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
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
US has low gut diversity — more diversity means more resilience
Autism and gut connection
Resetting your gut microbiota by changing diet
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
* Thyroid supplements
* Treating fertility
* 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?
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
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