You have been diagnosed with thyroid cancer, and contrary to your doctor's advice, you choose to not proceed with surgery.  Is this a patient trend, and how often are patients making this decision? In a qualitative analysis, Dr. Louise Davies reports on the experience of US patients who self-identify as having an over-diagnosed thyroid cancer. How likely is death as result of thyroid cancer?  In a study by H. Harach, he sites that when reviewing random autopsies, thyroid cancer was prevalent in 34% of the cadavers.   Dr. Davies states, if diagnosed with thyroid cancer, important questions to ask, include: How big is the tumor?How was the tumor discovered?Are there any symptoms? Dr. Davies says those who choose to opt for no surgery are sometimes called stupid by those who know them, and end up feeling isolated and anxious, with little or no support.   Louise Davies, MD, MS, FACS is an Associate Professor at Geisel School of Medicine and Dartmouth Institute for Health Policy & Clinical Practice (TDI). She is Chief, Otolaryngology at Veterans Administration, White River Jct., VT Dr. Davies is an otolaryngologist - head & neck surgeon whose thyroid related research is aimed at defining and documenting the problem of rising thyroid cancer incidence and developing management approaches to the problem in ways that are safe and effective. Clinically, Dr. Davies cares for patients with both head and neck and thyroid cancer and general otolaryngology problems primarily at the VA hospital, with a limited practice at Dartmouth Hitchcock Medical Center. Her career is defined by her goal of helping patients and physicians make good decisions for their cancer care by providing clear, helpful data in useful formats at the needed time and place. NOTES: JAMA Abstract: Dr. Davies Thyroid Stories Project Dr. Michael Tuttle, from Sloan Kettering Yasuhiro Itoa and Akira Miyauchi  Nonoperative management of low-risk differentiated thyroid carcinoma

Jonas de Souza participates in both clinical and outcomes research studies on malignancies of the upper aerodigestive tract, especially head and neck cancers. His research focuses on the use of novel therapeutic agents along with measurements of financial burden, patients’ preferences, and the trade-offs between the risks and benefits of cancer therapies. His research has sought to integrate outcomes research, patient preferences, health policy, and economics into clinical practice. His ultimate goal is to increase access to essential cancer therapies by providing policy makers and scientific communities with the required information on patient preferences and on barriers that lie between cancer patients and access to care.   De Souza has authored and presented papers and given lectures on head and neck malignancies, reimbursement methods in oncology, and evidence-based care. He is the principal investigator for a trial examining the role of SPECT-CT in the follow-up of patients with locally advanced head and neck cancers.   De Souza earned his MD from the University of Rio de Janeiro State. He completed his residency specializing in internal medicine at the University of Texas Health Science Center in 2008 and a fellowship focusing on hematology/oncology at the University of Chicago in 2011.   During this episode the following topics are discussed: “Financial toxicity,” or the financial burdens that some patients suffer as a result of the cost of their treatments can cause damage to their physical and emotional well-being.  Financial impact of thyroid cancer Lost income or high out-of-pocket costs for treatment, medication or related care. Like any other side effect, financial toxicity should be disclosed and discussed with the patients. Patients with thyroid cancer had a 41% increased risk for unemployment at 2 years      Jonas de Souza MD, MBA   The High Cost of Cancer Care May Take Physical and Emotional Toll on Patients   Thyroid Cancer Diagnosis Affects Employment, Income

Dr. Jeremy Freeman was born in Hamilton, Ontario and grew up in Toronto. He attended medical school at the University of Toronto, graduating with highest honours. He completed his otolaryngology residency at the University of Toronto. After receiving his Fellowship from the Royal College of Surgeons of Canada in 1978, he spent two further years of advanced training, one as a Gordon Richards Fellow at the Princess Margaret Hospital in Toronto in Radiation and Medical Oncology and a second year as a McLaughlin Fellow, training in Head and Neck Oncology at the Royal Marsden Hospital in London, UK. He was the first fellow of the Advanced Training Council sponsored by the two head and neck societies. A Full Professor, he occupies the Temmy Latner/Dynacare Chair in Head and Neck Oncology at the University of Toronto, Faculty of Medicine. He is former Otolaryngologist-in-Chief at the Mount Sinai Hospital stepping down after fulfilling his 10 year appointment. He has an active practice focusing on head and neck oncology with a primary interest in endocrine surgery of the head and neck. He has given over 500 scholarly presentations, has been invited as a visiting professor and surgeon internationally, and has published over 280 articles in the scientific literature. He has been involved in a number of administrative roles in the American Head and Neck Society and is also on the editorial board of a number of high impact journals focusing on head and neck oncology. He has recently been appointed to the National Institute of Health (in Washington DC) task force on the management of thyroid cancer. He is the Director of the University of Toronto Head and Neck Oncology Fellowship, considered to be one of the top three such fellowships in North America. He was the program chair and congress chair of the First and Second World Congresses on Thyroid Cancer held in 2009 and 2013 in Toronto. He was the Keynote speaker at the Congress held in Boston in 2017. He has been invited worldwide to deliver keynotes in the management of thyroid malignancies. In this episode the following topics are discussed: Cost of thyroid surgery in varies depending on jurisdictionSurgery and active surveillance is a fixed costCosts after surgeryTG tests, ultrasound, thyroid hormone costsContrary to some proponents, surgery is not more cost effective than active surveillanceHypo parathyroidism leads to daily doses of calcium and vitamin DIf there is RLN damage, then there could be more surgery and voice therapyThere are more costs than solely the surgical feeLevothyroxine costsRamifications of degree of thyroid cancerThyroid cancer is a low risk of deathMany people die with thyroid cancer but don’t die from itPossibility versus probabilityEmotional expense of malignancy and being labeled survivorLead a normal life or the survivor labelLifetime cost of thryoidectomyMedical costs and cost of travel, time of work, baby-sitters, and all expenses that go into managing thryoidectomy for ancillary itemsHow long can someone live without thyroid replacement hormone post thyroidectomy?Quality of life post thyroidectomyPsychological wellbeingDo not do a FNA for nodule under 1 cm NOTES Dr. Jeremy Freeman Jeremy Freeman's scientific contributions LinkedIn

