66: Five Important Things Your Thyroid Surgeon Maybe Not Telling You, with Dr. Akira Miyauchi

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. 

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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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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 markers Cytopathology categorizations Molecular marker technologies Gene expression classifier

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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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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?

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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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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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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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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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