Doctor Interviews

Functional medicine

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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Endocrine

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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Endocrine

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

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Endocrine

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

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Español

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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Podcast

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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