Podcasts about American Thyroid Association

In this SurgOnc Today® SOI Article Series episode, Dr. Shishir Maithel, Editor of Surgical Oncology Insight, discusses with Dr. Heather Wachtel and Dr. Sara Ginzberg rates of guideline-concordant postoperative radioactive iodine therapy in patients with well-differentiated thyroid cancer across six constituent hospitals, before and after the release of the 2015 American Thyroid Association guidelines, as reported in their article, "Implementation of the 2015 American Thyroid Association Guideline Changes Across a Health System: A Quality Improvement Opportunity."

Send us a textThyroid Talk with Dr. Angela Mazza, DOShow Notes Episode 36; Recorded: 1-3-2025Life Without a Thyroid GlandHost: Dr. Angela Mazza, DOCo-host: Dawn SheffieldI'm Dr. Angela Mazza, D.O., a thyroid, endocrine, and metabolism specialist with a private practice in CentralFlorida. My goal for this podcast is to define and demystify the thyroid gland, and thyroid-related medical conditions. Byproviding information in an easy-to-understand format, we hope to help patients better understand the ways in which theirbodies work, and to help them thrive. My goal is to help us live more fulfilling lives by taking control of our health, tofeel our best. I do this podcast to provide life-saving education and encourage patients to see a doctor in time to preventor minimize damage. That's deeply fulfilling. I enjoy helping folks understand how all aspects of their lives are tied toboth thyroid and overall health. That's why I went into endocrinology. It's a medical art that combines science with thestudy of our lives—and all that they encompass. Here's some of what we covered today, not necessarily in this order: Thyroidectomy, discussed in detail; Partial thyroidectomy (a hemithyroidectomy);The RFA--Radio Frequency Ablation--option; Possible risks, and benefits, of surgery vs. RFA;Post-surgery and post-RFA recovery discussed;When a thyroid gland may need to be removed;Living without a thyroid--the special challenges;Number of thyroid glands removed in the U.S. every year;And best of all, we learned that we can impact our thyroid health!My book, Thyroid Talk: An Integrative Guide to Optimal Thyroid Health, is available on Amazon. For information on the related Webinar and online master course, see thrivethyroid.com. Or forward your name and email to thyroidtalk.mazza@gmail.com or to our website: metaboliccenterforwellness.com The webinar coordinates with the online master class. The master class has modules that cover topics like diagnosis of thyroid issues, personalizedtreatment, gut healing, and much more--plus some bonuses. NOTE: A re-launch is coming soon!Regarding supplements mentioned in various episodes of this podcast, visit the Wellness Store: metaboliccenterforwellness.com Send your comments, show ideas, and questions to thyroidtalk.mazza@gmail.com We may disclose your general location on air (the city or town, for example), but we will NOT read your name NOR your address on the show. We reserve the right to edit your input as necessary. Please stay in touch; send us your questions!See the website at metaboliccenterforwellness.com; our YouTube channel at: Dr. Angela Mazza; Facebook, Instagram,and TikTok. The topic of our next episode, number 37, is still being determined.Citations, references, additional information:*Garcia H, Miralles F.  IKIGAI The Japanese Secret to a Long and Happy Life.  Copyright 2016 Hector Garcia andFrancesc Miralles.  Translation Copyright 2017 by Penguin Random House LLC.*Thyroidectomy.  August 2008.  American Thyroid Association.  thyroid.org.*https://my.clevelandclinic.org/health/treatments/7016-thyroidectomyDon't forget to ask your healthcare provider about any specific questions regarding your wellness. This podcast is meantfor educational purposes only.Copyright 2025 DrCheck out our YouTube channel - Dr. Angela Mazza, our website at Metabolic Center for Wellness, our FaceBook and our Instagram page.

In this eye-opening episode, we tackle the controversial topic of thyroid medication and its alleged link to osteoporosis and osteopenia. Dr. Rebecca Warren dives deep into the media's portrayal of this issue, the laziness within the medical system, and the lack of comprehensive studies addressing the root causes of thyroid dysfunction. With 7% of the American population on thyroid meds, this conversation is more relevant than ever. Dr. Warren covers: - The misleading nature of clickbait articles and the importance of critically assessing studies on thyroid medication and bone health. - The role of T3, the active thyroid hormone, in bone health and why its absence in studies is concerning. - The potential overprescription of thyroid medication and the necessity of understanding individual thyroid needs. - The impact of lifestyle factors like protein intake, weight-bearing exercises, and vitamin D levels on bone health. - The gender bias in the medical system, particularly in women's health, and how it contributes to untreated hormone issues. - The importance of a holistic approach to health, focusing on the body's ability to heal itself. Dr. Warren passionately advocates for informed decision-making and patient advocacy, urging listeners to question the status quo and prioritize their overall health. This episode is a must-listen for anyone navigating thyroid health, whether you're on medication or not.  NEXT STEPS:  // Join Dr. Warren's Thyroid Inner Circle for support and community at https://www.drrebeccawarren.com/thyroidmembership // Explore Dr. Warren's services and schedule a consult at https://www.drrebeccawarren.com // Download the free Optimal Thyroid Lab eBook to understand your thyroid labs at https://www.drrebeccawarren.com/thyroidlabsguide Don't forget to subscribe to The Thyroidless Life podcast, leave a review, and share this episode to help others on their thyroid health journey.   Disclaimer: The content of this podcast is for informational purposes only and is not intended as medical advice. Always consult a healthcare professional for any health concerns and before making any changes to your medications. The views expressed in this podcast, including those of Dr. Warren, do not constitute medical advice. The podcast and its host are not liable for any adverse effects resulting from information provided. Opinions of guests are their own, and the podcast does not endorse or assume responsibility for guest statements. Guests may have interests in products or services mentioned. If you have a medical issue, seek the advice of a licensed healthcare provider.  

Pregnancy leads to many physiologic changes, and thyroid and parathyroid disorders alter that physiology even more leading to complex laboratory interpretation and decision-making impacting both mother and fetus. In this episode, join endocrine surgeons Drs. Barb Miller, John Phay, Priya Dedhia, and Surgical Oncology Fellow Dr. Vennila Padmanaban from The Ohio State University. Hear about normal and abnormal thyroid and parathyroid physiology and treatment of patients with thyroid cancer. The group discusses several articles focusing on current guidelines from the American Thyroid Association as well as other key studies.  Hosts: Barbra S. Miller, MD (Moderator), Clinical Professor of Surgery, John Phay, MD, Clinical Professor of Surgery, Priya H. Dedhia, MD, PhD, Assistant Professor of Surgery, Vennila Padmanaban, MD, Surgical Oncology Fellow, Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio. Twitter handles:  Barbra Miller - @OSUEndosurgBSM John Phay – @JohnPhayMD Priya Dedhia – @priyaknows  Vennila Padmanaban - @vennilapadmanMD Learning objectives:  1)  Understand normal changes in thyroid and parathyroid physiology during pregnancy 2)  Describe the impact of thyroid and parathyroid dysregulation on maternal and fetal health 3)  Compare and contrast management of thyroid and parathyroid disorders during pregnancy vs. non-pregnancy   4)  Recognize the importance of multidisciplinary care of patients with thyroid and parathyroid disorders References: 1. Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, Grobman WA, Laurberg P, Lazarus JH, Mandel SJ, Peeters RP, Sullivan S. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017 Mar;27(3):315-389. doi: 10.1089/thy.2016.0457. Erratum in: Thyroid. 2017 Sep;27(9):1212. doi: 10.1089/thy.2016.0457.correx. PMID: 28056690 https://pubmed.ncbi.nlm.nih.gov/28056690/ 2. Jee SB, Sawal A. Physiological Changes in Pregnant Women Due to Hormonal Changes. Cureus. 2024 Mar 5;16(3):e55544. doi: 10.7759/cureus.55544. PMID: 38576690; PMCID: PMC10993087 https://pubmed.ncbi.nlm.nih.gov/38576690/ 3. Patel, Kepal N. MD; Yip, Linwah MD; Lubitz, Carrie C. MD, MPH; Grubbs, Elizabeth G. MD; Miller, Barbra S. MD; Shen, Wen MD; Angelos, Peter MD; Chen, Herbert MD; Doherty, Gerard M. MD; Fahey, Thomas J. III MD; Kebebew, Electron MD; Livolsi, Virginia A. MD; Perrier, Nancy D. MD; Sipos, Jennifer A. MD; Sosa, Julie A. MD; Steward, David MD; Tufano, Ralph P. MD; McHenry, Christopher R. MD; Carty, Sally E. MD. The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Annals of Surgery 271(3):p e21-e93, March 2020.  DOI: 10.1097/SLA.0000000000003580 https://pubmed.ncbi.nlm.nih.gov/32079830/ 4. Appelman-Dijkstra NM, Pilz S. Approach to the Patient: Management of Parathyroid Diseases Across Pregnancy. J Clin Endocrinol Metab. 2023 May 17;108(6):1505-1513. doi: 10.1210/clinem/dgac734. PMID: 36546344; PMCID: PMC10188304 https://pubmed.ncbi.nlm.nih.gov/36546344/  5. Eremkina A, Bibik E,  Mirnaya S, Krupinova J, Gorbacheva A, Dobreva E, Mokrysheva N. Different treatment strategies in primary hyperparathyroidism during pregnancy.  Endocrine. 2022 Sep;77(3):556-560. doi: 10.1007/s12020-022-03127-3. Epub 2022 Jul 12. PMID: 35821184 https://pubmed.ncbi.nlm.nih.gov/35821184/ TRUELEARN LINK: https://truelearn.referralrock.com/l/BTKPODCAST/ Discount code: BTKPODCAST Using the discount code, you can get a discount of $25 off our Residency (General surgery, anesthesiology, OBGYN, Psychiatry, Peds, Neurology, Emergency Medicine, Internal Medicine, and Family Medicine), USMLE, andCOMLEX SmartBank subscriptions of 90-days or more. The code can also be applied for 15% off our allied healthSmartBanks (PA, Nurse Practitioner, Pharmacy, PT, OT, etc.). Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

Raphael e Marcela convidam novamente Nathalie Santana para falar sobre tratamento do hipertiroidismo em 4 clinicagens: como escolher o melhor tratamento? como controlar os sintomas? como prescrever drogas antitireoidianas? como monitorar o paciente? Use o cupom TDC2024 para assinar o HITT do Medcof e ganhe um cupom de 6 meses gratuitos do Guia TdC! https://hiit.grupomedcof.com.br Referências: 1. Azizi, F et al. “Effect of long-term continuous methimazole treatment of hyperthyroidism: comparison with radioiodine.” European journal of endocrinology vol. 152,5 (2005): 695-701. doi:10.1530/eje.1.01904 2. Villagelin, Danilo et al. “Outcomes in Relapsed Graves' Disease Patients Following Radioiodine or Prolonged Low Dose of Methimazole Treatment.” Thyroid : official journal of the American Thyroid Association vol. 25,12 (2015): 1282-90. doi:10.1089/thy.2015.0195 3. Kahaly, George J et al. “2018 European Thyroid Association Guideline for the Management of Graves' Hyperthyroidism.” European thyroid journal vol. 7,4 (2018): 167-186. doi:10.1159/000490384 4. Villagelin, Danilo et al. “A 2023 International Survey of Clinical Practice Patterns in the Management of Graves' Disease: A Decade of Change.” The Journal of clinical endocrinology and metabolism, dgae222. 5 Apr. 2024, doi:10.1210/clinem/dgae222 5. Ross, Douglas S et al. “2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis.” Thyroid : official journal of the American Thyroid Association vol. 26,10 (2016): 1343-1421. doi:10.1089/thy.2016.0229 6. Shalaby M, Hadedeya D, Toraih EA, et al. Predictive factors of radioiodine therapy failure in Graves' Disease: A meta-analysis. Am J Surg. 2022;223(2):287-296. doi:10.1016/j.amjsurg.2021.03.068 7. Carella, C et al. “Serum thyrotropin receptor antibodies concentrations in patients with Graves' disease before, at the end of methimazole treatment, and after drug withdrawal: evidence that the activity of thyrotropin receptor antibody and/or thyroid response modify during the observation period.” Thyroid : official journal of the American Thyroid Association vol. 16,3 (2006): 295-302. doi:10.1089/thy.2006.16.295 8. Struja T, Kaeslin M, Boesiger F, et al. External validation of the GREAT score to predict relapse risk in Graves' disease: results from a multicenter, retrospective study with 741 patients. Eur J Endocrinol. 2017;176(4):413-419. doi:10.1530/EJE-16-0986 9. Park SY, Kim BH, Kim M, et al. The longer the antithyroid drug is used, the lower the relapse rate in Graves' disease: a retrospective multicenter cohort study in Korea. Endocrine. 2021;74(1):120-127. doi:10.1007/s12020-021-02725-x 10. Azizi F, Amouzegar A, Tohidi M, et al. Increased Remission Rates After Long-Term Methimazole Therapy in Patients with Graves' Disease: Results of a Randomized Clinical Trial. Thyroid. 2019;29(9):1192-1200. doi:10.1089/thy.2019.0180 11. Chaker L, Cooper DS, Walsh JP, Peeters RP. Hyperthyroidism. Lancet. 2024;403(10428):768-780. doi:10.1016/S0140-6736(23)02016-0 12. Lee SY, Pearce EN. Hyperthyroidism: A Review. JAMA. 2023;330(15):1472-1483. doi:10.1001/jama.2023.19052 13. https://www.tadeclinicagem.com.br/guia/146/tempestade-tireotoxica/

The American Thyroid Association estimates that more than 27 million American's have thyroid disease but more than half of them have no idea! Women are 5-8 times likely than men to develop a thyroid condition too and risk increases as we go through perimenopause and the years that follow! Why does this matter? We have had a LOT of popularity and questions about the THYROID. So I covered a LOT: - Symptoms of low thyroid function - How the thyroid actually works - Common thyroid issues we see - The connection between thyroid and cortisol/stress - The connection between thyroid and menopause/your menstrual cycle - Thyroid and your gut - What to do to prevent support our thyroid as we age - What to eat to support thyroid function - What to ask for to get tested TIMESTAMPS: (00:00) - Intro (01:13) - Overview of Hypothyroidism (05:08) - What is the Thyroid??? (08:22) - How the thyroid effects your health and your results (23:26) - Stress, inflammation, and your Thyroid (28:25) - Why so many women have thyroid issues (32:50) - How you can support your thyroid! (42:51) - These food can improve your Thyroid function (46:06) - What tests should you get done? (47:24) - Final thoughts + Reminders CONNECT WITH ME ONLINE: ‣ Check out our BRAND NEW workout subscription: ⁠⁠⁠⁠⁠⁠⁠https://www.trainerize.me/profile/vitalityoet/?planGUID=b020a7cf27f6453b9d29ca3dc9bbaf37&mode=checkout⁠⁠⁠⁠⁠⁠⁠ ‣ Join our community! Metabolism and Menopause by Vitality - Secrets for Fat Loss: ⁠⁠⁠⁠⁠⁠⁠https://m.facebook.com/groups/969761266958379⁠⁠⁠⁠⁠⁠⁠ ‣ Schedule a FREE consultation call - ⁠⁠⁠⁠⁠⁠⁠https://calendly.com/d/2p8-mxx-dgf/free-consultation-call-zoom⁠⁠⁠⁠⁠⁠⁠ ‣ Apply for coaching with us! - ⁠⁠⁠⁠⁠⁠⁠https://calendly.com/d/386-k9q-4cg/coaching-application-call-zoom⁠⁠⁠⁠⁠⁠⁠ ‣ Our Website! - https://www.vitalityoet.com/ ‣ Learn more about DUTCH hormone testing with VitalityOET - ⁠⁠⁠⁠⁠⁠⁠https://www.loom.com/share/a567d01c12b44aaf855dcf3d9049d537⁠⁠⁠⁠⁠⁠⁠ ‣ Menopause supplements (use code VITALITY10 for 10% off your order) - ⁠⁠⁠⁠⁠⁠⁠https://shop.nutritiondynamic.com/collections/all⁠⁠⁠⁠⁠⁠⁠ ‣ Instagram: ⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/vitalityoet.stephanie⁠⁠⁠⁠⁠⁠⁠ ‣ WATCH the podcast on YouTube: ⁠⁠⁠⁠⁠⁠⁠https://www.youtube.com/@metabolismandmenopausepodcast⁠⁠⁠⁠⁠⁠⁠ ‣ All other links: ⁠⁠⁠⁠⁠⁠⁠https://stan.store/vitalityoetstephanie⁠⁠⁠⁠⁠⁠⁠ ---- © 2024 Stephanie Fusnik & VitalityOE

Did you know that over 27 million Americans are suffering from thyroid disease? According to the American Thyroid Association, over half of those who are, don't even realize they have a thyroid condition! Your thyroid doesn't just ‘magically' decide to stop working - there's a much bigger reason as to WHY it's not functioning properly. Simply throwing a medication at your hypothyroid symptoms and expecting that to take care of your issues, will never truly fix (or heal) your thyroid. If you're currently struggling with frustrating thyroid issues, this episode will empower you with the knowledge and tools to take control of your health. If you're needing more support, our team would love to help you with a personalized treatment plan that will focus on a root-cause approach, and allow you to find the energy, balance, and joy that you're looking for in your life!Episode Recap: What the thyroid actually does + the 2 main hormones it secretes {3:46}The variety of symptoms that can present when your thyroid is working sub-optimally {4:40}Six interesting symptoms that typically correlate with hypothyroidism {8:42}The fascinating connection between ADHD and hypothyroidism {12:39}The most common triggers for hypothyroidism {16:01}3 halogen chemicals that greatly impact thyroid health + ways you can detox from halogen chemicals {18:21}The chronic dieting/undereating cycle paired with overexercising that many women get stuck in for so long + how this affects thyroid health {23:25}The symbiotic relationship between your gut health and thyroid health {29:38}How trauma and chronic stress really affect your thyroid {31:53} Adverse childhood experiences (ACEs) + its connection to autoimmune and hypothyroid symptoms {34:02}Common medications prescribed to treat hypothyroidism + how this impacts your thyroid {35:17}Bloodwork recommended to do in order to evaluate your thyroid + minerals that can support your thyroid {41:14}**Disclaimer: The information shared in this podcast is NOT meant to be taken as individual or medical advice. Please seek the advice of your physician or healthcare provider regarding any medical condition or treatment.Complete show notes (including all links and resources I mentioned in this episode): https://margaretpowell.com/podcast/episode40Connect with me on Instagram @margaretannpowell and @fueledandfreenutritionLearn more about working together by visiting https://fueledandfree.com/For questions or suggestions about the podcast, send us an email at fueledandfreepodcast@gmail.com