Thyroid radiofrequency ablation (RFA) is a treatment option for thyroid nodules that aims to remove the nodule while preserving the thyroid gland. This procedure has gained popularity in South Korea and other countries as an alternative to thyroidectomy, a surgery that involves removing the entire thyroid gland. However, the adoption of RFA has been slow in the United States due to insurance companies not covering the procedure, making it too costly for many patients. Dr. Baek, a specialist in thyroid RFA, believes that the procedure is important for preserving thyroid function and improving the quality of life for patients. In contrast to thyroidectomy, which requires patients to take lifelong hormone replacement medication, RFA allows patients to maintain natural thyroid hormone production. The cost of thyroid RFA is a significant barrier to its adoption in the United States. While the procedure is cheaper in South Korea and other countries, insurance coverage is a major factor in the affordability of treatment for patients. Insurance companies need to recognize the value of RFA and begin covering the procedure in order for it to become more widely available to patients. Overall, thyroid RFA is a promising treatment option that has the potential to improve the lives of many thyroid nodule patients. It is important for insurance companies to acknowledge the benefits of this procedure and work towards making it more widely accessible to patients. MORE INFO www.rfamd.com

RFA Doctor Directory: www.rfamd.com During this video, the following topics are discussed: ✅ Finding treatments that are not over-aggressive and less-invasive. ✅ 70% of women and 50% of men have thyroid nodules ✅ Less than 10% of nodules are cancerous  ✅ Is radiofrequency ablation (RFA) an effective treatment? ✅ Is radiofrequency ablation (RFA) painful? ✅ How long does radiofrequency ablation (RFA) take to show results or shrinkage of the nodule? ✅ Ultrasound can categorize a nodule by low risk, intermediate, or high risk. ✅ Thyroidectomy comes with risks, including: vocal cord paralysis, bleeding, parathyroid damage, and nerve damage. ✅ Patients must educate themselves before seeing a doctor.   ✅ About Dr. Larian Babak Larian is a highly experienced, board certified Ear, Nose, & Throat Specialist and Head & Neck surgeon. Dr. Larian is the current Clinical Chief of the Division of Otolaryngology at Cedars-Sinai Hospital in Los Angeles (January 2012 – present).  He graduated with academic and humanitarian distinction, from UC Irvine School of Medicine. In 2002 after completing a 6-year residency program in Ear, Nose, & Throat (otolaryngology) and Head & Neck Surgery at UCLA, he began his professional career. He then went on to become a founding member and later the Medical Director of the Cedars-Sinai Head & Neck Center of Excellence (November 2009 – October 2011). CONTACT Email: info@larianmd.com Phone: 310.461.0300 Website: https://https://www.parotidsurgerymd.... Hyperparathyroidism:  https://www.hyperparathyroidmd.com/doctor-larian/  Facebook: https://www.facebook.com/parotidsurge... Instagram: https://www.instagram.com/babaklarianmd/ ✅ About Philip James He is the host of the popular podcast: Doctor Thyroid www.docthyroid.com In 2013, his laryngeal nerve was severed, shoulder nerve damaged, parathyroids ruined, and residual cancer left behind — all for a 1 cm thyroid nodule. Later, a vocal cord implant was inserted to help him speak. All the above, the result of a bad thyroid surgery that dampened his quality of life — and left him wondering, what exactly happened — during what should be a low-risk surgery? His attempts to follow up with UCLA and the UCLA surgeon were ignored. He then turned to other doctors for answers — this was the beginning of the podcast: "Doctor Thyroid with Philip James" 100+ episodes later, the Doctor Thyroid podcast is popular amongst patients; allowing them to access information from top doctors, without being limited by geography or economics. The word he uses to describe his work as patient advocate is, ‘tonglen’. Or, using his pain and hardship to help others. When not producing podcast episodes or co-hosting live Q&As for patients with top doctors, he leads the creative team at Doctor Marketing and Philip James Media — a marketing agency dedicated to digital communications serving the sectors of healthcare, payments, and Greentech. The Doctor Thyroid podcast is available in Spanish and English - and listened to in over 30 countries: www.doctiroides.com (Spanish) www.docthyroid.com (English) ✅Please email your requests to philip@philipjames.co LinkedIn: www.linkedin.com/in/philip-james/ Facebook @docthyroid YouTube @Doctor Thyroid Twitter @docthyroid   Looking for a RFA doctor? Search the RFA Directory: www.rfamd.com

