59: No Biopsia es 100% Exacta⎥Exámenes Moleculares son los Mejores, con Dr. Paul Y. Casanova


Dr. Paul Y. Casanova-Romero, M.D., M.P.H., F.A.C.P., F.A.C.E, E.C.N.U, que se unió a Palm Beach Diabetes y Endocrine Specialists en 2012, recibió su grado médico con honores (Summa Cum Laude) y Doctor en Ciencias Médicas (DMSc), de la Universidad de Zulia, la Escuela de Medicina en Venezuela.
* ¿Cómo se identifican los nódulos y por qué ocurren? autoexamen o en la oficina del médico
* La mayoría de los nódulos son benignos pero ocurren porque en mas de 70% de la población
* ¿Qué tests puede realizar un médico para evaluar el nódulo?
* Ninguna test es 100%
* Ultrasonido – qué están buscando en general
* Que es ojo fina y el proceso general
* Tests moleculares
* ¿Qué tipos de resultados se pueden obtener de la citología y qué significan?
* La mayoria de ojo finas son benigno

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

57: The Gut⎥Antibiotics Danger, Fixing Inflammation, and Thyroid Health, with Dr. Lisa Sardinia


Dr. Lisa Sardinia is an associate professor in the Pacific University Biology Department. In this episode we discuss:
Majority of antibiotics given to children under three are for upper respiratory issues, fact is antibiotics do not work for such issues
85% of antibiotics used are given to food sources, and released into the environment including soil and water
Danger of consuming emulsifiers
Cow’s milk
US has low gut diversity — more diversity means more resilience
Autism and gut connection
Resetting your gut microbiota by changing diet

56: Levothyroxine and Hair Loss⎥Thyroid Health, with Dr. Susanne Breen


In this episode, the following topics are discussed:
* Fatigue, hair loss, weight gain, anxiety, and depression.
* Sub-clinical hypothyroidism
* Standard range for TSH has changed over the years, .5 – 1.5 TSH is optimal
* Armour Thyroid vs Levothyroxine
* If antibodies are involved than it is most likely related to the gut
* Getting off thyroid medication
* Testing: TSH, free T3 T4, TPO antibodies, reverse T3
* Getting motivated and inspired by fixing thyroid
* Selenium
* Iodine
* Thyroid supplements
* Treating fertility

55: Thyroid Cancer Treatment and Surgery Explained⎥Dr. Gerard Doherty from Harvard Medical School


* 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?

54: Hypothyroidism⎥Weight Gain, Fatigue, and Sluggishness, with Dr. Alan Farwell from Boston Medical Center


Thyroid surgery and RAI sometimes results in hypothyroidism
Most common cause is Hashimoto’s disease
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

53: Hypothyroidism — Diagnosis, Treatment, and Medication with Dr. Leonard Wartofsky from MedStar


Dr. Wartofsky is Professor of Medicine, Georgetown University School of Medicine and Chairman Emeritus, Department of Medicine, MedStar Washington Hospital Center.  He trained in internal medicine at Barnes Hospital, Washington University and in endocrinology with Dr. Sidney Ingbar, Harvard University Service, Thorndike Memorial Laboratory, Boston.  
In this episode, Dr. Wartofsky discusses the following:
* Hypothyroidism causes
* When is replacement thyroid replacement hormone necessary?
* The history of replacement thyroid hormone going back to 1891
* The early treatment included a chopped up sheep thyroid and served as a ‘tartar’, often resulting in vomiting
* Myxedema coma

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.

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.

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