When 6,058 endcrinologist from multiple european countries were polled for this study, they determined that for a MAJORITY of patients that had hypothyroid syptoms while being on T4 ONLY was ALL IN THEIR HEADS and patients have unrealsitic expectations on how they should be feeling...   This episode is a heartfelt exploration into the often-dismissed symptoms of hypothyroidism and the struggle to be heard and adequately treated in the medical community. Dr. Warren passionately argues against the study's conclusion that cognitive behavioral therapy is the primary solution for patients with persistent symptoms, advocating instead for a more holistic and informed approach to thyroid care. In this episode, you'll uncover: - Dr. Warren's personal reaction to a study that highlights the disconnect between patient experiences and medical acknowledgment of persistent hypothyroid symptoms. - The alarming notion that a significant number of practitioners attribute patient symptoms to psychosocial factors, despite clear indications of thyroid hormone imbalances. - The importance of comprehensive thyroid testing, including TSH, Free T3, and T4, to truly understand and address thyroid health, especially for those post-thyroidectomy. - The power of patient advocacy and the necessity of finding practitioners willing to listen and collaborate on treatment plans that include T3 when necessary. - The critical role of functional practitioners in guiding patients through the complexities of thyroid health, navigating the medical system, and advocating for optimal care. - The socioeconomic disparities in thyroid treatment access and the need for a more equitable healthcare system.   Studye referenced: https://pubmed.ncbi.nlm.nih.gov/38368541/ NEXT STEPS: //To join a community that champions your thyroid health journey, check out Dr. Warren's Thyroid Inner Circle at https://www.drrebeccawarren.com/thyroidmembership //To learn more about Dr. Warren's approach and how you can work with her, visit https://www.drrebeccawarren.com //For a comprehensive understanding of your thyroid labs and how to optimize them, grab the free Optimal Lab eBook at https://www.drrebeccawarren.com/thyroidlabsguide.   Don't forget to leave a five-star review if this episode resonates with you, subscribe for more empowering content, and share this powerful message with anyone who needs to hear that they are not alone in their thyroidless journey.       ---   Disclaimer: The content of this podcast is for informational purposes only and is not intended as medical advice. Always consult a healthcare professional for any health concerns. The views expressed in this podcast, including those of Dr. Warren, do not constitute medical advice. The podcast and its host are not liable for any adverse effects resulting from information provided. Opinions of guests are their own, and the podcast does not endorse or assume responsibility for guest statements. Guests may have interests in products or services mentioned. If you have a medical issue, seek the advice of a licensed healthcare provider.  

Step into the realm of self-advocacy and holistic understanding with Dr. Rebecca Warren in this enlightening episode of The Thyroidless Life, "Making the Case for T3 Testing, Meds and Beyond: A Holistic Thyroid Approach." Dr. Warren passionately dismantles the conventional medical approach that has left many thyroid patients unheard and underserved. She challenges the status quo and invites you to explore the comprehensive care your body deserves. This episode is a beacon for those who have felt lost in the healthcare system, covering: The historical context of thyroid medication and its impact on current treatment paradigms - The critical need for personalized medicine and the shortcomings of one-size-fits-all approaches - The power of T3, the active thyroid hormone, and why its measurement is essential for optimal health - The often-ignored significance of Reverse T3 as an indicator of bodily stress and its implications for thyroid health - The vital role of functional practitioners in addressing the interconnectedness of thyroid health with overall bodily functions - Practical guidance on navigating the medical system, advocating for comprehensive lab work, and understanding the importance of patient preference in treatment decisions - The transformative potential of identifying and addressing the primary stressors affecting your health Remember, your body is a marvel of resilience, and with the right tools and support, you can cultivate a life of wellness and vitality, even without a thyroid. Tune in to this episode to embrace the full spectrum of thyroid health management and rewrite your health destiny.   NEXT STEPS:   For a deeper dive into optimal thyroid health, grab your FREE copy of Optimal Thyroid Labs Ebook at https://www.drswarren.com/thyroidlabsguide To join a community that empowers and supports your thyroid health journey, explore the Thyroid Inner Circle membership group at https://www.drswarren.com/thyroidmembership Check out more resources at: www.drrebeccawarren.com Rethinking Hypothyrdoism: https://www.amazon.com/shop/drswarren/list/13UJOXEVQZ3T9?ref_=cm_sw_r_cp_ud_aipsflist_aipsfdrswarren_5WEGSKH9EZNCB4R7H8EV Healing After Thyroidectomy Support Supplements: Click here to check out my favorite supplements And get 10% off your first order with promo code FIRST  Thyroid Gland Support Supplements: Supplements for those WITH a Thyroid Click here  and get 10% of your first order with promo code FIRST  Stay informed and in control by subscribing to the podcast for the latest episodes and insights. ---               Disclaimer: This podcast is for informational purposes only. Statements and views expressed on this podcast are not medical advice. This podcast, including Dr. Warren, disclaim responsibility from any possible adverse effects from the use of information contained herein. Opinions of guests are their own, and this podcast does not accept responsibility for statements made by guests. This podcast does not make any representations or warranties about guests' qualifications or credibility. Individuals on this podcast may have a direct or non-direct interest in products or services referred to herein. If you think you have a medical problem, consult a licensed physician.

Thyroid Talk with Dr. Angela Mazza, DORecorded:  January 12, 2024SHOW NOTES EPISODE 26Thyroid CancerHost: Dr. Angela Mazza, DOCo-host: Dawn Sheffield I'm Dr. Angela Mazza, D.O., a thyroid, endocrine, and metabolism specialist with a private practice in Central Florida.  My goal for this podcast is to define and demystify the thyroid gland, and thyroid-related medical conditions.  By providing information in an easy-to-understand format, we hope to help patients better understand the ways in which their bodies work, and to help them thrive.  My goal is to help us live more fulfilling lives by taking control of our health, to feel our best. I do this podcast to provide life-saving education and encourage patients to see a doctor in time to prevent or minimize damage.  That's deeply fulfilling.  I enjoy helping folks understand how all aspects of their lives are tied to both thyroid and overall health.  That's why I went into endocrinology.  It's a medical art that combines science with the study of our lives—and all that they encompass.   To recap just some of what we covered in this episode, not necessarily in this order: ·        What are the types of thyroid cancer?·        How is thyroid cancer diagnosed?·        What are the treatment options for thyroid cancer?·        Cure rates are good but early detection is important.·        And best of all, we learned that we CAN impact our thyroid health!  My book, Thyroid Talk: An Integrative Guide to Optimal Thyroid Health, is now available on Amazon.  For information on the related Webinar and online master course, please go to thrivethyroid.com.  Or forward your name and email to thyroidtalk.mazza@gmail.com or to our website: metaboliccenterforwellness.com  The webinar coordinates with the online master class.  The master class has modules that cover topics like diagnosis of thyroid issues, personalized treatment, gut healing, and much more--plus some bonuses.  Regarding supplements mentioned in various episodes of this podcast, please visit the Wellness Store at metaboliccenterforwellness.com   Send your comments, show ideas, and questions to thyroidtalk.mazza@gmail.com  We may disclose your general location on air (the city or town, for example), but we will NOT read your name NOR your address on the show.  We reserve the right to edit your input as necessary.  Please stay in touch!  Check out our YouTube channel at: Dr. Angela Mazza; the website at metaboliccenterforwellness.com, as well as Facebook, Instagram, and TikTok.  Our next episode—number 27—will be on listener-requested Leaky Gut, Part 3.Citations, references, additional information:American Thyroid Association.  Thyroid Cancer FAQ.  Copyright Ó 2014 the American Thyroid Association.  www.thyroid.org.   Mazza A.  Thyroid Talk: An Integrative Guide to Optimal Thyroid Health.  Copyright Ó 2023.  Available now on Amazon. Don't forget to ask your healthcare provider about any specific questions regarding your wellness.  This podcast is meant for educational purposes only. Copyright 2024 Dr. Angela Mazza DO.  Thyroid Talk with Dr. Angela Mazza, DO.  All rights reserved   Check out our YouTube channel - Dr. Angela Mazza, our website at Metabolic Center for Wellness, our FaceBook and our Instagram page.

Kate Rice is proof of the power of persistence and positivity while navigating a cancer journey. Rice, an award-winning journalist, received a diagnosis of stage 4 anaplastic thyroid cancer in October 2021 — and quickly applied the same dogged dedication that had served her reporting in support of her own survival. “When I was a reporter, none of my sources or desired sources could escape me. Sooner or later, they were going to have to talk to me, I just have that kind of determination,” Rice said. “And it wasn't so much that I wanted to find out about the cancer I got diagnosed with; I wanted to find out who could cure it.” Years before receiving her thyroid cancer diagnosis, Rice had learned there were what doctors described as “indeterminant” nodules on her thyroid and was told to monitor them. She noticed small lumps on her neck in June 2021 and was told she would have to wait six months or so to be examined.  Rice, who had previously had a benign tumor removed from her neck and a case of melanoma, searched for doctors who could see her sooner — and, upon finally receiving her diagnosis, was told “I'll pray for you” by a surgeon. Anaplastic thyroid cancer, according to the American Thyroid Association, occurs in less than 2% of patients with thyroid cancers, but it is one of the fastest-growing and most aggressive of all cancers overall. The disease's average survival rate is six months, and just approximately one-fifth of patients live longer than a year after receiving a diagnosis. Immediately after receiving her diagnosis, Rice began sourcing for potential solutions, starting with a group text to her inner circle of loved ones. “My cousin, who had been one of the first people I'd sent (a message to when I) cast that wide net out to try to get information, had promptly gone online and found that (The University of Texas) MD Anderson Cancer Center in Houston had a clinic that specialized in this very rare (cancer) … and actually cured people with it. So, I got my diagnosis, I think, at two o'clock Friday afternoon, I was walking home up Columbus Avenue, I guess, and on the phone with MD Anderson, to get in there because I can jump on the phone with both feet.” Within days of receiving her diagnosis, Rice left New York City for Houston, Texas, seeking treatment from the Facilitating Anaplastic Thyroid Cancer Specialized Treatment Team at MD Anderson Cancer Center. Such determined self-advocacy, Rice said, is “absolutely essential.” “You have to stand up for yourself, you have to recognize that your doctors are specialists in whatever it is they're specialists in, but you're the specialist in your body,” she said. “And I knew something was going on. I mean, something was happening with my thyroid. Thyroid cancers, in general, are not the scariest cancers out there. They're serious cancers, and the treatment for a whole bunch of different thyroid cancers is not fun. But I knew this was something that was potentially a very big deal.  “And so when the first doctors I saw in New York were very relaxed and I couldn't get in to see a doctor I've been seeing for years because I had what are called indeterminate nodules on my thyroid — (which are) not malignant, but (they're) not benign, either — they were like, ‘Yeah, well, we can't get you in for six months, but that's OK,' I'm like, ‘No, not OK.' Even before I got the diagnosis, I was a pushy patient and we all have to do that. And the thing is, you're like, ‘Oh, I don't want to be much trouble. These guys are the pros, they know.' But really, you've got to listen to your body and stand up for yourself.” Following treatment at MD Anderson Cancer Center, Rice said she's “fine.” Now a radio disc jockey and ski instructor in Park City, Utah, she returns to Houston every six weeks for immunotherapy treatments at MD Anderson. She also documented her cancer journey in the 2023 book “Cured: A Tale of Badassery.” She has advice for fellow patients facing the long haul of a stage 4 cancer diagnosis. “Stay positive. Realize we all have to fight this cancer trauma that understandably, many people in this country, in this in the world, carry because we've seen terrible things happen to people we love, when my dad died of prostate cancer,” Rice said. “But, the thing to remember is so many cancers now are either curable or treatable and manageable. The whole thing is getting to the right place in time, which is a challenge with our healthcare system. But you really have to remember there is no such thing as false hope there is only hope.” For more news on cancer updates, research and education, don't forget to subscribe to CURE®'s newsletters here.

According to the American Thyroid Association, an estimated 20 million people suffer from thyroid disease. Even more surprising, around 60% of those people aren't even aware that they have an issue. Undiagnosed thyroid disease can lead to serious health risks including everything from cardiovascular issues to infertility. On a mission to change this statistic is today's guest, Dr. Anshul Gupta.    Dr. Anshul Gupta is a best-selling author, speaker, researcher, and the world expert in Hashimoto's disease. He educates people worldwide on reversing Hashimoto's disease. He is a Board-Certified Family Medicine Physician, with advanced certification in Functional Medicine, Peptide therapy, and also Fellowship trained in Integrative Medicine. He has worked at the prestigious Cleveland Clinic Department of Functional Medicine alongside Dr. Mark Hyman. He has helped thousands of patients to reverse their health issues by using the concepts of functional medicine.    He is now on a mission to help 1 million people reverse their health conditions. To achieve this mission he has written a bestselling book called Reversing Hashimoto's. He has also started a virtual functional medicine practice, a blog, and a YouTube channel so he can reach people from all over the world. His blog and YouTube videos have already reached more than 2 million people worldwide.     Inside this episode: The health struggles that led Dr. Gupta to functional medicine Why are people with Hashimoto's not feeling better What is the mito-thyroid connection? How and why brain fog is connected to Hashimoto's Tips for improving brain fog  What role do toxins play in brain fog    Get to know the root cause of YOUR thyroid with Dr. Gupta's Free Thyroid Quiz here:  https://www.anshulguptamd.com/thyroid-quiz/ Connect and learn more from Dr. Gupta!   Follow him on Youtube  Buy his Best Seller Book Schedule an Online Consultation with him Connect on Instagram Connect on Facebook Connect on LinkedIn

Dr. Bianco recently published the book, Rethinking Hypothyroidism: Why Treatment Must Change and What Patients Can Do.  Today I'll be speaking to Dr. Bianco, whom I deeply respect,  about his approach to thyroid health—and mine.  While we already had a lot of overlap in our approaches,  I walked away with new, incredible insights on hypothyroidism.  I think you'll feel the same way.  Featured Studies  https://pubmed.ncbi.nlm.nih.gov/25305308/ https://pubmed.ncbi.nlm.nih.gov/36079838/ https://pubmed.ncbi.nlm.nih.gov/29615976/ https://pubmed.ncbi.nlm.nih.gov/10378389/ https://pubmed.ncbi.nlm.nih.gov/27700539/ https://pubmed.ncbi.nlm.nih.gov/35445422/ https://pubmed.ncbi.nlm.nih.gov/34185829/ https://pubmed.ncbi.nlm.nih.gov/26940864/ https://pubmed.ncbi.nlm.nih.gov/35570696/ https://pubmed.ncbi.nlm.nih.gov/34457140/ https://pubmed.ncbi.nlm.nih.gov/34340589/  https://pubmed.ncbi.nlm.nih.gov/31396154/ Related Resources Rethinking Hypothyroidism: https://press.uchicago.edu/ucp/books/book/chicago/R/bo183892827.html  Thyroid Self-Management Course: https://drruscio.com/thyroid-course/  My articles: https://drruscio.com/blog/ My book: https://drruscio.com/getgutbook/  Courses, free guides, and more: https://drruscio.com/resources?utm_source=youtube&utm_medium=link&utm_campaign=drruscio.com_resources   Timestamps 00:00 Intro  03:33 Diagnosis is pretty straightforward  08:00 2 ways to diagnose hypothyroidism  12:20 Hypothyroidism prevalence  24:13 1 in 3 might be on meds they don't need 29:15 TSH is 6. Should we treat or not?  33:25 TPO values & risk 35:16 Normal labs, but there's symptoms 38:32 The misuse of T3 levels  45:15 Should patients start with combination therapy?  52:41 What to do step-by-step  55:10 What about liquid T4?  58:12 Side effects & risks of adding T3 Dr. Bianco received his MD from Santa Casa Medical School and a PhD in human physiology at the University of Sao Paulo, in Brazil. He's the former president of the American Thyroid Association (2015-2016) and author of the book "Rethinking Hypothyroidism" .  Currently, he's a Professor of Medicine at University of Chicago in the research unit called the Committee on Molecular Metabolism and Nutrition which focuses on thyroid hormone metabolism, more specifically, how certain enzymes called deiodinases control thyroid hormone action & metabolism. This research forms the basis for his understanding of the variable response to thyroid hormone replacement among individuals.  He has been published in over 200 peer reviewed papers.  Learn more about his work at www.deiodinase.org    Get the Latest Updates Facebook - https://www.facebook.com/DrRusciodc Instagram - https://www.instagram.com/drrusciodc/ Pinterest - https://www.pinterest.ca/drmichaelrusciodc DISCLAIMER: The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Music featured in this video: "Modern Technology" by Andrew G, https://audiojungle.net/user/andrew_g  *Full transcript available on YouTube by clicking the “Show transcript” button on the bottom right of the video.