Protecting the nerves during RFA and thyroid surgery with Dr. Julia Noel from Stanford Health Care. Hosted by Philip James. Supported by www.rfamd.com. Find an RFA doctor at www.rfamd.com 🔹🔹🔹 During this interview, the following topics are discussed: → Stanford University prioritizes anatomic structures, ultrasound, and how to best protect the laryngeal nerve → Pre- procedure ultrasound is instrumental in minimizing risk → Risk to the laryngeal nerve is minimal during RFA → Where to deliver heat is guided by ultrasound → If unintended consequences occurs during RFA, they are usually reversible → Most risk is affecting a patient’s voice → Technique and space — away from structures — can be controlled with extra fluid → Dr. Noel has conducted 80+ RFA procedures at Stanford University → What should every practitioner know in regard to protecting the nerves? → Commitment to ultrasound anatomy is critical → Ultrasound guided procedures → The Stanford RFA team for conducting a procedure is one assistant MD or Fellow, medical assistant laying out equipment and vital signs → Patient due diligence when selecting an RFA doctor is key: it should include vetting providers for their experience with RFA → Ask if the doctor has done RFA procedures, what’s the plan for follow up? → With RFA, are fewer thyroidectomies occurring?With RFA in clinic, patients now have more treatment options → “No hammers looking for nails” → Who is the ideal candidate for RFA? → Solitary, large, benign thyroid nodule is the ideal candidate → Cost is between $5000 - $10,000 → Reduction in thyroid nodule size is up to 80% → RFA can be used for malignant nodules → Why did it take so long for the U.S. to adopt RFA? FDA processes are laborious and time consuming → Is RFA painful? Generally “no” → RFA fills a void in treatment options for thyroid nodule → Preservation of thyroid function is key — the thyroid is preserved → Does insurance cover RFA treatment? → Sometimes the insurance company will cover the procedure through an appeal process About Dr. Julia Noel ✅ TWITTER @JuliaNoelMD ✅ WEBSITE https://profiles.stanford.edu/julia-noel ✅ WEBSITE https://rfamd.com/julia-noel/ ✅ Grand Rounds Video on YouTube https://www.youtube.com/watch?v=YeiOQ... ✅ About Philip James ✅ Instagram @philipjames360 ✅ TWITTER @docthyroid ✅ LinkedIn @Philip James ✅ Website www.philipjames.co ✅ YouTube https://www.youtube.com/c/DoctorThyroid  🔹🔹🔹 ✅ ABOUT Philip James I shared my story with many of you on my podcast: Doctor Thyroid www.docthyroid.com In 2013, my laryngeal nerve was severed, shoulder nerve damaged, parathyroids ruined, and residual cancer left behind — all for a 1 cm thyroid nodule.Later, a vocal cord implant was inserted to help me speak. The bad result of thyroid surgery dampened my quality of life → and left me wondering, what exactly happened → during what should be a low-risk surgery? My attempts to follow up with UCLA and the surgeon were ignored. So, I turned to other doctors for answers — this was the beginning of the podcast: "Doctor Thyroid with Philip James" 100+ episodes later, the Doctor Thyroid podcast is popular amongst patients; allowing them access to information from top doctors, without being limited by geography or economics. The word I use to describe my work as patient advocate is, ‘tonglen’. Or, using my pain and hardship to help others. When not producing podcast episodes or co-hosting live Q&As for patients with top doctors, I lead the creative team at Philip James Media — we are a marketing agency dedicated to digital communications — serving the sectors of healthcare, payments, and Greentech. The Doctor Thyroid podcast is available in Spanish and English - and listened to in over 30 countries: www.doctiroides.com (Spanish) www.docthyroid.com (English) Please email your requests to philip@philipjames.co 🔹🔹🔹

Looking for a radiofrequency ablation doctor? 🔹www.rfamd.com🔹 Dr. Leonardo Rangel and Radiofrequency Ablation (RFA) for Malignant Thyroid Nodules. During this episode the following topics are discussed: ✅we are treating malignant nodules with radiofrequency ablation therapy ✅We are using radiofrequency ablation therapy since 2006 ✅it is something that we are really experiencing is the treatment of those malignant thyroid nodules with radiofrequency ablation ✅avoid the risk of thyroidectomy ✅surgeons must give patients all treatment options; including no surgery ✅there are some nodules malignant nodules, they are not amenable for radiofrequency due to position, size, or something like this ✅patient consultations take longer because there are more treatment options to consider ✅ the problem of taking the levothyroxine ✅About Dr. Leonardo Rangel Staff da Universidade do Estado do Rio de Janeiro Membro da Sociedade Brasileira de Cirurgia de Cabeça e Pescoço Membro da Sociedade Americana de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço Membro da Sociedade Latinoamericana de Tireoidologia ✅Facebook Rangel MD - Cirurgia de Cabeça e Pescoço @cabecaepescoco ✅Website https://www.rfamd.com/leonardo-rangel/ ✅ABOUT RFA MD A guide for locating doctors of radiofrequency ablation. Find radiofrequency ablation doctors from across the world. rfamd.com ✅ Facebook @RFADOCTOR ✅ Instagram @RFADOCTOR ✅ LinkedIn @rfa-doctor-directory ✅ Twitter @RFADOC ✅ Internet www.rfamd.com ✅ ABOUT Philip James He is the host of the popular podcast: Doctor Thyroid www.docthyroid.com 🔹 In 2013, his laryngeal nerve was severed, shoulder nerve damaged, parathyroids ruined, and residual cancer left behind — all for a 1 cm thyroid nodule. Later, a vocal cord implant was inserted to help him speak. 🔹 All the above, the result of a bad thyroid surgery that dampened his quality of life — and left him wondering, what exactly happened — during what should be a low-risk surgery? 🔹 His attempts to follow up with UCLA and the UCLA surgeon were ignored. He then turned to other doctors for answers — this was the beginning of the podcast: "Doctor Thyroid with Philip James" 🔹 100+ episodes later, the Doctor Thyroid podcast is popular amongst patients; allowing them to access information from top doctors, without being limited by geography or economics. 🔹 The word he uses to describe his work as patient advocate is, ‘tonglen’. Or, using his pain and hardship to help others. 🔹 When not producing podcast episodes or co-hosting live Q&As for patients with top doctors, he leads the creative team at Doctor Marketing and Philip James Media — a marketing agency dedicated to digital communications serving the sectors of healthcare, payments, and Greentech. 🔹 The Doctor Thyroid podcast is available in Spanish and English - and listened to in over 30 countries: www.doctiroides.com (Spanish)🔹 www.docthyroid.com (English)🔹 ✅Please email your requests to philip@philipjames.co ✅Instagram @PhilipJames360 ✅ LinkedIn www.linkedin.com/in/philip-james/ ✅ Facebook @docthyroid ✅ YouTube @Doctor Thyroid ✅ Twitter @docthyroid ✅ Are you looking for an RFA doctor? Find one here: www.rfamd.com

