18: 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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16: 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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15: 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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14: 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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13: Nerve Monitoring During Thyroid Surgery, with Dr. Özer Makay from Ege University – Turkey

Dr. Özer Makay is an expert in nerve monitoring during thyroid surgery, and has been a guest faculty member in South Korea, Italy, France, the Netherlands, Germany, Belgium and Bulgaria.  This episode covers the following topics: * Protecting the recurrent laryngeal nerve (RLN) and superior laryngeal nerve during thyroid surgery. * Outcomes of damaging these nerves during surgery include no voice, hoarseness, shortness of breath, problem with drinking water or aspiration, impaired physical exertion with something as simple as climbing a flight of stairs. * Why some centers have a higher occurrence of damage during thyroid surgery and include an error rate as high as 10% * The cause of the damaged nerve include stretching or traction, and cutting or stitching. * How to reduce risk. * Is it possible to reattach a cut nerve?

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11: When Your Medical Professional Gets Thyroid Cancer with Dr. Aime Franco from University of Arkansas

Dr. Aime Franco from University of Arkansas is a leading thyroid cancer researcher and has overcome thryoid cancer. We discuss quality of life post surgery. During this interview we explore the following: Does thyroid cancer have a good prognosis compared to other cancers because its different or because we are aggressive with surgery and radiation therapy? What were some personal insecurities when facing thyroid cancer surgery? What are the questions in regard to TSH that the medical community is overlooking?


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