The American Thyroid Association estimates that five to eight women are affected with Hashimoto's for every one man. The ATA also estimates that one in eight women will be affected with Hashimoto's or another thyroid disorder at some point in their lives. So, if you're a woman, and you probably are if you're listening to this podcast… and you're not CURRENTLY dealing with thyroid issues… then there's a good chance that you will be dealing with a thyroid issue. Which also means that it's a good time to start making some shifts to have that NOT be the case.  But the bigger question is WHY?! Why does it seem like we all know a woman (or we are that woman) who has thyroid issues? In this episode, we're talking about some of the reasons (or, more aptly put- theories) why women deal with thyroid disease at a much higher rate than men… and of course, I have a few simple shifts that you can do to start making an impact in this area today..  to work towards reducing that statistic. Glad you're here, Sarah

Have you been experiencing symptoms of hypothyroidism even on medication but have been dismissed by your doctor? Learn the truth behind this issue from Antonio C. Bianco, MD, Ph.D., a professor of medicine at the University of Chicago and former president of the American Thyroid Association. Dr. Bianco's book, "Rethinking Hypothyroidism," provides an easy-to-understand overview of hypothyroidism treatment and the role of pharmaceutical companies in shaping it. His book argues that the current approach is not effective for many patients. Learn about the problems with current thyroid treatment and the changes needed in this Season 2 finale! Helpful Links: Dr. Bianco's book: Rethinking Hypothyroidism Learn more about Dr. Bianco Complete At-home Thyroid Test Kit from Paloma Health [$30 OFF CODE: HYPOTHYROIDCHEF] Thrivers Club Membership Subscribe to my newsletter and receive my FREE Thyroid-healthy Grocery Guide. Hypothyroid Chef Website Disclaimer: This content is for educational and informational purposes only. Always consult your doctor or other qualified healthcare provider before changing your diet, health care, or exercise regimen.

In recent times, hypothyroidism is by no means an unknown disease for many. With most of the population having thyroid problems, what is the real problem in treating it? What are the alternatives to conventional T4 medicines? In this episode, the renowned researcher Dr. Antonio Bianco is here to share his knowledge on Thyroid and combining T3 therapy for thyroid patients.What's Covered:2:22 - Why T4 medicines like Levothyroxine alone don't work for some?12:02 - Combination Therapy13:55 - Why just TSH testing is not enough?19:16 - Why does T4-T3 conversion not happen well for some?23:50 - Reason for choosing combination therapy28:23 - Options for T4, T3 combination therapy35:28 - Other aspects of proper thyroid treatment37:53 - The Book 'Rethinking Hypothyroidism'About the Guest:Dr. Antonio Bianco is a physician, scientist, and a writer working in the thyroid field. He obtained his MD and PhD in human physiology in Sao Paulo, Brazil, and then later immigrated to the United Status, where he maintains an NIH funded laboratory. His research career has focused on how T3 initiates or terminates clinical biological steps while maintaining relatively stable plasma levels. Dr. Bianco was elected and served as president of the American Thyroid Association in 2016.*** KNOW MORE AT ***https://www.anshulguptamd.com/ ***Book a call with Dr. Anshul Gupta ***https://www.anshulguptamd.com/work-with-me/Instagram : https://www.instagram.com/anshulguptamd/Twitter: https://www.twitter.com/anshulguptamdFacebook: https://www.facebook.com/drguptafunctionalmedicine/Pinterest : https://www.pinterest.com/anshulguptamd

According to the American Thyroid Association, as many as 60 percent of those with a thyroid disorder are unaware of their condition, and women are 5 to 8 times more likely than men to develop thyroid disease. If left untreated, thyroid dysfunction increases an individual's risk for other serious conditions such as cardiovascular disease, infertility and osteoporosis. Laboratory testing plays an important role to help diagnose and monitor thyroid disease states.    About our Speaker: Dr. Rea Castro is the Director of Medical Affairs at QuidelOrtho. She holds a Bachelor's degree in Medical Technology from the University of Santo Tomas and a Medical Degree from the University of the East in the Philippines, and a Master's in Public Health from Northern Illinois University in the United States. She has experience in both clinical and biotechnology product development covering multiple therapeutic areas. As the head of Medical Affairs, she is responsible for providing medical support of QuidelOrtho's products throughout the assay lifecycle. Her clinical focus before going into the industry was in Women's Health.

This small butterfly-shaped gland is situated at the bottom of the neck, wrapped around the windpipe. It plays an important role in a number of bodily functions, but isn't as well known as it should be.  According to The American Thyroid Association, over 12% of the country's population will develop a thyroid disorder at some point in their life. Many people are actually unaware of the fact that they even have thyroid disease. Such problems are actually five to eight times more common in women than in men. World Thyroid Day falls on 25th May every year, so let's take the opportunity to boost awareness. What is the purpose of the thyroid? How can I find out if my thyroid functions correctly? Is there anything I can do to stop myself from developing a thyroid disorder? In under 3 minutes, we answer your questions ! To listen to the last episodes, you can click here : Why was Kanye West's Twitter account suspended? How can you save money on your food bill? How did the Act Up group change the way we think about AIDS? A Bababam Originals podcast, written and produced by Joseph Chance. In partnership with upday UK. Learn more about your ad choices. Visit megaphone.fm/adchoices

Interview with Babak Givi, MD, author of American Thyroid Association Guidelines and National Trends in Management of Papillary Thyroid Carcinoma. Hosted by Paul C. Bryson, MD, MBA. Related Content: American Thyroid Association Guidelines and National Trends in Management of Papillary Thyroid Carcinoma

Interview with Babak Givi, MD, author of American Thyroid Association Guidelines and National Trends in Management of Papillary Thyroid Carcinoma. Hosted by Paul C. Bryson, MD, MBA. Related Content: American Thyroid Association Guidelines and National Trends in Management of Papillary Thyroid Carcinoma

What is the thyroid? This small butterfly-shaped gland is situated at the bottom of the neck, wrapped around the windpipe. It plays an important role in a number of bodily functions, but isn't as well known as it should be. According to The American Thyroid Association, over 12% of the country's population will develop a thyroid disorder at some point in their life. Many people are actually unaware of the fact that they even have thyroid disease. What is the purpose of the thyroid? How can I find out if my thyroid functions correctly? Is there anything I can do to stop myself from developing a thyroid disorder? In under 3 minutes, we answer your questions ! To listen to the last episodes, you can click here : What is asthma? What is ecological debt? What is a zombie company? A podcast written and realised by Joseph Chance. In partnership with upday UK. Learn more about your ad choices. Visit megaphone.fm/adchoices

In today's episode, NR founder Kyla and NR practitioner Kristin distinguish the difference between perimenopause and menopause, and examine how each can influence a female athlete's nutrition, training, and lifestyle recommendations. Please note that this podcast is created strictly for educational purposes and should never be used for medical diagnosis and treatment.***If you would like to work with our practitioners, click here: https://nutritional-revolution.com/work-with-us/Check out our Menopause Support Meal Plan!Check out our Plant-Based Menopause Support Program!Want to get your blood work tested? Try InsideTracker HERE or use the code NUTRITIONALREV to save 20%! If you're interested in sponsoring Nutritional Revolution Podcast, shoot us an email at nutritionalrev@gmail.com. See you in the next episode!***References:Cao, S., Wang, L., Zhang, Z., Chen, F., Wu, Q., & Li, L. (2018). Sulforaphane-induced metabolomic responses with epigenetic changes in estrogen receptor positive breast cancer cells. FEBS open bio, 8(12), 2022–2034. https://doi-org.logan.idm.oclc.org/10.1002/2211-5463.12543Rajoria, S., Suriano, R., Parmar, P. S., Wilson, Y. L., Megwalu, U., Moscatello, A., Bradlow, H. L., Sepkovic, D. W., Geliebter, J., Schantz, S. P., & Tiwari, R. K. (2011). 3,3'-diindolylmethane modulates estrogen metabolism in patients with thyroid proliferative disease: a pilot study. Thyroid : official journal of the American Thyroid Association, 21(3), 299–304. https://doi-org.logan.idm.oclc.org/10.1089/thy.2010.0245Maltais, M. L., Desroches, J., & Dionne, I. J. (2009). Changes in muscle mass and strength after menopause. Journal of musculoskeletal & neuronal interactions, 9(4), 186–197.Silva, T. R., Oppermann, K., Reis, F. M., & Spritzer, P. M. (2021). Nutrition in Menopausal Women: A Narrative Review. Nutrients, 13(7), 2149. https://doi-org.logan.idm.oclc.org/10.3390/nu13072149

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-241   Overview: Seven percent of the US population has an active levothyroxine prescription, which is significantly greater than the number of people diagnosed with overt hypothyroidism. Many of these prescriptions appear to be for the treatment of subclinical hypothyroidism and other conditions in euthyroid individuals. Join us to uncover the latest findings on the use of levothyroxine and what the evidence tells us about appropriate use and misuse of this drug.   Episode resource links: Brito, J., Ross, J., El Kawkgi, O., Maraka, S., Deng, Y., Shah, N., Lipska, K. & (9000). Levothyroxine Use in the United States, 2008-2018. JAMA Internal Medicine, Publish Ahead of Print, doi: 10.1001/jamainternmed.2021.2686. Johansen, M., Marcinek, J., Yun, J. & (2020). Thyroid Hormone Use in the United States, 1997–2016. Journal of the American Board of Family Medicine, 33 (2), 284-288. doi: 10.3122/jabfm.2020.02.190159. Jeffrey R. Garber, Rhoda H. Cobin,Hossein Gharib,James V. Hennessey, Irwin Klein, Jeffrey I. Mechanick, Rachel Pessah-Pollack, Peter A. Singer,Kenneth A. Woeber. Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association; November–December 2012. https://www.endocrinepractice.org/article/S1530-891X(20)43030-7/fulltext; https://www.endocrinepractice.org/action/showPdf?pii=S1530-891X%2820%2943030-7   Guest: Susan Feeney, DNP, FNP-BC, NP-C   Music Credit: Richard Onorato

In this episode, we review the diagnostic criteria and treatment strategy of hypothyroidism including the controversy surrounding brand versus generic levothyroxine and non-levothyroxine thyroid drugs. Key Concepts The most common cause of hypothyroidism is autoimmune thyroiditis - the body attacks the thyroid gland cells. Typically in hypothyroidism, TSH levels will be high and thyroid hormone levels (T3 and T4) will be normal or low. Levothyroxine is the drug of choice to treat hypothyroidism. Doses should start low (to avoid cardiovascular side effects) and then be titrated up based on TSH levels. All other thyroid hormone formulations (including Thyroid USP, Armour Thyroid, liothyronine, etc.) are NOT recommended for use in hypothyroidism. These are not FDA approved medications and there is no data showing these products are more effective than levothyroxine. Generic formulations of levothyroxine are as effective and safe as brand-name Synthroid®. Although several levothyroxine formulations are AB compatible and can be interchanged by a pharmacist, patients should be maintained on the same formulation whenever possible. References Dong BJ, Hauck WW, Gambertoglio JG, et al. Bioequivalence of generic and brand-name levothyroxine products in the treatment of hypothyroidism. JAMA. 1997;277(15):1205-1213. Rennie D. Thyroid storm. JAMA. 1997;277(15):1238-1243. American Thyroid Association. https://www.thyroid.org/

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-241   Overview: Seven percent of the US population has an active levothyroxine prescription, which is significantly greater than the number of people diagnosed with overt hypothyroidism. Many of these prescriptions appear to be for the treatment of subclinical hypothyroidism and other conditions in euthyroid individuals. Join us to uncover the latest findings on the use of levothyroxine and what the evidence tells us about appropriate use and misuse of this drug.   Episode resource links: Brito, J., Ross, J., El Kawkgi, O., Maraka, S., Deng, Y., Shah, N., Lipska, K. & (9000). Levothyroxine Use in the United States, 2008-2018. JAMA Internal Medicine, Publish Ahead of Print, doi: 10.1001/jamainternmed.2021.2686. Johansen, M., Marcinek, J., Yun, J. & (2020). Thyroid Hormone Use in the United States, 1997–2016. Journal of the American Board of Family Medicine, 33 (2), 284-288. doi: 10.3122/jabfm.2020.02.190159. Jeffrey R. Garber, Rhoda H. Cobin,Hossein Gharib,James V. Hennessey, Irwin Klein, Jeffrey I. Mechanick, Rachel Pessah-Pollack, Peter A. Singer,Kenneth A. Woeber. Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association; November–December 2012. https://www.endocrinepractice.org/article/S1530-891X(20)43030-7/fulltext; https://www.endocrinepractice.org/action/showPdf?pii=S1530-891X%2820%2943030-7   Guest: Susan Feeney, DNP, FNP-BC, NP-C   Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-241   Overview: Seven percent of the US population has an active levothyroxine prescription, which is significantly greater than the number of people diagnosed with overt hypothyroidism. Many of these prescriptions appear to be for the treatment of subclinical hypothyroidism and other conditions in euthyroid individuals. Join us to uncover the latest findings on the use of levothyroxine and what the evidence tells us about appropriate use and misuse of this drug.   Episode resource links: Brito, J., Ross, J., El Kawkgi, O., Maraka, S., Deng, Y., Shah, N., Lipska, K. & (9000). Levothyroxine Use in the United States, 2008-2018. JAMA Internal Medicine, Publish Ahead of Print, doi: 10.1001/jamainternmed.2021.2686. Johansen, M., Marcinek, J., Yun, J. & (2020). Thyroid Hormone Use in the United States, 1997–2016. Journal of the American Board of Family Medicine, 33 (2), 284-288. doi: 10.3122/jabfm.2020.02.190159. Jeffrey R. Garber, Rhoda H. Cobin,Hossein Gharib,James V. Hennessey, Irwin Klein, Jeffrey I. Mechanick, Rachel Pessah-Pollack, Peter A. Singer,Kenneth A. Woeber. Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association; November–December 2012. https://www.endocrinepractice.org/article/S1530-891X(20)43030-7/fulltext; https://www.endocrinepractice.org/action/showPdf?pii=S1530-891X%2820%2943030-7   Guest: Susan Feeney, DNP, FNP-BC, NP-C   Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-241   Overview: Seven percent of the US population has an active levothyroxine prescription, which is significantly greater than the number of people diagnosed with overt hypothyroidism. Many of these prescriptions appear to be for the treatment of subclinical hypothyroidism and other conditions in euthyroid individuals. Join us to uncover the latest findings on the use of levothyroxine and what the evidence tells us about appropriate use and misuse of this drug.   Episode resource links: Brito, J., Ross, J., El Kawkgi, O., Maraka, S., Deng, Y., Shah, N., Lipska, K. & (9000). Levothyroxine Use in the United States, 2008-2018. JAMA Internal Medicine, Publish Ahead of Print, doi: 10.1001/jamainternmed.2021.2686. Johansen, M., Marcinek, J., Yun, J. & (2020). Thyroid Hormone Use in the United States, 1997–2016. Journal of the American Board of Family Medicine, 33 (2), 284-288. doi: 10.3122/jabfm.2020.02.190159. Jeffrey R. Garber, Rhoda H. Cobin,Hossein Gharib,James V. Hennessey, Irwin Klein, Jeffrey I. Mechanick, Rachel Pessah-Pollack, Peter A. Singer,Kenneth A. Woeber. Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association; November–December 2012. https://www.endocrinepractice.org/article/S1530-891X(20)43030-7/fulltext; https://www.endocrinepractice.org/action/showPdf?pii=S1530-891X%2820%2943030-7 Guest: Susan Feeney, DNP, FNP-BC, NP-C   Music Credit: Richard Onorato

Rick Greene, MD and Nancy Cho, MD discuss the impact of the 2015 American Thyroid Association guideline change on clinical practice in low-risk differentiated thyroid cancer, specifically regarding the rate of completion thyroidectomy. Dr. Cho is author of the article, “Completion Thyroidectomy is Less Common Following Updated 2015 American Thyroid Association Guidelines.” Dr. Cho is Associate Surgeon, Brigham and Women's Hospital and Dana-Farber Cancer Institute, and Assistant Professor of Surgery, Harvard Medical School, Boston, MA.