Looking for a radiofrequency ablation doctor? 🔹www.rfamd.com🔹 Radiofrequency Ablation 🛑 REMOVE Thyroid Nodules 🛑 NO SURGERY 🛑 Dr Ralph Tufano During this podcast, the following topics are discussed: ✅advocate for patients to be as well informed as possible and consider all treatment options for thyroid problems, including avoiding surgery whenever possible and radiofrequency ablation. ✅ five thousand dollars out of pocket and save your thyroid with radiofrequency ablation or thyroidectomy and maybe nothing out of pocket with an insurance paid thyroidectomy? ✅if there are isn't if there are options available if there is an option available to avoid surgery and it gives you an equivalent outcome or maybe even better outcome why wouldn't you choose radiofrequency ablation? ✅with radiofrequency ablation now it's exciting because for thyroid nodules they can be removed without doing surgery ✅before radiofrequency ablation all you had was surgery really and obviously with surgery we talked about the possible risks of surgery and of course probably more concerning sometimes to a lot of people is if you take out half of the thyroid even if you're functioning normally with thyroid your thyroid levels you're having normal thyroid function 25% of those patients will still need thyroid hormone ✅the beauty of radiofrequency ablation is that first of all in most circumstances it's no general anesthesia you can do it in the office much like when you go to your dentist and maybe you're getting a cavity filled you get novocaine or lidocaine to numb up the neck area and then under guidance with an ultrasound you take a needle ✅the beauty of that is that the overwhelming majority of times radiofrequency ablation does not change your thyroid function so think about it we're talking about an invasive procedure surgery general anesthesia complication risk ✅ they have a thyroid problem goiter or a nodule that can be treated by radiofrequency ablation that they seriously consider radiofrequency ablation in preserving the thyroid as a treatment option versus a surgery or a thyroidectomy ✅radiofrequency ablation is very effective and more effective than surgery in fact in ablating and controlling papillary micro-cancer without any real complications ✅radiofrequency ablation seems to be a little more focused and maybe a little bit more able to control that destructive process in that area so you can protect those important structures ✅About Dr. Ralph Tufano Dr. Ralph P. Tufano is the Director of the Division of Head and Neck Endocrine Surgery and conducts thyroid and parathyroid surgery with a focus on optimizing outcomes. He is a recognized world authority on the management of thyroid cancer, thyroid nodules, benign thyroid diseases and parathyroid disease. He has expertise in the management of thyroid cancer nodal metastases, advanced and invasive thyroid cancers as well as recurrent thyroid cancers. His work in molecular markers, improving surgical outcomes, nerve monitoring and exploring novel treatment techniques for thyroid and parathyroid diseases has helped the medical field tailor and personalize treatment for patients with these conditions. Dr. Tufano has performed every type of minimally invasive endoscopic and robotic thyroid and parathyroid surgery over the years and was director of the initial team that developed the now internationally accepted approach for the scarless transoral thyroidectomy and parathyroid surgery. Website https://rfamd.com/doctors/dr-ralph-tufano/ ✅ABOUT RFA MD A guide for locating doctors of radiofrequency ablation. Find radiofrequency ablation doctors from across the world. rfamd.com ✅ Facebook @RFADOCTOR ✅ Instagram @RFADOCTOR ✅ LinkedIn @rfa-doctor-directory ✅ Twitter @RFADOC ✅ Internet www.rfamd.com ✅ ABOUT Philip James He is the host of the popular podcast: Doctor Thyroid www.docthyroid.com 🔹 In 2013, his laryngeal nerve was severed, shoulder nerve damaged, parathyroids ruined, and residual cancer left behind — all for a 1 cm thyroid nodule. Later, a vocal cord implant was inserted to help him speak. 🔹 100+ episodes later, the Doctor Thyroid podcast is popular amongst patients; allowing them to access information from top doctors, without being limited by geography or economics. 🔹 The word he uses to describe his work as patient advocate is, ‘tonglen’. Or, using his pain and hardship to help others. 🔹 The Doctor Thyroid podcast is available in Spanish and English - and listened to in over 30 countries: www.doctiroides.com (Spanish)🔹 www.docthyroid.com (English)🔹 ✅Please email your requests to philip@philipjames.co ✅Instagram @PhilipJamesMedia ✅ LinkedIn www.linkedin.com/in/philip-james/ ✅ Facebook @docthyroid ✅ YouTube @Doctor Thyroid ✅ Twitter @docthyroid ✅ ¿Está buscando un médico RFA? Encuentre un médico aquí: www.rfamd.com

