repaired, with proper surgeon skill and training.
5. The most common question asked to Dr. Miyauchi by surgeons from around the world.
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
64: Managing Indeterminate Thyroid Nodules, with Dr. Kimberly Vanderveen from Denver Center for Endocrine Surgery
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.
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.
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