Today's episode is dedicated to the approach to thyroid storm. It's the first in our Mini-Case series. Show Highlights: Our case, symptoms, and diagnosis: A 12-year-old female presents to the PICU with chest discomfort. She was noted to be anxious by her parents over the past few days. They felt she was a bit "off," as she would constantly drop items and have a tremor. A few weeks prior to these symptoms, she was noted to have rhinorrhea, congestion, and progressive neck swelling. Her parents became increasingly concerned this morning as her temperature was 104F. Per her parents, she was agitated throughout the night and became increasingly somnolent in the early morning.  To summarize key elements from this case, this patient has: Chest pain likely due to a cardiac etiology or musculoskeletal cause. Tremor likely due to a primary neurologic cause or increased metabolic drive. Neck swelling with fever after a prodrome of URI symptoms which could be concerning for lymphadenitis or thyroid goiter. Synthesizing these symptoms together, this patient likely has a systemic etiology such as hyperthyroidism, with the most severe manifestation being thyroid storm, a toxidrome, or a pheochromocytoma. Given the fever and altered mental status, considering sepsis is key. Key history features in this child with tachycardia and signs of hyperthyroidism: High fevers up to 104F Altered mental status Neck swelling  Red flag symptoms and physical exam components in a patient with severe hyperthyroidism include: Airway Check for dyspnea or stridor when the patient is supine. Do a Mallampati assessment. Auscultate for a bruit in the neck.  Cardiovascular system Concerns include congestive heart failure and cardiac dysrhythmias. Widened pulse pressure is common  The American Thyroid Association has advocated for the Burch-Wartofsky Point Scale (BWPS) for severe thyrotoxicosis. A score of 45 or higher indicates thyroid storm. A case-control study published in 2015 in the Journal of Endocrinology noted that the BWPS may overdiagnose up to 20% of patients. Clinical criteria on the BWPS include the following: Thermoregulatory dysfunction Central nervous system effects Gastrointestinal-hepatic dysfunction Cardiovascular dysfunction Congestive heart failure Presence or absence of a precipitant history of URI or underlying thyroid condition Back to our specific case, the patient's labs are consistent with low TSH and elevated free T4, indicating primary hyperthyroidism, positive for TSH-receptor antibodies, and the diagnosis of thyroid storm was confirmed. Other lab findings included elevated WBC, high ALT and AST, elevated glucose, and elevated cortisol. Her cardiac evaluation was notable for sinus tachycardia with occasional PACs. Other important labs include a coagulation panel, BNP and lactate, CRP, procalcitonin, blood cultures, and basic blood chemistries. Let's quiz ourselves with a multiple choice question: A patient with thyroid storm is admitted to the PICU. He is started on thyroid modulating therapy. Which of the following mechanisms of action does this medication likely work by?  A. Activate Thyroid Peroxidase  B. Inhibit Thyroid Peroxidase  C. Inhibit Iodine Uptake within the Thyroid  D. Increase conversion from T4 to T3    The correct answer is B. The most likely medication which is used in thyroid storm is methimazole or propylthiouracil. Both of these medications block thyroid peroxidase.  In terms of differential in our case, you want to think about other causes of fever, tachycardia, and CNS dysfunction, including, but not limited to sepsis, serotonin syndrome, neuroleptic malignant syndrome, heatstroke, and drug intoxication.  The diagnostic approach for our patient should focus on her history and physical examination. Be sure to include thyroid function tests, cardiac evaluation via EKG or Echo, chest x-ray, blood culture, urine...

According to the American Thyroid Association, over 12 percent of the U.S. population will develop a thyroid condition during their lifetime. However, up to 60 percent of the 20 million Americans who have thyroid disease are unaware of their condition.Victoria Gasparini, founder of The Butterfly Effect Blog, which began as a result of her own thyroid condition, shares her story and covers the following:Learnings she gleaned from the patients she has connected through her blog which would benefit both patients and the medical community alikeRealistic suggestions for how to manage thyroid disease in the short term and over your lifetimeTips for knowing what information to trust onlineRelated EpisodesCould Your Unresolved Symptoms Be a Thyroid Condition?ResourcesThe Butterfly Effect BlogThe Hormone Diet by Natasha TurnerIf you liked this episode and you're feeling generous, please leave a review on iTunes!And be sure to:Sign up for the Fempower Health Monthly NewsletterFollow  on Instagram for updates and tips.Shop the Fempower Health store for products discussed on the podcast.Sponsors:ReceptivaDx the sponsor of all of Season 2.  Provide code FEMPOWER-HEALTH for $75 off.About Victoria GaspariniVictoria is a naturopathic medical student at the Canadian College of Naturopathic Medicine, as well as a patient advocate for thyroid and autoimmune disease. She is the founder of The Butterfly Effect Blog and instagram, @thefedupthyroid, where she is dedicated to providing research and patient-patient advice on healing and dealing with thyroid disease. **The information shared by Fempower Health is not medical advice but for information purposes to enable you to have more effective conversations with your doctor.  Always talk to your doctor before making health-related decisions. Contains affiliate links.Support the show (https://www.patreon.com/fempowerhealth)

Ever wonder if you are taking the vitamins your body needs? Tune in as Arielle Levitan, MD and Romy Block, MD founders of Vous Vitamin, LLC share ways we can live healthier lives. Arielle Levitan, MD, is a board-certified internal medicine physician and the co-founder of Vous Vitamin, LLC. She is the co-author of the award-winning book The Vitamin Solution: Two Doctors Clear Confusion About Vitamins and Your Health, published in November 2015. She attended Stanford University and Northwestern University’s Feinberg School of Medicine, and has served as chief medical resident for the Northwestern University McGaw Medical Center’s Evanston Hospital Program and as a clinical instructor for its medical school. Dr. Levitan has a special interest in women’s health and preventive medicine and currently practices general internal medicine on the North Shore of Chicago where she teaches medical students on-site. She enjoys cooking, cardio tennis, running, being a soccer mom (sometimes), and spending time with her three kids and husband, also a doctor of internal medicine. Romy Block, MD, is a board-certified specialist in endocrine and metabolism medicine, member of the American Thyroid Association, and the co-founder of Vous Vitamin, LLC. She is the co-author of the award-winning book The Vitamin Solution: Two Doctors Clear Confusion About Vitamins and Your Health, published in November 2015. She attended Tufts University and Tel Aviv University’s Sackler School of Medicine. She completed residency training in internal medicine at North Shore University Hospital—North Shore-LIJ and did a fellowship at New York University. Dr. Block practices on the North Shore of Chicago where she specializes in thyroid disorders and pituitary diseases. She enjoys travel, food and wine, working out with a personal trainer, and spending time with her husband (a pulmonary and sleep specialist) and their three boys. If you need help getting organized to better manage your time and life click the following link to learn how I can help you Strategize and Organize. Check this week's product suggestion is the Lazy Susan's available in my Amazon Shop. This episode’s book selection is Medical Medium Life-Changing Foods: Save Yourself and the Ones You Love with the Hidden Healing Powers of Fruits & Vegetable available in my Amazon Shop. Join my FREE Facebook Group For Women Ready To Live Life Totally Organized. --- Send in a voice message: https://anchor.fm/janetmtaylor/message

In this episode, the Good GP interviews Professor Creswell (Cres) Eastman on Hypothyroidism in pregnancy. This episode covers how pregnancy affects the thyroid, the complications, case detection, treatment and management. Prof Cresman (Cres) Eastman is a world-renowned endocrinologist and the principal medical advisor to the Australian Thyroid Foundation. He is also the Clinical Professor of Medicine at the Westmead Clinical School, University of Sydney and remains in active clinical practice as a Consultant Physician in Endocrinology and as an aviation medical consultant. Resources: Australian Thyroid Foundation: https://thyroidfoundation.org.au/ American Thyroid Association guidelines: https://www.liebertpub.com/doi/full/10.1089/thy.2016.0457 Journal of Clinical Endocrinology and Metabolism: Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline https://academic.oup.com/jcem/article/97/8/2543/2823170?searchresult=1

Using health literacy to improve resultsGetting any type of cancer diagnosis can be terrifying, but it’s even worse when you don’t really understand what’s happening. On this episode of WE Have Cancer, Lee talks with Carly Flumer about her experiences -- from getting a thyroid cancer diagnosis herself to now advocating for medical professionals to use health literacy concepts to improve patient compliance. Guest biographyCarly Flumer received a thyroid cancer diagnosis at 27 years old and found the journey confusing, frustrating, and even offensive at times. All it took was one doctor drawing a picture to better explain her condition and it all made sense. Carly now works for the National Cancer Institute and as an independent advocate for improving how doctors inform patients. Table of contents:Introduction Thyroid cancer diagnosis At an annual physical, a doctor found a lump in her throat. Though an ultrasound proved the lump wasn’t actually cancer, they did find something else they wanted to get a little closer look at. A biopsy later and Carly had her thyroid cancer diagnosis. Thyroidectomy With metastasis, Carly ended up needing further treatment, including a total thyroidectomy. “The good cancer” Throughout her journey, Carly heard she had “the good cancer” as a way of helping try to ease fears. But Carly found the term to be offensive and believes it doesn’t make things any less stressful or difficult. Advocacy through experience Having found her journey with thyroid cancer to be confusing and difficult. From people downplaying her experiences to doctors failing to explain things properly, Carly shares what she feels is a common problem that can make all the difference for non-compliant patients. Compliance vs. Non-compliance Carly breaks down what she feels is non-compliance from a patient perspective and how she believes the doctor plays a big part in a patient’s success. From lapses in medication to getting scans and bloodwork done on time. Working at the National Cancer Institute Carly talks about how she came to work at the National Cancer Institute during her journey with thyroid cancer. She discusses how her job helps other patients learn about new and emerging cancer treatments through clinical trials. Clinical trials for cancer Through her own experience going through clinical trials, Carly explains what clinical trials offer to patients. She also breaks down how clinical trials can differ -- from trying new treatments to finding specific tumor markers. Why and when should patients look at clinical trials? Beyond what clinical trials are at a base level, Lee and Carly talk about why someone might want to participate in a clinical trial and when they should begin looking for one. Phases of clinical trials Carly explains the different phases of a clinical trial and what each phase might offer to both patients, doctors, and researchers alike. Advocating for improving patient education With the experience of her doctors struggling to really teach her about her cancer or the support systems available, Carly is taking up the charge instead. She talks about how she’s been an advocate for improving patient education by sharing her story with others, and how it’s given her a sense of empowerment along the way. Twitter chats and advocacy Carly found Twitter chats during grad school and has begun using the social media format as a part of her advocacy. She’s helped not only other patients but other advocates, doctors, nurses, and even executives of healthcare companies. Links mentioned in the show:https://www.healthliteracy.media/post/teach-don-t-preach-instilling-health-literacy-principles-from-a-patient-s-perspective (Health Literacy Media - Instilling health literacy) https://www.cancer.gov/ (National Cancer Institute) https://www.thyroid.org/thyroid-cancer/ (American Thyroid Association) https://twitter.com/carlyflumer (Carly Flumer - Twitter) Subscribe to the...

January is Thyroid Awareness Month!  There are many types of thyroid conditions. This  episode will focus on hypothyroidism. Hypothyroidism is a common medical condition. Listen to this episode to learn some quick and basic information about the disease. In addition, please check out the link below from the American Thyroid Association website to learn more about other thyroid diseases along with additional information about hypothyroidism.https://www.thyroid.org/Below is link to share with family/friends/colleagues for quick access to Refine Your Health Facebook page please like and follow for great content and includes links to choose a preferred podcast streaming platform.Refine Your Health Podcast https://linktr.ee/refineyourhealth 

In this podcast, Dr. Leslie Eldeiry, practicing endocrinologist in Boston, Massachusetts, interviews Dr. Elizabeth Pearce, Professor of Medicine at Boston University School of Medicine, Boston Medical Center, as well as former president of the American Thyroid Association (2018-2019). The discussion focuses on thyroid function tests in pregnant women, thyroid hormone levels in women before, during and after pregnancy, as well as different treatments for pregnant women who are either hyper- or hypothyroid.

As a companion to Monique's episode, Mary dives into Hypothyroidism and how it affects fertility. Hypothyroidism is a leading cause of difficulty in achieving and maintaining pregnancy. Low thyroid function has a negative impact on reproductive health and is more common than most women realize. When your thyroid gland isn't making enough thyroid hormone, it can have a serious effect on every organ in your body — including your reproductive system. This means hypothyroidism may make it difficult to conceive if you're planning on having children. A study published in August 2015 in the Journal of Pregnancy found that women with hypothyroidism were less likely to become pregnant — and more likely to take longer to become pregnant — than women without the condition. That's because women with hypothyroidism may not ovulate or ovulate with any regularity, and you have to ovulate to get pregnant. Hypothyroidism can affect fertility in men as well, according to the Thyroid Foundation of Canada. Although hypothyroidism is less common in men, those who do have an underactive thyroid may have low libido and low sperm count, according to a review of research published in November 2013 in Frontiers in Endocrinology in November 2013. If you're experiencing symptoms of hypothyroidism — fatigue, increased sensitivity to cold, constipation, dry skin, weight gain, muscle weakness, and heavier than normal or irregular menstrual periods in women, among others — you should get tested for the condition. A simple blood test can reveal whether your thyroid gland is functioning normally. The test measures the amount of thyroid stimulating hormone (TSH) in your bloodstream, and high levels suggest hypothyroidism, according to the American Thyroid Association.  Hypothyroidism is one of the many common conditions that your doctor can test for as part of a pre-pregnancy health check, according to the American Pregnancy Association, noting that it's better to identify and treat health issues before conception. A conversation about pre-pregnancy testing is especially warranted if thyroid health problems run in your family, the British Thyroid Foundation says. Women who have difficulty getting pregnant or who have had miscarriages previously should be tested When hypothyroidism is the reason for infertility, taking thyroid medication will enable most women to conceive, from as soon as six weeks after treatment, according to a study published in February 2015 in the IOSR Journal of Dental and Medical Sciences. The study also pointed out that many women who have a problem conceiving may have no apparent symptoms of hypothyroidism and only slightly elevated TSH levels, making it all the more important to have a TSH blood test if you're having a hard time getting pregnant and don't know why. Another study found that treating hypothyroidism with medication not only improved conception rates, but also reduced miscarriages early in pregnancy, which can happen as a result of untreated severe hypothyroidism. Those results were published in January 2015 in The Obstetrician & Gynaecologist. It is best to see your doctor if you think that you may have hypothyroidism and further blood work can be done to investigate. This episode was brought to you by Fertility Fundamentals. Fertility fundamentals is a naturopath led collective of women supporting each other in their fertility journey. Join the collective for free at www.facebook.com/groups/fundamentalfertility and come join your tribe! If you enjoyed today's episode, subscribe to the Fertility Stories podcast and leave a review. --- Send in a voice message: https://anchor.fm/fertilitystories/message

In this episode of BTBHA, Dr. Meaghan talks to Dr. Eric Balcalvage and Dr. Kelly Halderman about their new book "The Thyroid Debacle".     According to the American Thyroid Association, an estimated 20 million Americans have some form of thyroid disease, which causes symptoms such as extreme fatigue, depression, forgetfulness, weight gain, and hair loss. If thyroid conditions go undiagnosed, those patients - the vast majority of them women - may be at risk for cardiovascular disease, osteoporosis, and infertility. Unfortunately, conventional Western medicine views thyroid conditions as solely a glandular problem, and doctors are taught to employ a simplistic model of testing TSH and T4 to evaluate patients’ thyroid health. By the time a true glandular disorder presents itself, many prior opportunities to address the condition have been missed. In The Thyroid Debacle, Eric Balcavage, DC, and Kelly Halderman, MD, explore thyroid disorders from a functional medicine perspective, looking to create a paradigm shift in how doctors and patients understand and approach thyroid physiology. They argue that hypothyroidism is more commonly a systemic cellular event and not a localized glandular problem, as is often presumed, and that the key is to look at root causes rather than attempt to mask symptoms with pills. Evaluating the activators of cellular hypothyroidism requires an exploration into the various factors that contribute to the cell danger response - an evolutionary mechanism by which cells and organisms attempt to protect themselves from harm triggered by chemical, physical, or biological threats - as well as tools to reverse it.   In this book, you will learn: what causes hypothyroid symptoms and thyroid gland dysfunction why your doctors are failing you with an outdated model of treating thyroid dysfunction what common factors contribute to cellular hypothyroidism, including physical, chemical, emotional, and microbial stressors how to overcome chronic hypothyroid symptoms This revolutionary new approach will help those affected by thyroid disorders make informed decisions with their doctor and take back control of their health.   Click here to pre-order The Thyroid Debacle!