🔹 Roberto Valcavi 🔹 MD, FACE, ECNU Reggio Emilia, Italy RFA for benign nodules, for cystic nodules, for hyper functioning nodules, benign nodules, and now for malignant micro-papillary tumors. During this episode the following topics are discussed: The six steps that go into the RFA STEP 1: setup of the patient. The setup of the patient is in an operatory room -- the safety of a operatory room is by far greater than the setting of an ambulatory room so STEP 2: prepare for anesthesia. STEP 3: electrode needle insertion; it is done at the point exactly at the point transistorically... Step 4: preparation in regard to the laryngeal nerve…. the laryngeal nerve is the most delicate point. The laryngeal nerve may be cooled. Step 5: extraction; simply take out the needle and at the same time it must. Use compression; avoids bleeding both internal and external Step 6: Final check. ✅ About Roberto Valcavi 20 years and 1800+ RFA procedures done; laser since 2000 and radiofrequency ablation starting in 2010. ✅ www.rfamd.com/roberto-valcavi/ ✅ABOUT RFA MD A guide for locating doctors of radiofrequency ablation. Find radiofrequency ablation doctors from across the world. rfamd.com ✅ Facebook @RFADOCTOR ✅ Instagram @RFADOCTOR ✅ LinkedIn @rfa-doctor-directory ✅ Twitter @RFADOC ✅ Internet www.rfamd.com ✅ ABOUT Philip James He is the host of the popular podcast: Doctor Thyroid www.docthyroid.com 🔹 In 2013, his laryngeal nerve was severed, shoulder nerve damaged, parathyroids ruined, and residual cancer left behind — all for a 1 cm thyroid nodule. Later, a vocal cord implant was inserted to help him speak. 🔹 All the above, the result of a bad thyroid surgery that dampened his quality of life — and left him wondering, what exactly happened — during what should be a low-risk surgery? 🔹 His attempts to follow up with UCLA and the UCLA surgeon were ignored. He then turned to other doctors for answers — this was the beginning of the podcast: "Doctor Thyroid with Philip James" 🔹 100+ episodes later, the Doctor Thyroid podcast is popular amongst patients; allowing them to access information from top doctors, without being limited by geography or economics. 🔹 The word he uses to describe his work as patient advocate is, ‘tonglen’. Or, using his pain and hardship to help others. 🔹 When not producing podcast episodes or co-hosting live Q&As for patients with top doctors, he leads the creative team at Doctor Marketing and Philip James Media — a marketing agency dedicated to digital communications serving the sectors of healthcare, payments, and Greentech. 🔹 The Doctor Thyroid podcast is available in Spanish and English - and listened to in over 30 countries: www.doctiroides.com (Spanish)🔹 www.docthyroid.com (English)🔹 ✅Please email your requests to philip@philipjames.co ✅Instagram @PhilipJamesMedia ✅ LinkedIn www.linkedin.com/in/philip-james/ ✅ Facebook @docthyroid ✅ YouTube @Doctor Thyroid ✅ Twitter @docthyroid ✅ Are you looking for an RFA doctor? Find one here: www.rfamd.com

This is a candid interview with Dr. Gary Clayman about thyroid cancer surgery and making sure a patient receives the best available care.  Dr. Clayman has performed more than four hundred thyroid cancer operations per year for over twenty years among patients ranging from 6 months to 100+ years of age. Nearly half of Dr. Clayman’s patients have undergone failed initial surgery for their thyroid cancer by another surgeon or have recurrent, persistent, or aggressive thyroid cancer. If it pertains to thyroid surgery or thyroid cancer, there is likely nothing that he hasn’t seen. Dr. Clayman left the M. D. Anderson Cancer Center in the fall of 2016 to form the Clayman Thyroid Cancer Center in Tampa, Florida If someone is considering surgery, Dr. Clayman discusses important topics, including: Do not let a doctor operate on you unless the surgeon can prove to you that he/she has done a minimum of 150 annual thyroid surgeries, and for a minimum of ten years.  This means, do not see a surgeon unless he/she has completed a minimum of 1500 thyroid surgeries. Damage to voice box nerves is preventable, when surgery is done right.90% of thyroid surgeries done in the U.S. are by doctors doing fewer than fifteen thyroid surgeries per yearThere is a growing trend of patients being more informed compared to years pastDo not rush into a surgery.  Vet your doctor and hospital.  Talk to people and make sure you have selected a skilled surgeon Surgery is not franchisable, use caution whenIf a case is too complex, important that a less experienced surgeon seek help from a more experienced surgeonIncomplete surgery is completely unacceptable (persistence of disease)Advice to surgeons, especially less-experienced ones Other Doctor Thyroid episodes referenced during this interview: The Financial Burden of Thyroid Cancer with Dr. Jonas de Souza from The University of Chicago Medicine The Parathyroid, and a Safer — Less-Scarring Thyroid Surgery with Dr. Babak Larian from Cedars-Sinai A Must Listen Episode Before Getting Surgery – Do Not Do It Alone, with Douglas Van Nostrand from MedStar Washington Hospital SHOW NOTES: Dr. Gary Clayman Thyroid Cancer Overview Book: Atlas of Head and Neck Surgery   Health Grades Zoc Doc The American Thyroid Association

