73: The Aggressive Mission to Find Cancer is Going Too Far? with Dr. Gilbert Welch from The Dartmouth Institute
H. Gilbert Welch, MD, MPH An internationally recognized expert on the effects of medical screening and over-diagnosis Dr. Gilbert Welch’s work is leading many patients
72: [Spanish] La Conexión Entre el Corazón y el Hipotiroidismo. Entrevista con la Dra. Gabriela Brenta de Buenos Aires
En esta entrevista, discutimos los siguientes temas:
* Menos función cardiovascular
* La conexión entre el funcionamiento del corazón menos y el hipotiroidismo
* El riesgo cardiovascular
* Resistencia cardiovascular
* Mayor colesterol LDL e hipotiroidismo
* Hipotiroidismo subclínico y riesgo
* Niveles de TSH
* Niveles de TSH por encima de 10
* Colesterol e hipotiroidismo
* Riesgo residual y estatinas
* Mejorando la absorción de T4
* Levotiroxina y buen cumplimiento
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