Los exámenes moleculares pueden reducir las cirugías innecesarias de tiroides en un 50% o mas Dr. Paul Y. Casanova-Romero, M.D., M.P.H., F.A.C.P., F.A.C.E, E.C.N.U que se unió a Palm Beach Diabetes y Endocrine Specialists desde en 2012, recibió su grado médico con honores (Summa Cum Laude) y Doctor en Ciencias Médicas (DMSc), de  la Escuela de Medicina de   la Universidad de Zulia, en Venezuela. Posteriormente se unió a la facultad de su Alma Mater y en 1998, el Grupo de Investigación del Programa de Prevención de la Diabetes (D.P.P.) en el Instituto de Investigación de la Diabetes-Universidad de Miami. Completó su posgrado en Medicina Interna y Endocrinología (Jackson Memorial Hospital) y estudios de postgrado en Salud Pública (M.P.H.) con el Premio de Mérito Académico en la Universidad de Miami. Un consultor privado endocrinólogo y orador nacional desde 2006, el Dr. Paul Y. Casanova-Romero de investigación extensa sobre la prevención de la diabetes, trastornos de la tiroides, síndrome metabólico y otros trastornos endocrinos han sido ampliamente publicadas. Sigue colaborando en estudios de investigación en Estados Unidos y Latinoamérica, el más reciente en pruebas moleculares de tiroides. El Dr. Casanova-Romero está certificado por la Junta en Medicina Interna, así como en Endocrinología, Diabetes y Metabolismo. Es miembro del Colegio Americano de Endocrinología (F.A.C.E.) y miembro del Colegio Americano de Médicos (F.A.C.P.). Actualmente es profesor voluntario de medicina en la Universidad de Miami. Dr. Paul Y. Casanova-Romero se especializa en el tratamiento de la enfermedad de la tiroides incluyendo nódulos tiroideos, hipotiroidismo, hipertiroidismo y cáncer de tiroides, enfermedad paratiroidea, diabetes, pre-diabetes, trastornos lipídicos y otros trastornos endocrinos. Él ha estado usando la prueba molecular para la caracterización de los nódulos de la tiroides desde 2010. Él ha satisfecho con éxito los requisitos para la certificación endocrina en el ultrasonido del cuello (ECNU) para realizar la biopsia internamente guiada por ultrasonido de la aspiración de la aguja fina de nódulos de tiroides, de la paratiroides, nodos. Es miembro del panel de membresía de la American Thyroid Association, miembro activo de la Endocrine Society, la Asociación Americana de Endocrinólogos Clínicos, la American Diabetes Association, el American College of Physicians y la National Lipid Association. En esta entrevista hablamos sobre esta temas: ¿Cómo se identifican los nódulos y por qué ocurren? autoexamen o en la oficina del médico La mayoría de los nódulos son benigno, estos se pueden presentar hasta en más del 70% de la población ¿Qué tests puede realizar un médico para evaluar el nódulo? Ningún test es 100% seguro Ultrasonido – qué están buscando en general Que es aguja  fina y el proceso general de la biopsia Tests moleculares ¿Qué tipos de resultados se pueden obtener de la citología y qué significan? La mayoria de ojo finas son benigno Maligno o sospechoso de malignidad, todavía tiene la posibilidad de no ser cáncer Los arco iris – 3,4,5 – indeterminate categoria Systema BETHESDA ¿Qué tests adicionales se pueden realizar para resolver los nódulos indeterminados? – Tests moleculares Que son todas los tests moleculares?  Y son las mismas? Dr. Casanova prefiere usar test de Afirma, este es por que MAS INFORMACIÓN Listen to Doctor Thyroid here!American Thyroid Association (español)Dr. Paul CasanovaAfirmaLa prueba de la expresión génica de Afirma puede reducir cirugías innecesarias del cáncer de tiroides Ninguna Biopsia es 100% Exacta, Los Marcadores Moleculares Son Los Mejores   Dr. Casanova:  ...Utilicemos, precisamente, marcadores moleculares, para definir y clarificar qué personas, definitivamente, se benefician de ir a cirugía y cuáles son aquellas que, basado en el resultado molecular, pueden permanecer sin cirugía y con observación a través del ultrasonido.   ...En Colombia, México, Brasil y en Chile lo están realizando; también el test puede solicitarse para poder ser realizado en cualquier momento. Hay compañías que ya tienen la licencia para enviar el paquete que se requiere para tomar la muestra por el patólogo que lo está realizando en cada uno de los paises de Latinoamerica.   ...Si, en la mayoría de estos nódulos indeterminados, sobretodo de las categorías III y IV, es posible que hasta un 60 % de los pacientes no tenga cáncer y vayan a una cirugía innecesaria. La cirugía innecesaria no solamente implica el hecho de retirar un órgano tan noble como el tiroides (que tiene una función única y es particularmente difícil, inclusive para los endocrinólogos una vez que la persona va a cirugía, manejarlo), sino que también tiene que tomar en cuenta que una persona que va a cirugía se expone a otros riesgos: el tiroides es uno de los órganos que tiene además, en la parte posterior, otras glándulas como las paratiroides que controlan el calcio; está cerca de nervios que, básicamente, comprometen la voz del paciente. Es una cirugía; dependiendo de la edad del paciente, los riesgos de cirugía pueden ser menos o más altos...   ...En el futuro estos análisis moleculares van a cambiar totalmente la manera en que nosotros vamos a clasificar, finalmente, los nódulos. Estos análisis moleculares están avanzando a pasos gigantes. Esperamos, además, que va a ser un beneficio para clarificar el diagnóstico de los pacientes que, a futuro, también nos guíe acerca de cómo tratar, si se da la situación a las personas con cáncer, de una manera más adecuada...   Philip James, presentador: Hoy estamos con el Doctor Paul Casanova. El hizo sus estudios en la Universidad de Miami y también en Venezuela. El está trabajando en el Palm Beach Diabetes and Endocrine Specialist y es un miembro de la American Thyroid Association.    Doctor Casanova, Bienvenido.    Dr. Casanova:  Muchas gracias, Philip, por la invitación.Y a todos aquellos que te escuchan: hoy, precisamente, vamos a hablar un poco más alrededor del tema de la evaluación de nódulos tiroideos. Ha sido un viaje a través del tiempo y a través de los últimos años; ahora tenemos mucho más que compartir con las personas que te escuchan. Philip James, presentador: Si, el tema de hoy es: Nódulos Indeterminados. Hablaremos más sobre este tema.   Pero, acerca de su experiencia valorando los nódulos, lo cual ha hecho por muchos años... Por favor ¿puede compartir algo de su experiencia anterior?   Dr. Casanova: Si, mi experiencia ha comenzado hace más de, aproximadamente, siete años (en el 2010). Tuve la oportunidad de tomar los primeros tests, que fueron utilizados, precisamente, para el diagnóstico de nódulos indeterminados y malignos, que fueron, en aquel momento, presentados por la Universidad de Pittsburgh, por el Doctor Yuri Nikiforov. Esos tests (que no estaban disponibles para el público) nos permitieron entrar en conocimiento de una de las mutaciones más frecuentes que se ven en nódulos malignos y tratar de probar si eso tenía cierta utilidad para los pacientes en términos de asegurar el diagnóstico o darle alguna explicación adicional a los cirujanos. Más adelante, otra serie de tests moleculares han salido en los últimos 7 años y estos tests moleculares han sido, básicamente, probados a través de diferentes estudios. Y eso es lo que he utilizado a través de estos últimos años y he visto los resultados a través [de ello], y el beneficio para mis pacientes, particularmente aquellos que tienen un diagnóstico de nódulos indeterminados.   Philip James, presentador:  Entonces, en el tema de nódulos, ¿cuántas personas en el mundo tienen un nódulo de tiroides?   Dr. Casanova: Eso es un elemento variable en cada población. En términos generales, aquí en los Estados Unidos por ejemplo, podría decirse que después de la edad de 40 años, más del 50 % de las mujeres pueden tener nódulos tiroideos; es, de hecho, el tumor endocrino más común que tenemos presente en la actualidad. Pero el hecho de ser común no quiere decir que todo nódulo tiroideo es maligno; de hecho, la gran mayoría de estos nódulos son de naturaleza benigna.    En términos generales podemos decir que, en Los Estados Unidos, unos 450 mil casos de biopsia de tiroides se han hecho en los últimos años y, a pesar de esa cantidad de biopsias, la gran mayoría de ellas no tiene ningún tipo de malignidad; es por ello que ahora hay un énfasis en tratar de mejorar cada uno de los recursos que tenemos para evitar, precisamente, que personas vayan a cirugía, y tratar de no hacer un exceso de cirugías innecesarias en esta población.   Philip James, presentador: Y para aquellos que están escuchando esta entrevista y posiblemente están pensando: “¿Cómo sabemos si tenemos un nódulo de tiroides?” Dr. Casanova: Si. En términos generales, la primera observación que tiene la persona es ir al médico. Estos nódulos de tiroides, aun cuando es una minoría, pueden ser detectados por su médico. Nódulos de más de 2.5 cm pueden ser palpables a través del examen físico del cuello; el examen físico del cuello, si usted lo solicita, su médico general, su ginecólogo puede realizarlo.    Aun cuando esta es una de las formas de poder diagnosticar nódulos, la mayoría de los nódulos que nosotros vemos son diagnosticados porque la persona va a estudios diferentes. Por ejemplo: la persona va y se va a hacer un ultrasonido de las arterias carótidas y alguien le dicen: “Mira, tienes algo en el tiroides”; la persona va a hacerse un estudio del pecho y le dicen: “tienes algo en el tiroides”. Y eso es algo también muy común; la mayoría de los nódulos tiroideos no son diagnosticados necesariamente por palpación, solo aquellos que son grandes y están superficiales.    Los nódulos tiroideos en algunas ocasiones, si hay síntomas (si la persona tiene problemas para tragar; la persona tiene de pronto problemas para respirar; o en algunas ocasiones, con historia familiar en el pasado de que los padres o sus hermanos tienen nódulos; o la persona tienen historial de cáncer de tiroides; o fue expuesto a radiación), lo óptimo sería que la persona solicitara al menos hacerse un ultrasonido del cuello que incluya el tiroides.   Philip James, presentador: Doctor Casanova, entonces si un paciente tiene un nódulo de tiroides, ¿hay algún examen en particular para saber con certeza si es cáncer o no?   Dr. Casanova: Una vez que la persona se hace el ultrasonido y se ha hecho una evaluación propia de la historia del paciente, el ultrasonido como tal no es, completamente, una herramienta para nosotros decirle al paciente si tiene o no tiene algo maligno. El ultrasonido nos guía para, precisamente, seleccionar qué casos requieren, lo que es el tema de tu pregunta y es, hacer una biopsia de aguja fina dirigida por ultrasonido para obtener una muestra de citopatología. El diagnóstico de malignidad requiere, y está basado en, la obtención de material dentro de los nódulos que son sospechosos, y ser analizados entonces por un patólogo [el cual] nos indica si existe la certeza de si es malignidad, o no.   Philip James, presentador: Pero, ¿podemos saber, con cierto porcentaje de certeza, si es cáncer?   Dr. Casanova:  No. Lastimosamente ningún test, ni siquiera la citopatología, es 100% seguro; uno obtiene a través de la citopatología, un análisis a través de, aproximadamente, 6 tipos de diagnóstico. Los diagnósticos que podemos obtener a través de la muestra citopatologica, inclusive cuando es benigno, pudiera todavía tener un porcentaje mínimo de un 6 a un 7% de malignidad. Y esto es importante que la gente lo entienda porque muchas veces, a pesar de que recibe diagnóstico de benignidad, después de una biopsia de tiroides todavía requiere que el nódulo sea observado a través del tiempo para ver si se comporta como debe hacerlo un nódulo benigno. Si ese nódulo se comporta de una manera diferente, entonces requiere otra vez evaluacion.   Pero, en términos generales, es lo mejor que tenemos en este momento: la citopatología sigue siendo el estándar para diagnostico, y ahora estamos agregando, precisamente, el análisis molecular, que va a incrementar nuestra certeza y la información que le vamos a dar, entonces, a los pacientes. Philip James, presentador:  En ocasiones anteriores, usted ha hablado sobre un arcoiris o “rainbow”, sobre qué ocurre después de este examen, ¿puede compartir más detalles sobre eso? Dr. Casanova:  Exacto. En la actualidad, desde 1909, los patólogos han llegado a un acuerdo para tener un lenguaje común, y ese lenguaje común lo podemos, precisamente, tomar como referencia a un arco iris de diagnósticos que van en 6 diferentes categorías:  la categoría número I es que de la persona, por razones diversas, no se obtuvo suficiente material y no hay un diagnóstico preciso; no existe el suficiente grupo de células para definir si es algo bueno o algo malo; las categorías que van del II al VI son precisamente ese arcoiris: la categoría 2 es la categoría buena, benigna; la categoría 6 es la categoría maligna. Ello nos da una definición para tomar decisiones quirúrgicas.   Sin embargo, debido a las categorías particulares del tiroides, hay otras tres características entre la buena y la mala (entre la benigna y la maligna) con las que, básicamente, el citopatólogo o la persona que está leyendo la lámina o la muestra de la biopsia de tejido [tiroideo], puede, totalmente, tomar una decisión adecuada. Esas categorías, que son la III, IV, V, son categorías que nosotros la llamamos globalmente como Nódulos Con Una Citopatología Indeterminada.    Si esa categoría, que va del III al V se acercaba más a la parte benigna, el porcentaje de personas (en el pasado, cuando no teníamos ciertas herramientas como los análisis y marcadores moleculares), todas estas personas iban a cirugía. Las personas que iban a cirugía en la categoría III tenían un porcentaje de malignidad entre un 15 y un 30%, esto se incrementaba en la categoría IV de un 30 a un 40%, y en la categoría V era un 70% de riesgo de malignidad.   Por eso, porque esa característica indeterminada está presente particularmente en las categorías III y IV ([y de ahí] el riesgo de ir a una cirugía innecesaria, sin propósito, porque iban a hacer un diagnóstico al final benigno), ahora los endocrinólogos, los otorrinolaringólogos y los patólogos, utilizamos marcadores moleculares para definir y clarificar qué personas, definitivamente, se benefician de ir a cirugía y cuáles son aquellas que, basados en el resultado molecular, pueden permanecer sin cirugía y con observación a través del ultrasonido.   Lo que estamos buscando con estos análisis moleculares es igualar el riesgo que una persona tendría si es diagnosticado ese nódulo como benigno. Como yo lo dije y comenté anteriormente: un nódulo benigno no significa 100 % seguridad de que no pueda ser algo malo, pero nos puede dar hasta un 94 % de seguridad de que uno está a salvo de tener cáncer de tiroides. Si nosotros tenemos un test que (en estas categorías III y IV, que son indeterminadas), nos permita igualar ese riesgo de llevar esos nódulos al mismo porcentaje de seguridad de observación, estamos ayudando al paciente a evitar cirugía innecesaria y, además de eso, le evitamos costos al sistema de salud pública.    Philip James, presentador: Entonces, sobre este tema de las categorías III y IV...    Dr. Casanova: El Bethesda III y IV, exacto.   Philip James, presentador: ¿Qué podemos hacer para obtener más información sobre este tema de las categorías III y IV?   Dr. Casanova:  Si. La parte de lo que son las categorías III y IV, que son, para los patólogos, categorías del Sistema de Bethesda.    Para las personas que van [a consulta], en un momento dado su médico toma la decisión de hacer una biopsia por aguja fina, requiere que la persona solicite que al mismo tiempo tomen la muestra para el análisis molecular. Los análisis moleculares que nosotros tratamos de recomendar a las personas son análisis moleculares que pregunten o traten de definir, si este nódulo es realmente benigno. Hay dos tipos de análisis moleculares: unos que son de confirmación de si “¿tú eres un nódulo malo?”, pero hay otros análisis que se basan, básicamente, en descartar que son malos; en este caso, confirmar la benignidad.   Es el médico que está realizando la biopsia el que tiene la oportunidad, al hacer el mismo pase de agujas que utilizamos para la citopatología, de tomar una muestra del test molecular y guardarlo al momento en espera del resultado final de la citopatología o del reporte. Si el reporte de la patología viene con categorías III o IV (que son indeterminados), en ese momento ya la persona tiene la muestra y puede ser enviada para el análisis y la clarificación, para evitar entonces la decisión final, en este caso, de ir a cirugia sin ningún otro tipo de ayuda. Y lo que hacemos con el análisis molecular, en este caso, es ayudar a la persona a tomar la decisión clínica correcta. Eso es lo que hacemos con este nuevo tipo de análisis moleculares.   Philip James, presentador: Para terminar. Cuando un paciente va por primera vez y el nódulo es indeterminado, ¿necesita volver otra vez para otra punción con aguja fina?, o ¿se pueden usar los resultados de la primera?   Dr. Casanova: Si la persona que está haciendo la biopsia toma la previsión de tomar la muestra (porque estas son muestra en las que están separadas la biopsia de la citopatología), de tomar la muestra y colocarla en el tubo (es un tubo especial; muchos de estos estudios moleculares requieren de un tubo especial), la persona no requiere repetir la biopsia.   En otras ocasiones, (porque en categoría III, la Asociación Americana de Tiroides lo recomienda), tiene 3 posibilidades: o ir a cirugía; o repetir la biopsia; o hacer observación. El repetir la biopsia: si la persona no pudo tomar la muestra molecular en ese momento, se toma la muestra y se clarifica (pero todavía en este punto no ha ido a cirugía). Nosotros recomendamos de nuevo, que la persona, cuando vaya a hacerse una biopsia, le pregunte a la persona que la está haciendo si va, al mismo tiempo de tomar la muestra para citopatología, a guardar una muestra para el análisis molecular, y así evitar hacer dos veces un procedimiento que, por supuesto, produce molestias. En términos generales, volver a repetir lo mismo otra vez [genera] un costo adicional para el paciente    Philip James, presentador: Y ¿esto es común para los médicos en general?, ¿ellos están usando el examen molecular?   Doctor casanova: La mayoría de los médicos que hacen biopsia (la gran mayoría) están ya familiarizados con estos tests moleculares. De hecho (...) Aquí particularmente, en Los Estados Unidos, el test ha sido aprobado, inclusive para su utilización en el sistema de Medicare; es decir, que ha sido reconocido como un elemento que tiene un costo-beneficio. Muchos de los seguros (de nuevo, aquí en los Estados Unidos) tienen cobertura de los más importantes tests moleculares. En términos generales, si hay algún problema con una persona, por ejemplo en Los Estados Unidos (o alrededor del mundo), las asociaciones de tiroides de cada continente tienen listas donde ellos le informan a las personas, si el médico hace biopsias con test molecular. La Asociación Americana de Tiroides [American Thyroid Association] tiene esa facilidad para los pacientes aquí en Los Estados Unidos, pero sé también que otras asociaciones de tiroides alrededor del mundo también le permiten a las personas, a través del internet, buscar quién es el médico que está haciendo biopsias utilizando este test molecular.   Philip James, presentador: Y actualmente, por ejemplo, en América Latina ¿también está disponible el exámen molecular?    Dr. Casanova: Si, el test está disponible en América Latina. Básicamente hay países que ya lo están realizando. [Tengo] conocimiento de que en Colombia, México, Brasil, en Chile lo están realizando. También, el test, puede solicitarse para ser realizado en cualquier momento y hay compañías que ya tienen la licencia para enviar el paquete que se requiere para tomar la muestra por el patólogo que lo está realizando en cada uno de los países de Latinoamérica.   Philip James, presentador: ¿Hay alguna empresa que ofrezca estos exámenes moleculares?, y si hay más de una, ¿cuáles son?   Dr. Casanova:  Ahorita tenemos 4 grandes grupos o compañías que están haciendo este test y cada una de ellas tiene su nivel de estudios que soportan, precisamente, este tipo de test molecular.    Está la compañía Veracyte que tiene un test que se llama Afirma. El Afirma viene en dos variantes: ellos tienen lo que se llaman un GC y actualmente están haciendo un test que van a introducir (más avanzado) que se llama GSC. Está otra compañía que está basada en la Universidad de Pittsburgh, la cual, en conjunto con un grupo de patólogos que se llaman CVL (Clinical Virology Laboratory) que están radicados en Nueva York, ellos hacen la muestra [prueba] que se conoce como ThyroSeq v2.    Está el grupo que se conoce como el Rosetta y, por supuesto, está también el otro grupo que hace el test molecular, y tienen dos tipos de test al mismo tiempo que se llaman ThyGeNEXT™ y ThyraMIR®. En Latinoamérica, en mi entender, el test que está siendo utilizado y que está licenciado en muchos de los países, es el que proviene del grupo Veracyte: Afirma.   Hay intenciones, de todos estos grupos, de trabajar [a lo largo] de Latinoamérica y, evidentemente, al contactar directamente a esos grupos en Los Estados Unidos, el patólogo o la persona que está interesada en utilizar esos test en sus prácticas a nivel de Latinoamérica, podría hacer [algún tipo de] acuerdo con estas compañías.   Philip James, presentador :  Y usted ¿cuál es el exámen está usando y por qué?   Dr. Casanova: Yo, en estos momentos estoy utilizando, fundamentalmente, un test de la compañía Veracyte: Afirma. Es el más avanzado, se llama Afirma GSC. La razón para utilizar éste test es, precisamente, porque en nuestra experiencia particular, la gran mayoría de los nódulos tiene un bajo riesgo de malignidad. Este test está basado en la lectura de ARN mensajero.    Y para ponerle [un ejemplo], a los pacientes y a las personas que nos escuchan, sobre “qué es lo que hace cada uno de los tests (?)”, es semejante a que: “usted tiene una persona que es su hija, la hija llega con su novio, y usted al ver novio [se lleva] una primera impresión”; el nódulo viene a ser el novio. Si el nódulo se observa, y se ve como que parece que no es bueno, la pregunta que uno hace no es “si usted es un mal muchacho”, es “si usted en verdad es un buen muchacho para mi hija”. El test o los tests que, precisamente, descartan que es malignidad son tests que tratan de responder esta pregunta que es: “¿Eres tú un nódulo benigno?” Los tests como Afirma, como Rosetta, están diseñados para responder esa pregunta.   Ahora, si una persona tiene un nódulo que es altamente sospechoso de cáncer, [ahí] es cuando nosotros (o mi persona) aplica tests como ThyroSeq v2, o los test, en este caso, del Thyroid Oncogene. Pero los tests moleculares basados en ADN, (que es lo que, algunas veces los cirujanos tratan de contestarse) son solamente aplicables, de manera cierta, a aquellos nódulos que son realmente sospechosos de malignidad.    La información que yo tengo [sobre] este test que te estoy comentando, el Afirma GSC, (...) la he podido corroborar personalmente. Muchos de estos casos, que han sido sospechosos a través del test molecular, van a cirugía y se corrobora que la información del test es precisamente la que nos informa el análisis molecular. Pero también el test me ha dado la oportunidad de evitar cirugías en pacientes y tener el orgullo de poder haber salvado de una cirugía innecesaria a más del 50 % de los pacientes que, en un momento dado tenían estos [nódulos] indeterminados.   Philip James, presentador: Esto es muy importante porque, anteriormente y hoy en día, hay muchas cirugías en las que se está extirpando la tiroides aunque no se sabe si es cáncer o no, pero el doctor dice: “Vamos a quitar su tiroides, no sabemos si es cáncer, pero…” ¿Cuántas veces no tienen cáncer?, ¿una de cada dos o cuantas?   Dr. Casanova: Si, en la mayoría de estos nódulos indeterminados, sobretodo de las categorías III y IV, es posible que hasta un 60 % de los pacientes no tenga cáncer y vayan a una cirugía innecesaria. La cirugía innecesaria no solamente implica el hecho de retirar un órgano tan noble como el tiroides (que tiene una función única y es particularmente difícil, inclusive para los endocrinólogos una vez que la persona va a cirugía, manejarlo), sino que también tiene que tomar en cuenta que una persona que va a cirugía se expone a otros riesgos: el tiroides es uno de los órganos que tiene además, en la parte posterior, otras glándulas como las paratiroides que controlan el calcio; está cerca de nervios que, básicamente, comprometen la voz del paciente. Es una cirugía; dependiendo de la edad del paciente, los riesgos de cirugía pueden ser menos o más altos.   De tal manera que la óptica que tienen, y de hecho ese es el propósito que tienen las asociaciones alrededor del mundo y particularmente la Asociación Americana del Tiroides, es minimizar el potencial de dañar o de sobretratar a la mayoría de los pacientes con un riesgo bajo de mortalidad y de enfermedad.   Los nódulos tiroideos son, solo una mínima parte, malignos; la mayoría son benignos, pero en este caso deben tomarse las previsiones para que cuando tengamos la respuesta a través de la citología, o a través del análisis molecular, sea la adecuada para evitar cirugías innecesarias.   Philip James, presentador:  Si yo soy un paciente y el resultado de mi punción con aguja fina (FNA) fue “nódulo indeterminado” ¿cómo sé si mi médico está utilizando el test para nódulo indeterminado?    Dr. Casanova: Bueno, básicamente porque el reporte lo indica. Cuando la persona recibe un reporte, además de la parte indeterminada, recibe una hoja adicional con la explicación del test molecular que fue seleccionado por su médico. En el caso de los test Afirma, el ThyroSeq de Rosetta o de otros tests moleculares, (en este caso) ellos informan directamente, además de la respuesta de la citopatología, le informan a la persona que un test molecular ha sido realizado.   Si el test molecular no está reflejado en el reporte, es importante que la persona (dependiendo de la categoría que tiene, ya sea III o IV) tenga la opción antes de hacer cirugía de, inclusive, poder realizar de nuevo el test molecular. Lo correcto es hacer todo en un solo paso. [Se trata de] tomar la previsión de que esto puede ocurrir. A a pesar de que no ocurre en todos los pacientes (solo entre un 15 a un 30%, dependiendo del lugar del mundo donde esté, puede ser indeterminado), y si existe esa posibilidad, y la posibilidad de ese diagnóstico es potencialmente de ir a una cirugía innecesaria, es importante que antes, al momento de la biopsia, solicite a su médico: “Por favor, envíeme a un doctor que haga este test al mismo tiempo, para poder tener tranquilidad”.    Philip James, presentador:  Doctor Casanova, gracias.   Antes de irnos, ¿hay alguna otra información que quiera compartir con las personas que están escuchando sobre este tema?    Dr. Casanova: Si, yo en lo particular, recomiendo a las personas que, siempre que evalúen los nódulos tiroideos, tomen en cuenta que a pesar que es una patología que es muy frecuente en nuestra población, siguen siendo (la mayoría de ellos) benignos. Siempre vayan con la óptica de que en los diagnósticos de nódulos tiroideos existen un alto porcentaje que usted vaya a salir con una respuesta que lo va a poner contento. Pero, si se tomó la decisión (dependiendo de su historia familiar o de su historia de exposición; y de las características del nódulo; y de los exámenes que se realizan preliminarmente) de que se necesita una biopsia, prepárese para que todas las respuestas sean respondidas en una sola ocasión. Eso indica, hacer la biopsia guiada por ultrasonido, tomar y enviar la muestra a un patólogo reconocido y, además, que al mismo tiempo que le hayan tomado la muestra citopatológica, guarden la muestra molecular.   En el futuro estos análisis moleculares van a cambiar totalmente la manera en que nosotros vamos a clasificar, finalmente, los nódulos. Estos análisis moleculares están avanzando a pasos agigantados. Esperamos, además, que va a ser un beneficio para clarificar el diagnóstico de los pacientes que, a futuro, también nos guíe acerca de cómo tratar, si se da la situación a las personas con cáncer, de una manera más adecuada   Así que, manténganse conectados con estos podcasts, que son siempre muy interesantes, y a futuro, probablemente escucharán, más allá del capitulo 60, muchos más de estos análisis.   Philip James, presentador: Este es el fin del episodio número 59. Yo soy Philip James. Si quiere escuchar más entrevistas con otros médicos, acerca del tema de tiroides, cáncer de tiroides  e hipotiroidismo, puede visitar la página web doctiroides.com.