University of Chicago Medicine researchers Briseis Aschebrook-Kilfoy, PhD, assistant research professor in epidemiology, and Raymon Grogan, MD, assistant professor of surgery lead the North American Thyroid Cancer Survivorship Study (NATCSS). For their most recent research, Aschebrook-Kilfoy and Grogan recruited 1,174 thyroid cancer survivors – 89.9 percent female with an average age of 48 After treatment, thyroid cancer survivors face a lifetime of cancer surveillance and an anxiety-inducing high rate of recurrence, which could contribute to their findings. "The goal of this study is to turn it into a long-term, longitudinal cohort," said Grogan, who hopes to develop a tool that physicians can use to assess the psychological wellbeing of thyroid cancer survivors. "But, there was no way to do that with thyroid cancer because no one had ever studied quality of life or psychology of thyroid cancer before.” In this episode, we will explore: The spiritual, social, psychological, and physical impacts of thyroid cancer.  Some of the sometimes over-looked physical impacts include dry mouth, voice problems, dry eyes, dental problems, fatigue, dry skin,  and hypoglycemia.   What happens to vocal cords after surgery?  Even when not paralyzed, quality of voice is effected.  Often times, family members don't take treatment seriously.  Society, healthcare professionals, and the media have minimized thyroid cancer, and in return has made patients feel minimized. Anxiety about reoccurrence, RAI treatment, and self-concept, influence quality of life for thyroid cancer patients. A 2011 study by Aschebrook-Kilfoy and Grogan found that thyroid cancer, which is most common in women, will double in incidence by 2019.

In this episode, Dr. Spencer, Professor of Medicine at University of Southern California, discusses the importance of testing for thyroglobulin-antibodies and thyroglobulin.   Important notes from this interview include: only 10% of nodules are malignant.when getting blood panels each six months, it is very the important to of measure TgAb every time.  consistency is important in blood tests, meaning, use the same laboratory and manufacturer's method every time.the most reliable method of testing TgAb is the machine manufactured by Kronus (RSR) or Roche.  When getting blood tests, be sure to request either of these manufacturers for TgAb results, each of these manufacturers are 100% sensitive.Beckman is  the most commonly used manufacturer, but only is 79% sensitive to TgAb results.always use the same Tg and TgAb methods and the same laboratory.   Dr. Spencer's major areas of research interest are thyroid physiology and pathology, thyroglobulin and thyroid cancer, immunoassay techniques, thyroid hormone metabolism, and the cost-effective use of thyroid tests. Her current research includes clinical significance of Tg and TgAb in patients with thyroid cancers, parameters for optimizing thyroid hormone suppression of TSH for DTC. Studies on hypothalamic/pituitary mechanisms for regulating TSH, and testing for thyroid dysfunction during pregnancy. Dr. Spencer earned her PhD from Glasgow University in Scotland. She then went on to complete two fellowships, one in Clinical Biochemistry at Glasgow, and the other at the National Academy of Clinical Biochemistry.     resources: www.thyroidlab.com/updates

Dr. Susanne Breen is a board certified naturopathic physician. She completed her medical training at the National University of Natural Medicine (NUNM) after initial medical studies at the Oregon Health Sciences University in conventional medicine.  Healing, she discovered, required more than medication or even natural remedies. Her inspiration came from her advanced studies at NUNM in gastroenterology, including Small Intestinal Bacterial Overgrowth (SIBO), where she learned about the root causes of her personal health challenges. She read Breaking the Vicious Cycle, changed her diet, found direction from practitioners and started her path to health. She brings her personal experience and training to help others do the same. Dr. Breen completed a residency with Dr. Gary Weiner at Pearl Natural Health and continues to see patients at this location.  Her training and expertise in the areas of IBD/IBS, thyroid health, bio-identical hormones, gynecology, IV therapy, herbal, nutritional and lifestyle changes offers people a holistic, integrative and comprehensive model of care. Dr. Breen is a wife and mother of two children.  She enjoys living in the Pacific Northwest where she hikes, snow skis, and gardens.  She has a special love for animals, including her two cats, fermented foods and Tabata workouts. In this episode, the following topics are discussed: Fatigue, hair loss, weight gain, anxiety, and depression.Sub-clinical hypothyroidismStandard range for TSH has changed over the years, .5 - 1.5 TSH is optimalArmour Thyroid vs LevothyroxineIf antibodies are involved than it is most likely related to the gutGetting off thyroid medicationTesting: TSH, free T3 T4, TPO antibodies, reverse T3Getting motivated and inspired by fixing thyroidSeleniumIodineThyroid supplementsTreating fertilityHair loss and levothyoxineJoint pain and levothyroxine Nature vs ArmourMagnesium interfering with T4Analysis of gut and assessment: bad breath, burping, etc.Stool testing for SIBOProgesterone and testosteroneTesting for adrenal fatigue through saliva throughout the dayCortisol secretion related to grief or stressDesiccated bovine adrenalGraves’ disease and testosterone fixBreath tests and pathogensMicrofloraDigestive and thyroid health are connectedBowel movement frequency and constipationWhole foods and unprocessed foodsSugar, inflammation, and heart diseaseHomemade yogurt and cow’s milk and removing lactose, fixing bloatingFood allergy testingAchy joints, painful feet, anemia, cramping, testosterone and estrogen, neuro-therapy, ozone therapy, acupuncture, blood flow, dizziness, hydration, lyme disease, and muscle spasms. NOTES: Mysymotoms.com Susanne Breen, N.D.

