Doctor Interviews

Surgery

Pathology

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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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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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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Endocrine

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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Endocrine

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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