According to the American Thyroid Association, 60% of women have an undetected thyroid problem at some point in their life.

According to the American Thyroid Association, 60% of women have an undetected thyroid problem at some point in their life.

Aaron talks about thyroid and pregnancy with Elizabeth Pearce, professor of medicine at Boston University Medical Center and president of the American Thyroid Association. For more information, including helpful links and other episodes, visit our website at https://www.endocrine.org/podcast.

Aaron talks about thyroid and pregnancy with Elizabeth Pearce, professor of medicine at Boston University Medical Center and president of the American Thyroid Association. For more information, including helpful links and other episodes, visit our website at https://www.endocrine.org/podcast.

Aaron talks about thyroid and pregnancy with Elizabeth Pearce, professor of medicine at Boston University Medical Center and president of the American Thyroid Association.

On this episode, we dive into a 2017 study by the American Thyroid Association that details rampant dissatisfaction levels in the hypothyroid community with the existing care and treatment options. Learn about Paloma Health

According to the American Thyroid Association, 60% of women have an undetected thyroid problem at some point in their life!

According to the American Thyroid Association, 60% of women have an undetected thyroid problem at some point in their life!

随着甲状腺彩超被许多公司列入员工常规体检套餐，越来越多的人知道了“甲状腺结节”这个词儿。国内的权威调查报告《甲状腺疾病流行病学调查》发现，目前甲状腺结节的患病率已高达30%。也就是说，每三个人中就有一个有甲状腺结节。如果你没有，你的朋友、亲人也可能有结节。什么是结节？根据美国甲状腺学会(American Thyroid Association,ATA)给出的定义，它是甲状腺里，能与周围的组织清楚区分的孤立肿块。简单来说，就是甲状腺上长了小瘤子。“瘤子”？听起来很可怕。严重吗？如果有了甲状腺结节，该怎么办？今天我们就来说一说你肯定会关心的几个问题。首先，我们来重新认识一下甲状腺。甲状腺在人体颈部正前方靠下，形状像一只大蝴蝶趴在气管上，也像是护在气管前的一面盾甲，所以叫做“甲状腺”。它是人体重要的内分泌器官，分泌的激素参与全身所有器官的代谢活动，是维持生命活力所必须的物质。抽血时经常检查的甲功五项、甲功七项，查的就是甲状腺分泌激素的功能。甲状腺激素分泌过多，人就会得甲亢，变得急躁、容易激动、失眠、怕热多汗、多吃但消瘦、心慌。女性还会月经失调。甲状腺激素分泌过少，就会得甲减，体重增加、面部虚肿、目光迟滞，同时感觉怕冷、疲倦、嗜睡。根据2018年权威体检机构的数据报告，甲状腺是体检中最常被发现疾病的器官。对于甲状腺结节发病率升高的原因有很多猜测，比如环境污染、食品安全、作息习惯等等，还有人把锅甩给了我们每天吃的碘盐。碘盐？好像是对甲状腺有好处的，我没听错吧？没错，碘是合成甲状腺激素的主要原料，饮食中缺碘易得甲状腺增生肿大，也叫大脖子病。食用加碘盐以及常吃含碘的食物，可以预防大脖子病。但是现在运输发达、物资丰富，有的人担心食用碘盐导致碘摄入量超标，会不会引发甲状腺结节？但这些猜测目前都没有得到科学层面的证实。其实，甲状腺结节的大量检出是因为技术进步了。过去体检，医生采用“触诊”，也就是用手摸，来检查甲状腺，位置隐蔽的、或者小于1厘米的结节很难被发现。现在改用彩超检查后，各种处在深宅大院里的微小结节就被检查出来。好，我们继续说，一旦检出了甲状腺结节，接下来需要明确结节是良性还是恶性。如果结节是良性的，那要恭喜你了，对身体可以说基本没有危害。只是结节过大时，比如直径超过了4cm，可能会压迫周围组织，比如气管、食道，造成呼吸困难、还有声音嘶哑，像曾志伟似的。如果甲状腺结节被确诊为恶性，那就是甲状腺癌。不过幸运的是，95%的甲状腺结节都是良性病变，甲状腺癌，也就是恶性结节，仅占5%。接下来，我教你如何查看自己的甲状腺报告。当你的彩超报告出现了这些描述时，就需要引起重视了：比如微钙化，沙粒样，意思是有沙粒一样的钙化，80%左右的恶性肿瘤内有钙化。还有“低回声”，密度低的东西会产生低回声，所以低回声往往表明有水肿的情况，几乎所有的甲状腺恶性肿瘤都是低回声的。另外，“边界不规则”也是恶性肿瘤的显著特征。结节内血流丰富更需要警惕，不仅恶性可能大，丰富的血流营养还会让结节增长较快。如果彩超报告显示，向周围浸润，或者同侧淋巴结异常，那么肿瘤可能已经开始转移了。出现上面这些描述的人群，需要尽快去内分泌科复诊。我们上面提到，低回声是恶性结节的重要标志，反之，高回声说明组织里面密度高，有硬东西，一般是结石或者大的钙化，相对好处理，绝大多数是良性。海绵状改变也是良性结节的常见描述，意思是结节内有很多很多微小的囊状结构聚集在一起，中间还有纤细的分隔，形态就像海绵一样，这意味着结节内出血或者胶质沉淀，不用太担心。当你的结节符合这几种描述时，每年体检，定期观察就可以了。典型的良性或者恶性结节通过超声检查就可以确诊，对于“可疑恶性”或者情况复杂的结节，还得进行穿刺活检，这是甲状腺结节诊断的金标准。和其他癌症相似，甲状腺癌的癌细胞像一颗埋伏在体内的不定时炸弹，毫无控制、毫无章法地自我膨胀、如果治疗不及时，癌细胞还可能转移到淋巴、肺部和其他远处器官，危害生命健康。那么，有没有什么方法能够帮助我们预防甲状腺癌呢？与其他很多肿瘤一样，甲状腺癌的发病机理目前还没有完全确定。但是目前，经医学研究唯一明确的是，电离辐射会导致甲状腺癌。因此，尽量避免颈部遭受辐射，比如颈部CT、颈椎X片，还有做胸片和牙齿X光片时，因为距离甲状腺比较近，也最好采用金属铅制作的防护板对甲状腺进行遮挡。另外，甲状腺癌的发生与遗传有一定关系。大约10%～15%患者的直系亲属患甲状腺癌，有家族史的人群患甲状腺癌危险度较一般人高5～6倍。所以，直系亲属中有患甲状腺癌的人群，应该每年做甲状腺彩超检查。还有，女性朋友要注意少吃富含雌激素的食品，因为雌激素对甲状腺结节的发生有促进作用。富含雌激素的食物有蜂王浆、黄豆、葵花籽、洋葱等，这些食物不是不能吃，而是最好不要同时、大量地吃，最好跟其他食物穿插交替来吃，而且不要刻意服用补充雌激素的保健品。最后，我还要提醒大家，长期处于疲劳状态也会加重甲状腺这个内分泌器官的负担，让身体免疫力降低，进而引发甲状腺病变。所以，劳逸结合、保持健康的生活方式，也是预防甲状腺疾病的有效方法。好了，以上就是有关甲状腺结节的自救指南。听完之后，愿你了解脖子上的疙瘩，也解开心中的疙瘩。我们下期见！参考资料：1.甲状腺结节怎么吃碘和海鲜?医生这样说…京医通2.甲状腺结节诊疗路上的那些坑知乎3.甲状腺结节怎么确诊良性还是恶性？

The Case: Sally is 41 year old mom working part time. She was experiencing extreme fatigue, needing naps to get through the day and unable to find the energy to do anything. She thought it might be a thyroid issue because it runs in her family but her doctor said her levels were in the normal range. The Investigation When fatigue is a symptom, the thyroid is often involved. I wasn’t about to take that possibility off the table. According to the American Thyroid Association, an estimated 20 million Americans have some form of thyroid disease. But, it is more prevalent in women. One in eight women will develop a thyroid condition in their lifetime. I invited Dr. Justin Marchegiani to join me in discussing Sally’s case. He is a virtual functional medicine doctor and the author of the Thyroid Reset. He knows all too well that the typical tests done in traditional medicine don’t tell the whole thyroid story. We spend the first part of our discussion explaining exactly how the thyroid works, it’s connection to the brain (the hypothalamus), the pituitary gland, the adrenal glands, and how that all affect metabolism. Which is why symptoms can vary widely. Most will experience fatigue as Sally did, while others may also experience feeling cold all the time, hair loss, moodiness, depression, and/or constipation. A Normal TSH Doesn't Mean the Thyroid is Functioning Properly. Dr. J explained that the TSH (thyroid stimulating hormone) range that is considered normal by traditional medicine doesn’t tell the whole story. There are too many other factors at play in how the thyroid gland actually functions. It’s important to look at how the connected systems are functioning too. Hashimoto’s Thyroiditis May be the Cause Studies have found that the antibody associated with Hashimoto’s disease is much more common than previously thought and may be the cause of hypothyroidism even at a subclinical level. This was something I knew I needed to test Sally for. Consider Optimal Range Not Normal Range If there is one thing that Dr. J stressed throughout this interview it’s that we can’t just look at whether TSH, T3, or T4 each fall into the normal range. We need to look at the relationships of these hormone levels. And, we need to strive to have them all in optimal range because when they are not in optimal range, they are not functioning properly which means they are not supporting the other glandular systems that dictate how we feel on a day to day basis. Mystery Solved Testing your thyroid function is far more complex than what traditional labs will cover. As Dr. J pointed out, thyroid function is critical to optimal health so we need to dig a little with the appropriate tests, to ensure that it’s truly is functionally optimally. For Sally, doing a few more tests revealed that her original hunch was correct - her thyroid was the cause of her fatigue. We were able to uncover where the system was breaking down and correct it. While medication was an option, she chose to try a functional medicine approach first. After a liver cleanse, we were able to help support her thyroid conversion through natural supplements and an anti-inflammatory diet. After a month, her energy had returned and she no longer needed naps to get through the day. If you are dealing with fatigue (or any other hypothyroid related symptoms like hair loss, feeling cold, moodiness, depression and/or constipation) but your doctor says your lab results are ‘normal’ do yourself a favor and do more in depth tests to determine if in fact your thyroid is not functioning optimally. If could totally change how much energy and joy you have to face your day. Eliminating Health Mysteries For Sally, we were able to find that missing piece of the health puzzle and help her regain her health. Could this be the missing clue for you or someone in your life? Resources and products mentioned on the podcast: ThyroCNV - You must create an account to access this regulated product. Zinc Selenium Free Guide to an Anti-Inflammatory Diet PushCatch Liver Detox (30 Days) Thanks to my guest Dr. Justin Marchegiani of Just In Health Wellness Clinic. You can connect with him on Facebook.  Or, listen to his podcast, Beyond Wellness Radio or his watch his Youtube videos. Thanks for Listening If you like what you heard, please rate and review this podcast. Every piece of feedback not only helps me create better shows, it helps more people find this important information. Never miss an episode –  Subscribe NOW to Health Mysteries Solved with host, Inna Topiler on Apple Podcasts, Spotify,  or Stitcher. Say hi to me on Facebook and Instagram. Comment on this episode and let me know if it helped. Or visit http://healthmysteriessolved.com   Overcoming Hashimoto’s Summit Claim your free spot to this 7-day virtual summit featuring the top experts in Hashimoto’s and Hypothyroidism so that you can overcome this diagnosis and feel better. https://bit.ly/2KigemW   PLEASE NOTE All information, content, and material on this podcast is for informational purposes only and is not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. 