In this episode our guest is Dr. Martin Milner.  Today's interview features information on optimizing medication with slow-release compounded thyroid replacement.   Can adding adjusting your medication from T4 to slow release with T3 really make you feel better?  The answer is, yes!  And, could also be the key to losing weight. We also discuss the following topics, painful feet, dizziness, fatigue, hair loss, iron deficiency, chronic pain, fibromylagia, adrenal connection to to inflammation, sleep problems, muscle spasms, caution with your morning smoothies, and why you should stand up when taking T3. Want to find a compounding pharmacy that will make your slow release T3 and T4?  Start here:  http://www.pccarx.com/      Dr. Milner has published several articles on new treatment protocols for hypothyroidism. Most recently, ” Hypothyroidism: Optimizing Medication with Slow-Release Compounded Thyroid Replacement” was published in the peer review journal of compounding pharmacists, International Journal of Pharmaceutical Compounding (IJPC) Vol. 9 No. 4 July/August 2005. In 2006 and 2007 he lectured around the United States guiding physicians and compounding pharmacists in the management of hypothyroidism using his protocol of slow released compounded thyroid replacement. Also to his credit are “Wilson’s Syndrome and T3 therapy – A Clinical Guide to Safe and Effective Patient Management” IJPC Vol. 3 No. 5, Sept/Oct 1999, p. 344-349 and Assessment and Management of Thermoregulation, IJPC Vol. 3 No. 5, Sept/Oct 1999, p. 350-351. Reprints of many of these and other Dr. Milner articles are available at CNMWellness.com, the medical education website of the Center for Natural Medicine. Dr. Milner co-authored chapter 14 in An Alternative Medicine Definitive Guide to Cancer by J. Diamond and W.L. Cowden, the most definitive text on alternative cancer therapies. He also served as the primary consulting physician for Judith Sach’s book Natural Medicine for Heart Disease. The has authored many articles over the years in cardiology. Dr. Milner is well published with texts, medical journal articles and studies in cardiology, endocrinology, pulmonology, oncology, and environmental medicine. Dr. Milner published in May 2005, Menopause Revolution: Smashing the HRT Myth- Alternatives to Manufactured Drug Therapy , Agora Health Books. He enjoys what he calls practicing “integrated endocrinology” balancing all the endocrine hormones using bio-identical hormone replacement and amino acid neurotransmitter precursors.

Today's guest is Wendy Sacks, M.D., endocrinologist in the Division of Endocrinology, Diabetes and Metabolism and the Thyroid Cancer Program at Cedars-Sinai in Los Angeles.   Some of the topics covered include radioactive iodine treatment, blood testing, the role of the pathologist, selecting the right hospital and medical team for your thyroid cancer treatment, monitoring thyroid cancer reoccurrence, and supplementation.

Dr. Douglas Van Nostrand, MD is the Director of Nuclear Medicine and the Program Director of the Nuclear Medicine Residency Program at Washington Hospital Center and Professor of Medicine, Georgetown University Hospital Center. His specialty is nuclear medicine, and his primary area of interest and expertise is the nuclear medicine diagnosis and treatment of thyroid cancer. He has held numerous academic and medical society positions including Clinical Professor of Radiology and Nuclear Medicine, Uniformed Services University of Health Sciences; past President, Mid-Eastern Society of Nuclear Medicine, Director of Continuing Medical Education Department, and other elected positions of the Medical Staff of Good Samaritan Hospital. He has over 150 articles published and has been the co-editor of seven medical books including the medical textbook entitled Thyroid Cancer, A Comprehensive Guide to Clinical Management. In this episode, get the critical questions to ask prior to committing to a surgeon.  And, other useful strategies to make sure a patient gets the best outcome possible.

One-third of all thyroid nodule fine needle aspirations come back indeterminate. When surgery is performed on these cases, pathology of the thyroid reveals that many times the nodule is benign.  Through molecular profiling, patients with indeterminate thyroid nodules, can now avoid unnecessary surgery and get more accurate pathology results from the fine needle aspiration. Are you a patient and your doctor has said your thyroid nodule is indeterminate and is recommending surgery as an option?  The key is, to confirm that molecular profiling was performed.    Jennifer Kuo, MD is Director of the Thyroid Biopsy Program, Director of the Endocrine Surgery Research Program, and Instructor in Surgery, at the Columbia University Medical Center. Dr. Kuo received her medical degree from the College of Physicians and Surgeons at Columbia University and completed surgical training at the University of California, Davis Medical Center, in Sacramento.  Her new position follows completion of her clinical fellowship in the Department of Surgery, Division of Endocrine Surgery. Dr. Kuo has clinical expertise in minimally invasive endocrine surgery and fine-needle thyroid biopsy and is dedicated to the advancement of the field of endocrine surgery. NOTES: Dr. Jennifer Kuo Afirma - Veracyte RELATED DOCTOR THYROID EPISODES 23: You Have a Thyroid Nodule, What Happens Next? with Dr. Regina Castro from The Mayo Clinic

