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?

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

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

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.

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?

44: Cáncer de Tiroides, con la Dra Ines Califano de Universidad de Buenos Aires


Cáncer de Tiroides, con la Dra Ines Califano de Universidad de Buenos Aires
Reduzca la ansiedad durante el tratamiento del cáncer de tiroides
En esta entrevista, discutimos lo siguiente:
1. ¿Qué es un nódulo?
2. ¿Qué sucede durante ecografia?
3. ¿Qué sucede durante la oja fina?
4. Si es cáncer, ¿siempre hace la cirugía?
5. Si no es cáncer, ¿algunas veces hace cirugía?

42: Flame Retardants Connected to Thyroid Cancer, with Dr. Julie Ann Sosa from Duke University


This is an in depth discussion about the connection between flame retardants and plastics, and thyroid cancer.  These chemicals, also known as endocrine disruptors, have a clear connection to thyroid cancer occurrence.
The research is presented by Julie Ann Sosa, MD MA FACS is Chief of Endocrine Surgery at Duke University and leader of the endocrine neoplasia diseases group in the Duke Cancer Institute and the Duke Clinical Research Institute. She is Professor of Surgery and Medicine. Her clinical interest is in endocrine surgery, with a focus in thyroid cancer. 

40: New Research Reveals Thyroid Surgery Errors 5x More Frequent Than Reported with Dr. Maria Papaleontiou from Michigan Medicine


Scheduled to publish next month, the statistics show thyroid surgery much less safe than thought.
The findings that 12% of patients overall had thyroid surgery specific complications is concerning, but more concerning is surgeons quote a 1 to 3 percent rate of error.
In the case of surgery for metastatic thyroid cancer, the error rate skyrockets to 23%.
Dr. Maria Papaleontiou is an Assistant Professor of Internal Medicine with an appointment in the Division of Metabolism, Endocrinology and Diabetes.