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.

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61: Drug Resistant Thyroid Cancer, with Dr. Carmelo Nucera from Harvard Medical School

Carmelo Nucera, M.D., Ph.D., is currently an Assistant Professor at Harvard Medical School, Boston, in the Division of Cancer Biology and Angiogenesis (Department of Pathology), Beth Israel Deaconess Medical Center. Dr. Nucera received his M.D. and Ph.D. in Experimental Endocrinology and Metabolism from Italy. In this episode, Dr. Nucera discusses a combination drug therapy using vemurafenib and palbociclib represents a novel therapeutic strategy to treat papillary thyroid carcinoma (PTC). 

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60: Pregnancy and Thyroid⎥Hypothyroidism and Hyperthyroidism, with Dr. Angela Leung from UCLA

In this episode, the following topics are explained: * Optimizing thyroid health prior to conception * Thyroid issues that affect pregnancy * Hypothyroid as result of surgery or Hashimotos * Hyperthyroidism and pregnancy * Adjusting current thyroid treatment, meaning optimizing thyroid levels by adjusting dosage of thyroid medication * TSH levels in light of pregnancy * Planned pregnancy usually means a dose increase

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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

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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

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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

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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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37: Adding T3 to T4 Will Make You Feel Better? For Some the Answer is ‘Yes’ with Dr. Antonio Bianco from Rush University

A little T3 can make a world of difference for some thyroid patients. Antonio Bianco, MD, PhD, is head of the division of Endocrinology and Metabolism at Rush University Medical Center. Dr. Bianco also co-chaired an American Thyroid Association task force that updated the guidelines for treating hypothyroidism. Dr. Bianco’s research has revealed the connection between thyroidectomy, hypothyroidism symptoms, and T4-only therapy. Although T4-only therapy works for the majority, others report serious symptoms

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35: Rethinking Thyroid Cancer – When Saying No to Surgery Maybe Best for You with Dr. Allen Ho from Cedars-Sinai in Los Angeles

Weighing treatment options for thyroid cancer, with deep consideration for the patient’s lifestyle, could become the new norm in assessing whether surgery is the best path. Dr. Allen Ho states, “if a patient is a ballerina or an opera singer, or any other profession that could be jeopardized due to undesired consequences of thyroid cancer surgery, then the best treatment path maybe active surveillance.” Undesired consequences of thyroid cancer surgery could be vocal cord paralysis, damage to the parathyroid glands resulting in calcium deficiencies, excessive bleeding or formation of a major blood clot in the neck, shoulder nerve damage, numbness, wound infection, and mental impairment due to hypothyroid-like symptoms.

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32: Thyroid Cancer Surgery? The Single Most Important Question to Ask Your Surgeon with Dr. Gary Clayman

This is a candid interview with Dr. Gary Clayman about thyroid cancer surgery and making sure a patient gets the best available care. If someone is considering surgery, Dr. Clayman discusses related topics, including: Do not let a doctor operate on you unless the surgeon can prove to you that he/she has done a minimum of 150 annual thyroid surgeries, and for a minimum of ten years. This means, do not see a surgeon unless he/she has completed a minimum of 1500 thyroid surgeries. Damage to voice box nerves is preventable, when surgery is done right. 90% of thyroid surgeries done in the U.S. are by doctors doing fewer than fifteen thyroid surgeries per year

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