In this episode, we hear from Elle Russ, Author of The Paleo Thyroid Solution, and former hypothyroidism sufferer.  Elle discusses: Hypothyroidism symptoms — including physical, mental, and emotional.How to find the right health professional.Hypothyroidism treatment with T3.The importance of iron and ferritin. The emotional toll of hypothyroidism. Nutrition strategies. Basal body temperature method for testing hypothyroidism. Elle Russ is a writer, health/life coach, and host of the Primal Blueprint Podcast. She is becoming the leading voice of thyroid health in the burgeoning Evolutionary Health Movement (also referred to as Paleo, Primal, or Ancestral Health). Elle has a B.A in Philosophy from The University of California at Santa Cruz and is a certified Primal Health Coach. She sits on the advisory board of The Primal Health Coach Program created by Mark Sisson, bestselling author of The Primal Blueprint.  Exasperated and desperate, Elle took control of her own health and resolved two severe bouts of hypothyroidism on her own – including an acute Reverse T3 problem. Through a devoted paleo/primal lifestyle, intensive personal experimentation, and a radically modified approach to thyroid hormone replacement therapy…Elle went from fat, foggy, and fatigued – to fit, focused, and full of life!   NOTES: Elle Russ web site http://www.elleruss.com/   Primal Blueprint Podcast http://blog.primalblueprint.com/   Yahoo Natural Thyroid Support Group https://beta.groups.yahoo.com/neo/groups/NaturalThyroidHormones/info

Combination Therapy of T4 and T3 as a way to combat Hypothyroidism Thyroidectomy often leads to hypothyroidism-like symptoms.  This includes brain fog, sluggishness, weight gain, unmotivated, and water accumulation.  Dr. Bianco’s research has revealed the connection between thyroidectomy, hypothyroidism symptoms, and T4 only therapy.  Although T4 only therapy works for the majority, others report serious symptoms.  Listen to this segment to hear greater detail in regard to the following topics: Combination therapy of adding T3 to T4 85% of patients on Synthroid feel fine. Nearly 5% of the U.S. population takes T4, as revealed by the NHANE survey Residual symptoms of thyroidectomy include depression, difficulty losing weight, poor motivation, sluggishness, and lack of motivation.  For some, there is no remedy to these symptoms.  The importance of physical activity and its benefit in treating depression If we normalize T3 does it get rid of hypothyroid symptoms? Overlap between menopause and hypothyroidism symptoms Dr. Antonio Bianco, Rush University Medical Center as professor of medicine, senior vice chair in the Department of Internal Medicine and division chief of endocrinology at Rush University Medical Center.  He has more than 30 years of experience in thyroid research. Bianco’s research interests have been in the cellular and molecular physiology of the enzymes that control thyroid hormone action in which he contributed more than 200 papers, book chapters and review articles, and lectured extensively both nationally and internationally. Recently, he has focused on the aspects of the deiodination pathway that interfere with treatment of hypothyroid patients, a disease that affects more than 10 million Americans. He is Director of Bianco Labs.   Notes: Bianco Lab http://deiodinase.org/   Bianco Lab on Facebook https://www.facebook.com/biancolab/   NHANES Survey The National Health and Nutrition Examination Survey (NHANES) is a program of studies designed to assess the health and nutritional status of adults and children in the United States. The survey is unique in that it combines interviews and physical examinations. https://www.cdc.gov/nchs/nhanes/

You have been diagnosed with thyroid cancer, and choose no surgery.  Although thyroid cancer diagnosis has spiked around the world, a trend is to pass on surgery if the cancer is identified as low risk.  In doing so, mortality rate does not increase and it avoids unfavorable events sometimes related to surgery, such as vocal chord paralysis, hypothyroidsm, financial costs, and lifelong thyroid hormone treatment.  In this episode, we visit with Dr. hypothyroidism, a pioneer in prescribing active surveillance in place of immediate surgery.     Dr. Miyauchi is President and COO of Kuma Hospital, Center for Excellence in Thyroid Care, Kobe, Japan. He is an endocrine surgeon, especially interested in thyroid and parathyroid diseases. He earned his MD and PhD at Osaka University Medical School in 1970 and 1978, respectively. He was Associate Professor of Department of Surgery, Kagawa Medical University until he was appointed to Vice President of Kuma Hospital in 1998. Since 2001, he is at his present position. About 2,000 operations, including about 1,300 thyroid cancer cases, are done every year at Kuma Hospital. He is currently serving as Chairman of the Asian Association of Endocrine Surgeons. He also served as Council of the International Association of Endocrine Surgeons until August 2015. Topics covered, include: Incidence versus mortalityWorldwide trends related to thyroid cancerPapillary Microcarcinoma of the Thyroid (PMCT)Unfavorable events following immediate surgeryResults of research which began in 1993The current trend in the incidence of thyroid cancer is expected to create an added cost of $3.5 billion by 2030, to the individual and as a society. NOTES Akira Miyauchi, MD, PhD (Kuma Hospital)