Dr. Leonard 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.   Dr. Wartofsky is past President of both the American Thyroid Association and The Endocrine Society.  He is the editor of books on thyroid cancer for both physicians and for patients, and thyroid cancer is his primary clinical focus.   He is the author or coauthor of over 350 articles and book chapters in the medical literature, is recent past Editor-in-Chief of the Journal of Clinical Endocrinology & Metabolism, and is the current Editor-in-Chief of Endocrine Reviews. In this episode, Dr. Wartofsky discusses the following: Bioavailability versus content of a thyroid replacement tablet, and how it is absorbed. 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 The danger of taking generic T4; are cheaper, larger profit margin, but the content varies. Synthroid versus generic Manufacturing plants in Italy, India, Puerto Rico are known to produce generics Content versus absorption when taking generic T4 An explanation of TSH 1.39 is a healthy TSH level for women in the U.S. Symptoms of hypothyroidism, such as a slow mind, poor memory, dry skin, brittle hair, slow heart rate, problems with pregnancy, miscarriage, and hypertension. Screening TSH levels if contemplating pregnancy T4 is the most prescribed drug in the U.S. Hypothyroidism is common when there is a family history Auto-immune disease is often associated with hypothyroidism An explanation of T3 An explanation of desiccated thyroid The T3 ‘buzz’ Muhammed Ali’s overdose of T3 Dangers of too much T3 When to take T4 medication, and caution toward taking mediations that interfere with absorption Coffee and thyroid hormone absorption Losing muscle and bone by taking too much thyroid hormone Taking ownership of your disease NOTES Listen to Doctor Thyroid Related Episode : 37: Adding T3 to T4 Will Make You Feel Better? For Some the Answer is ‘Yes’ with Dr. Antonio Bianco from Rush University American Thyroid Association Leonard Wartofsky

John initially went to the doctor in May 2017 to treat what he thought was strep throat. Multiple doctor visits revealed a larger issue and John was diagnosed with HPV cancer of his left tonsil and lymph node region.After his diagnosis, John underwent rounds of chemotherapy and radiation. However, he has now completed his treatment.Dr. Hanna completed his residency training in internal medicine at Beth Israel Deaconess Medical Center and fellowship training in hematology & medical oncology at the Dana-Farber Cancer Institute in 2016.Dr. Hanna's research focuses on understanding mechanisms of response and resistance to immunotherapies in head and neck cancer.The American Thyroid Association has awarded a 2017 Research Grant, funded by the Thyroid Cancer Survivors' Association, Inc. to Dr. Hanna to open a phase II study of the effect of two combined immune-checkpoint inhibitors on advanced thyroid cancer.John initially chose Dana-Farber for his care because of its affiliations and its reputation for excellent care in the area. In his spare time, John loves to golf and run. This year, he will be running the Boston Marathon to raise money for Dana-Farber under the charity “Golf Fights Cancer.”Throughout his treatment, John has been supported by his wife, Cheryl, and their four kids.Dr. Hanna completed his residency training in internal medicine at Beth Israel Deaconess Medical Center and fellowship training in hematology & medical oncology at the Dana-Farber Cancer Institute in 2016.Dr. Hanna's research focuses on understanding mechanisms of response and resistance to immunotherapies in head and neck cancer.The American Thyroid Association has awarded a 2017 Research Grant, funded by the Thyroid Cancer Survivors' Association, Inc. to Dr. Hanna to open a phase II study of the effect of two combined immune-checkpoint inhibitors on advanced thyroid cancer.

The past year has been fascinating and highly fruitful year for Dartmouth Institute Associate Professor Louise Davies, MD, MS. A 2017-2018 Fulbright Global Scholar, Davis spent several months in Japan at the Kuma Hospital in Kobe, Japan, studying the hospital's pioneering surveillance program for thyroid cancer. Davies, the chief of otolaryngology-head & neck surgery-at the Veterans Affairs Medical Center in White River Junction, Vermont, has researched U.S. patients' experiences of monitoring thyroid cancers they self-identify as overdiagnosed, and has found that such patients often feel unsupported, even ostracized. Following her stay in Japan, Davies, who also develops and teaches courses in qualitative research methods in Dartmouth Institute's MPH programs, spent several months in the U.K. at the Health Experiences Research Group (HERG) at Oxford University. There, she learned skills that will help her develop web-based materials to raise public awareness about surveillance, surveillance programs, and overdiagnosis in general. As if the year wasn't packed enough, Davies also visited the site of the Fukushima Daiichi nuclear power plant, site of the 2011 nuclear accident in Japan. Unrelated to her Fulbright work, Davies is a member of an international task force organized through the International Agency for Research on Cancer, a branch of the World Health Organization. The task force will make recommendations on the monitoring of the thyroid gland after nuclear accidents. Learn more about her incredible year and what's next for her research in overdiagnosis! Q: As a practicing physician, how did your interest in overdiagnosis develop? A: My interest in over diagnosis grew from my work with Dr. Gil Welch, dating back to 2004. He was and is a mentor to me, and we developed the work on thyroid cancer together. I have always had an interest in making sure that patients receive care that aligned with their values. The problem of overdiagnosis is particularly intriguing because if people do not understand the concept, they may undergo treatment that, had they understood more about their risks, they might not have elected. Finding ways to solve that problem has been a fascinating focus for me. Q: Is overdiagnosis and/or overtreatment in thyroid cancer on the rise, if so what accounts for this increase? A: Thyroid cancer incidence has more than tripled in the U.S. over the past 30 years. The majority of the increase has been due to the detection of small cancers, which we know exist as a subclinical reservoir in otherwise asymptomatic people. As more attention has been drawn to the problem of overdiagnosis, the rate of increase has slowed, which has been gratifying to see; although it has not stopped completely or reversed. In the most recent national guidelines on the treatment of thyroid cancer (from the American Thyroid Association), there has been a clear suggestion that treatment should be more conservative for the small cancers that are so commonly detected now. It is not yet clear how much of an impact these new guidelines have had on practice patterns. Q: You've studied the experiences of patients who are diagnosed with thyroid cancer but choose not to intervene. What are some of the commonalities you've found? A: The patients who were the first to understand that their small, asymptomatic thyroid cancers picked up incidentally might not need immediate intervention, but instead could be monitored through regular checkups and active surveillance did not receive a lot of support from the medical community. Many managed their cancer by keeping it a secret, which can be stressful in itself, and several stopped getting follow ups-the recommended care if surveillance rather than interventions chosen for a small thyroid cancer. This was a unique group of patients who represented the first people to undertake what is a new and incompletely understood treatment option in the U.S. As such, they are probably more representative of people going against medical convention than thyroid cancer patients who elect to undertake surveillance, per se. Q: What will/have you been looking for when evaluating the surveillance program at Kuma Hospital? How will you combine this with your own U.S. pilot data? My goal in going to Kuma Hospital last fall was to understand more about the active surveillance program they have there. They were the first in the world to run such program and collect data on it, and have been doing so since 1993. I wanted to understand their data on active surveillance in more detail. I wanted to understand the patient experience of being on surveillance, and how the program worked operationally. I was able to do all those things and gathered patient experience data through a survey as well as interviews. I also was lucky to get to spend a fair amount of time in the operating room, where I learned a number of new surgical techniques that will advance my own practice in thyroid surgery. My goal is to report what I learned at Kuma Hospital as broadly as possible, so that people in the U.S. begin to feel comfortable adopting active surveillance as a method of managing the early thyroid cancers that are appropriate candidates for surveillance. What's next for you in overdiagnosis research? My work on the task force about thyroid monitoring after nuclear power plant accidents has given me a new appreciation for the complexity of public health communication about risk, emergency preparedness, and the problem of over diagnosis when it comes to policy setting. I hope to be able to continue to contribute in other ways to the broader public health discussion about over diagnosis. In my next steps looking at the epidemiology of thyroid cancer, I plan to focus on understanding more about why we see such variation in thyroid cancer incidence across geography, age groups, and gender. NOTES Louise Davies, MD, MS Thyroid cancer and overdiagnosis American Thyroid Association 35: Rethinking Thyroid Cancer – When Saying No to Surgery Maybe Best for You with Dr. Allen Ho from Cedars-Sinai in Los Angeles 21: Diagnosed with Thyroid Cancer and You Say No to Surgery with Dr. Louise Davies 50: Regarding Thyroid Cancer, Are You a Minimalist or a Maximalist? with Dr. Michael Tuttle from Sloan Kettering

Victor J. Bernet, MD, is Chair of the Endocrinology Division at the Mayo Clinic in Jacksonville, Florida and is an Associate Professor in the Mayo Clinic College of Medicine. Dr. Bernet served 21+ years in the Army Medical Corps retiring as a Colonel. He served as Consultant in Endocrinology to the Army Surgeon General, Program Director for the National Capitol Consortium Endocrinology Fellowship and as an Associate Professor of Medicine at the Uniformed Services University of Health Sciences. Dr. Bernet has received numerous military awards, was awarded the “A” Proficiency Designator for professional excellence by the Army Surgeon General and the Peter Forsham Award for Academic Excellence by the Tri-Service Endocrine Society. Dr. Bernet graduated from the Virginia Military Institute and the University of Virginia School of Medicine. Dr. Bernet completed residency at Tripler Army Medical Center and his endocrinology fellowship at Walter Reed Army Medical Center. Dr. Bernet’s research interests include: improved diagnostics for thyroid cancer, thyroidectomy related hypocalcemia, thyroid hormone content within supplements as well as management of patient’s with thyroid cancer. He is the current Secretary and CEO of the American Thyroid Association. In this episode Dr. Bernet describes that Hashimoto’s thyroiditis is an autoimmune condition that usually progresses slowly and often leads to low thyroid hormone levels — a condition called hypothyroidism. The best therapy for Hashimoto’s thyroiditis is to normalize thyroid hormone levels with medication. A balanced diet and other healthy lifestyle choices may help when you have Hashimoto’s, but a specific diet alone is unlikely to reverse the changes caused by the disease. Hashimoto’s thyroiditis develops when your body’s immune system mistakenly attacks your thyroid. It’s not clear why this happens. Some research seems to indicate that a virus or bacterium might trigger the immune response. It’s possible that a genetic predisposition also may be involved in the development of this autoimmune disorder. A chronic condition that develops over time, Hashimoto’s thyroiditis damages the thyroid and eventually can cause hypothyroidism. That means your thyroid no longer produces enough of the hormones it usually makes. If that happens, it can lead to symptoms such as fatigue, sluggishness, constipation, unexplained weight gain, increased sensitivity to cold, joint pain or stiffness, and muscle weakness. If you have symptoms of hypothyroidism, the most effective way to control them is to take a hormone replacement. That typically involves daily use of a synthetic thyroid hormone called levothyroxine that you take as an oral medication. It is identical to thyroxine, the natural version of a hormone made by your thyroid gland. The medication restores your hormone levels to normal and eliminates hypothyroidism symptoms. You may hear about products that contain a form of thyroid hormones derived from animals. They often are marketed as being natural. Because they are from animals, however, they aren’t natural to the human body, and they potentially can cause health problems. The American Thyroid Association’s hypothyroidism guidelines recommend against using these products as a first-line treatment for hypothyroidism. Although hormone replacement therapy is effective at controlling symptoms of Hashimoto’s thyroiditis, it is not a cure. You need to keep taking the medication to keep symptoms at bay. Treatment is usually lifelong. To make sure you get the right amount of hormone replacement for your body, you must have your hormone levels checked with a blood test once or twice a year. If symptoms linger despite hormone replacement therapy, you may need to have the dose of medication you take each day adjusted. If symptoms persist despite evidence of adequate hormone replacement therapy, it’s possible those symptoms could be a result of something other than Hashimoto’s thyroiditis. Talk to your health care provider about any bothersome symptoms you have while taking hormone replacement therapy. NOTES and REFERENCES Request an Appointment Victor Bernet, M.D.  

Antonio Bianco, MD, is the Charles Arthur Weaver Professor of Cancer Research in the Department of Internal Medicine. He is the president of Rush University Medical Group and vice dean for clinical affairs in Rush Medical College. Bianco came to Rush from the University of Miami Health System, where he served as professor of medicine and chief of the Division of Endocrinology, Diabetes and Metabolism. He has more than 30 years of experience in the thyroid field. He has been recognized with a number of national and international awards and membership in prestigious medical societies. A well-rounded investigator in the field of thyroid disease, Bianco led two American Thyroid Association task forces: one charged with drafting guidelines for thyroid research (as chair) and another responsible for developing guidelines for the treatment of hypothyroidism (co-chair). Bianco’s research interests include the cellular and molecular physiology of the enzymes that control thyroid hormone action (the iodothyronine deiodinases). He has contributed approximately 250 papers, book chapters and review articles in this field, and has lectured extensively both nationally and internationally. Recently, he has focused on aspects of the deiodination pathway that interfere with treatment of hypothyroid patients, a disease that affects more than 10 million Americans. He directs an NIH-funded research laboratory where he has mentored almost 40 graduate students and postdoctoral fellows. This episode includes the following topics: Thyroid produces thyroxin of T4.  T4 is not the biologically active, rather it is T3 T3 is biologically active Transformation of T4 to T3 happens throughs the body Levothyroxine has become the standard of care for treating hypothyroid patients T3 is the biologically active hormone, it could be by giving T4 only we are falling short Evidence based medicine wants to only treat with proven and documented therapy; T3 combination therapy is still not scientifically proven If patient takes T3 in the morning, it peaks about three hours later We have not developed a delivery system to maintain stable T3 levels The most important that we can challenge the pharmacy community is to deliver T3 in a way that it mimics the way it behaves in the human body Surveyed 12,000 patients and the ones on desiccated thyroid have higher QoL compared to those on Levothyroxine I was okay, I had a job, and then I had TT, and from that day forward my life is not the same.  Brain fog, and lack motivation We do not yet have evidence proving that combination therapy works, but some patients report improvement to QoL Mood disorders, depression, brain fog, memory loss, and lack of motivation are reported by TT patients T3 combination therapy does not Many symptoms of hypothyroidism is similar to menopause Depression like symptoms, difficult for weight loss, low motivation, less desire for physical activity, brain fog, memory loss are all symptoms patients report post TT Cannot yet yet distinguish between positive effects of T3 and placebo effects Side effects of T3 may include palpitation or sweating Improvement with combination T3 can be immediate, as reported by patients Patients on Levothyroxine most likely to be on statins, beta-blockers, and anti depressants Blood tests for TT patients, taking T3 and not Time of day to take blood tests Time blood sample depending on when patient takes lab work.  Ideally 3 or 4 hours after taking the T3 tablet Hypothyroid-like symptoms could be depression There is greater likelihood of depression symptoms for those taking Nearly 5% of the U.S. population takes T4 or Levothyroxine, as revealed by the NHANE survey.  This means 10 – 15 million Americans.  Levothyroxine is the most prescribed drug in the U.S. NOTES American Thyroid Association Bianco Lab A Controversy Continues: Combination Treatment for Hypothyroidism  

Normal pregnancy is associated with profound hormonal and metabolic changes in the mother, including changes in thyroid hormones.  These normal changes include increased thyroid binding globulin, increased total T3 and total T4, transient decrease in TSH, and in some patients, a transient increase in serum FT4 during the first trimester. In 2017, the American Thyroid Association issued new guidelines for the diagnosis and management of thyroid diseases during pregnancy, which can be difficult due to the numerous normal physiological changes.  Most would agree that the document is an excellent review of current literature relating to the assessment of thyroid status during pregnancy.  However, one researcher wonders if a particular recommendation of the document is misguided.

Filmmaker Maggie Hadleigh-West, whose 1991 documentary "War Zone" addresses sexual harrassment in public, discusses her latest movie, "Sick to Death" (sick2death.com) which addresses her lifelong struggle with thyroid disease which included seeing multiple doctors, misdiagnosis and undertreatment. According to the American Thyroid Association more than 12% of the U.S. population, and 1 in 8 women, will develop some form of thyroid disease. Up to 60% are unaware of their condition.This show is broadcast live on Wednesday's at 12PM ET on W4WN Radio – The Women 4 Women Network (www.w4wn.com) part of Talk 4 Radio (http://www.talk4radio.com/) on the Talk 4 Media Network (http://www.talk4media.com/).

A native of Saskatchewan, Canada, Dr. Kaptein began teaching at the Keck School of Medicine in the Endocrinology Division in 1977. She became a tenured Professor of Medicine in 1990, a position she currently holds. Dr. Kaptein is a distinguished member of the Western Society for Clinical Investigation, American Society of Nephrology, the Endocrine Society and the American Thyroid Association. An accomplished researcher and lecturer, Dr. Kaptein has been invited to speak on the topics of Endocrinology and Nephrology in such cities as Montreal, Milan, Tel Aviv, Jerusalem, Vienna and Rotterdam, to name a few. In this interview, Dr. Kaptein discusses the need to consider each patient before making treatment decisions.  In some cases, this may mean foregoing the removal of cancerous lymph nodes.  NOTES American Thyroid Association Dr. Elaine Kaptein    

Carmelo Nucera, M.D., Ph.D., is currently an Assistant Professor at Harvard Medical School, Boston, in the Division of Cancer Biology and Angiogenesis (Department of Pathology), Beth Israel Deaconess Medical Center. Dr. Nucera received his M.D. and Ph.D. in Experimental Endocrinology and Metabolism from Italy. Dr. Nucera is highly driven by an intense desire to make important contributions that will directly benefit patients. Dr. Nucera is strongly committed to make discovery aimed to immediately cure patients that are suffering with aggressive tumors and rare/orphan cancer disease. Dr. Nucera has a clinical background and intensely served patients with fatal human diseases. In this episode, Dr. Nucera discusses a combination drug therapy using vemurafenib and palbociclib represents a novel therapeutic strategy to treat papillary thyroid carcinoma (PTC).  NOTES Carmelo Nucera Researchers identify novel therapeutic strategy for drug-resistant thyroid cancers Publication: Thyroid Cancer and resistance to BRAFV600E inhibitors American Thyroid Association  

Dr. Angela M. Leung is an Assistant Professor of Medicine at the UCLA David Geffen School of Medicine and an endocrinologist at both UCLA and the VA Greater Los Angeles Healthcare System. After pursuing her undergraduate studies at Occidental College, Dr. Leung completed her internal medicine residency and endocrinology fellowship training at Boston University School of Medicine. She also studied at the Boston University School of Public Health and obtained a master's degree in Epidemiology. Dr. Leung has particular clinical and research interests in thyroid disorders, and she also sees patients regarding parathyroid and adrenal disorders.  She has published widely and lectures frequently on thyroid disease, including hyperthyroidism, hypothyroidism, thyroid nodules, thyroid cancer, and thyroid disease during pregnancy. In this episode, the following topics are explained: Optimizing thyroid health prior to conception Thyroid issues that affect pregnancy Hypothyroid as result of surgery or Hashimotos Hyperthyroidism and pregnancy Adjusting current thyroid treatment, meaning optimizing thyroid levels by adjusting dosage of thyroid medication TSH levels in light of pregnancy Planned pregnancy usually means a dose increase What happens if someone does not get treatment during pregnancy? Hypothyroidism and the fetus Brain development for the fetus Lower IQ scores and hypothyroid in pregnancy CATS study from UK and Italy Iodine and pregnancy Iodine intake prior to pregnancy Armour thyroid and pregnancy Concerns regarding animal derived thyroid replacement TSH levels NOTES Dr. Angela Leung CATS study American Thyroid Association 49: Thyroid and Pregnancy⎥Why It Matters, with Dr. Elizabeth Pearce from Boston University

Dr. Paul Y. Casanova-Romero, M.D., M.P.H., F.A.C.P., F.A.C.E, E.C.N.U, que se unió a Palm Beach Diabetes y Endocrine Specialists en 2012, recibió su grado médico con honores (Summa Cum Laude) y Doctor en Ciencias Médicas (DMSc), de la Universidad de Zulia, la Escuela de Medicina en Venezuela. Posteriormente se unió a la facultad de su Alma Mater y en 1998, el Grupo de Investigación del Programa de Prevención de la Diabetes (D.P.P.) en el Instituto de Investigación de la Diabetes-Universidad de Miami. Completó su posgrado en Medicina Interna y Endocrinología (Jackson Memorial Hospital) y estudios de postgrado en Salud Pública (M.P.H.) con el Premio de Mérito Académico en la Universidad de Miami. Un consultor privado endocrinólogo y orador nacional desde 2006, el Dr. Paul Y. Casanova-Romero de investigación extensa sobre la prevención de la diabetes, trastornos de la tiroides, síndrome metabólico y otros trastornos endocrinos han sido ampliamente publicadas. Sigue colaborando en estudios de investigación en Estados Unidos y Latinoamérica, el más reciente en pruebas moleculares de tiroides. El Dr. Casanova-Romero está certificado por la Junta en Medicina Interna, así como en Endocrinología, Diabetes y Metabolismo. Es miembro del Colegio Americano de Endocrinología (F.A.C.E.) y miembro del Colegio Americano de Médicos (F.A.C.P.). Actualmente es profesor voluntario de medicina en la Universidad de Miami. Dr. Paul Y. Casanova-Romero se especializa en el tratamiento de la enfermedad de la tiroides incluyendo nódulos tiroideos, hipotiroidismo, hipertiroidismo y cáncer de tiroides, enfermedad paratiroidea, diabetes, pre-diabetes, trastornos lipídicos y otros trastornos endocrinos. Él ha estado usando la prueba molecular para la caracterización de los nódulos de la tiroides desde 2010. Él ha satisfecho con éxito los requisitos para la certificación endocrina en el ultrasonido del cuello (ECNU) para realizar la biopsia internamente guiada por ultrasonido de la aspiración de la aguja fina de nódulos de tiroides, de la paratiroides, nodos. Es miembro del panel de membresía de la American Thyroid Association, miembro activo de la Endocrine Society, la Asociación Americana de Endocrinólogos Clínicos, la American Diabetes Association, el American College of Physicians y la National Lipid Association. En esta entrevista hablamos sobre esta temas: ¿Cómo se identifican los nódulos y por qué ocurren? autoexamen o en la oficina del médico La mayoría de los nódulos son benignos pero ocurren porque en mas de 70% de la población ¿Qué tests puede realizar un médico para evaluar el nódulo? Ninguna test es 100% Ultrasonido - qué están buscando en general Que es ojo fina y el proceso general Tests moleculares ¿Qué tipos de resultados se pueden obtener de la citología y qué significan? La mayoria de ojo finas son benigno Maligno o sospechoso de malignidad, todavía tiene la posibilidad de no ser cáncer Los arco iris - 3,4,5 - indeterminate categoria  Systema BETHESDA ¿Qué tests adicionales se pueden realizar para resolver los nódulos indeterminados? - Tests moleculares Que son todas los tests moleculares?  Y son las mismas? Dr. Casanova prefiere usar test de Afirma, este es por que MAS INFORMACIÓN Dr. Paul Casanova American Thyroid Association (español) La prueba de la expresión génica de Afirma puede reducir cirugías innecesarias del cáncer de tiroides Afirma

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.   Dr. Wartofsky is past President of both the American Thyroid Association and The Endocrine Society.  He is the editor of books on thyroid cancer for both physicians and for patients, and thyroid cancer is his primary clinical focus.   He is the author or coauthor of over 350 articles and book chapters in the medical literature, is recent past Editor-in-Chief of the Journal of Clinical Endocrinology & Metabolism, and is the current Editor-in-Chief of Endocrine Reviews. In this episode, Dr. Wartofsky discusses the following: Hypothyroidism causes When is replacement thyroid 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 The danger of taking generic T4; are cheaper, larger profit margin, but the content varies. Synthroid versus generic Manufacturing plants in Italy, India, Puerto Rico are known to produce generics Content versus absorption when taking generic T4 An explanation of TSH 1.39 is a healthy TSH level for women in the U.S. Symptoms of hypothyroidism, such as a slow mind, poor memory, dry skin, brittle hair, slow heart rate, problems with pregnancy, miscarriage, and hypertension. Screening TSH levels if contemplating pregnancy T4 is the most prescribed drug in the U.S. Hypothyroidism is common when there is a family history Auto-immune disease is often associated with hypothyroidism An explanation of T3 An explanation of desiccated thyroid The T3 ‘buzz’ Muhammed Ali’s overdose of T3 Dangers of too much T3 When to take T4 medication, and caution toward taking mediations that interfere with absorption Coffee and thyroid hormone absorption Losing muscle and bone by taking too much thyroid hormone Taking ownership of your disease Related episodes: 37: Adding T3 to T4 Will Make You Feel Better? For Some the Answer is ‘Yes’ with Dr. Antonio Bianco from Rush University NOTES Leonard Wartofsky American Thyroid Association  

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. This can help thyroid cancer patients avoid unnecessary and potentially damaging over-treatment, while still providing the best option for control of their cancer and better quality of life after treatment. Dr. Shaha works very closely with Memorial Sloan Ketterings’ endocrinologists to monitor the careful post-treatment hormone balancing necessary for thyroid cancer patients. Many academic hospitals and medical societies worldwide have invited Dr. Shaha to speak on the principles of targeted thyroid surgery and to share his expertise in the treatment of head and neck cancers.   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. Anxiety when diagnosed with cancer. Medical legalities — spend a lot of time with patient — and empower patient. Let the treatment not be worse than the disease. Large tumors, more than 4 cm,  bulky nodes,  voice hoarseness,  vocal cord is paralyzed.  All circumstances where surgery maybe advocated. If a tumor is benign but there is presence of compressive goiters, or deviation of trachea or swallowing difficulty. Considering the condition of the patient, age, cardiac issues. When voice is critical to the patients livelihood, such as teachers, politicians, and singers. Main three complications of surgery include bleeding, change of voice, calcium problems. Non-academic surgeons. Cancer treatment requires a team: surgeons, anesthesiologist, pre-op, radiologist, pathologist, endocrinologists, oncologists. When wind pipe is involved with tumor. When in surgical business a long time, you become humble no matter how good you are. Family present during consultation. God gave you an organ — you took it away — now you are on a pill — since the surgery its ’just’ not the same. When treatment is out of the box — many will not agree with you. How to develop a scale to measure quality of life. To avoid scarring, surgery maybe conducted through the armpit in Korea and Japan. Fibrosis Progress in understanding biology of thyroid cancer only cancer, that there is 98% survival. NOTES: Dr. Ashok R. Shaha   RELATED EPISODES: 50: Regarding Thyroid Cancer, Are You a Minimalist or a Maximalist? with Dr. Michael Tuttle from Sloan Kettering 40: New Research Reveals Thyroid Surgery Errors 5x More Frequent Than Reported with Dr. Maria Papaleontiou from Michigan Medicine 42: Flame Retardants Connected to Thyroid Cancer, with Dr. Julie Ann Sosa from Duke University 35: Rethinking Thyroid Cancer – When Saying No to Surgery Maybe Best for You with Dr. Allen Ho from Cedars-Sinai in Los Angeles   21: Diagnosed with Thyroid Cancer and You Say No to Surgery with Dr. Louise Davies 09: Thyroid Cancer Patients Experience Quality of Life Downgrade with Dr. Raymon Grogan and Dr. Briseis Aschebrook from the University of Chicago Medicine 36: 1 in 3 People Die With Thyroid Cancer — Not From with Dr. Seth Landefeld from UAB   American Thyroid Association

In this episode, topics include: Hypothyroidism and hyperthyroidism during pregnancy Pregnant and without a thyroid Avoiding T3 during pregnancy, including concerns with desiccated thyroid If being treated for hypothyroidism already, the importance of upping dose while pregnant Pregnant with auto-immunity Pregnant with Graves’ disease The dangers of pregnancy and overt hypothyroidism or hyperthyroidism Three-percent of pregnancies are affected The importance of iodine during pregnancy Dr. Pearce received her undergraduate and medical degrees from Harvard and a masters’ degree in epidemiology from the Boston University School of Public Health. She completed her residency in internal medicine at Beth Israel Deaconess Medical Center, and her fellowship in endocrinology at the Boston University Medical Center. She is currently an Associate Professor of Medicine at Boston University School of Medicine. She has served as a member of the board of directors of the American Thyroid Association and is currently on the management council of the Iodine Global Network.  She recently co-chaired the ATA’s Thyroid in Pregnancy Guidelines Task Force. She was the 2011 recipient of the ATA’s Van Meter Award for outstanding contributions to research on the thyroid gland. NOTES Elizabeth Pearce American Thyroid Association

Antonio Bianco, MD, PhD, is head of the division of Endocrinology and Metabolism at Rush University Medical Center.   Dr. Bianco also co-chaired an American Thyroid Association task force that updated the guidelines for treating hypothyroidism. 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 or Levothyroxine, as revealed by the NHANE survey.  This means 10 - 15 million Americans.  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.  For others, adding T3 to T4 shows immediate improvement.  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 hypothyroid symptoms Notes: American Thyroid Association Bianco Lab Bianco Lab on Facebook 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.

What Happens When Thyroid Cancer Travels to the Lungs? Fabian Pitoia, M.D., serves as the Head of the Thyroid Section of the Division of Endocrinology and Investigation Area Coordinator at the Hospital de Clinicas of the University of Buenos Aires (UBA). He works also as an Proffessor of internal medicine at the Faculty of Medicine (UBA). Dr Pitoia serves as a Full Member of the Argentine Society of Endocrinology and Metabolism, of the Latin American Thyroid Society, the Endocrine Society and he is a Correspondent Member of the American Thyroid Association. In this episode Dr. Pitoia addresses the following topics: 10% of thyroid cancer patients will have distant metastatic disease The disease will travel to lungs, bones, or both Treatment with RAI is most effective for those under 40 years old Evaluation of metastatic thyroid cancer in the lungs is a CT scan In 2006, there was a change in the treatment of the disease Adverse events of medication The coordination between the endocrinologist and the oncologist  RESOURCES ResearchGate Dr. Pitoia - Facebook Dr. Pitoia - web site Dr. Pitoia - Twitter Thyroid Cancer Alliance American Thyroid Association Hospital de Clínicas de la Universidad de Buenos Aires - Ciudad Autónoma de Buenos Aires.  Consultorio privado: Pte. J.E. Uriburu 754 - Piso 2. Teléfonos: 49545488/49525496  fpitoia@glandulatiroides.com.ar  

Andrew J. Bauer, MD is an Associate Professor of Pediatrics at the Perelman School of Medicine, University of Pennsylvania and serves as the Director of the Thyroid Center in the Division of Endocrinology and Diabetes at The Children’s Hospital of Philadelphia. Dr. Bauer maintains active membership as a fellow in the American Academy of Pediatrics (FAAP), the Endocrine Society, the Pediatric Endocrine Society, and the American Thyroid Association. He also volunteers as a consultant for the Thyroid Cancer Survivors Association and the Graves’ Disease and Thyroid Foundation. In the American Thyroid Association Dr. Bauer has recently served as a member of the pre-operative staging committee, the thyroid hormone replacement committee, and as a co-chair for the task force charged to author guidelines on the evaluation and treatment of pediatric thyroid nodules and differentiated thyroid cancer. His clinical and research areas of interest are focused on the study of pediatric thyroid disease, to include hyperthyroidism, thyroid nodular disease, thyroid cancer, and inherited syndromes associated with an increased risk of developing thyroid nodules and thyroid cancer. In this episode Dr. Bauer shares the complexities of managing children with thyroid nodules, and differentiated thyroid cancer.  This is a must listen interview for parents whose child has a thyroid nodule or thyroid cancer diagnosis.  There are a several important differences in how pediatric thyroid nodules and differentiated thyroid cancer (DTC) present and respond to therapy. Kids are less frequently diagnosed with a thyroid nodule; however, the risk for malignancy is four- to fivefold higher compared with an adult thyroid nodule. For DTC (specifically papillary thyroid cancer), more than 50% of pediatric-aged patients will have metastases to cervical lymph nodes at the time of diagnosis, but because the tumors typically retain the ability to absorb iodine (retain differentiation), disease-specific mortality is very low, with > 95% of pediatric patients surviving from the disease. This is true even for children with pulmonary metastases, which occur in approximately 15% of patients who present with lateral neck disease. With the high risk for malignancy and the invasive potential of the cancer, there has been a stronger tendency to take kids with thyroid nodules to the operating room (OR) and to administer RAI to those found to have DTC. With a greater realization of the increased risk for surgical complications as well as the short- and long-term complications of RAI treatment, the guidelines emphasize the need for appropriate preoperative assessment of nodules, and the approach to surgical resection, and they provide a stratification system and guidance for surveillance to identify which patients may benefit from RAI. The stratification system, called the "ATA pediatric risk classification," is not designed to identify patients at risk of dying of disease; it is designed to identify patients at increased likelihood of having persistent disease. We have known about these differences for years, but the approach to evaluation and care has never been summarized into a pediatric-specific guideline. The adult guidelines aren't organized to address the differences in presentation, and the adult staging systems are targeted to identify patients at increased risk for disease-specific mortality. So, the adult guidelines are not transferable to the pediatric population. NOTES: Dr. Andrew Bauer American Thyroid Association

In this episode Dr. Bernet describes that Hashimoto’s thyroiditis is an autoimmune condition that usually progresses slowly and often leads to low thyroid hormone levels — a condition called hypothyroidism. The best therapy for Hashimoto’s thyroiditis is to normalize thyroid hormone levels with medication. A balanced diet and other healthy lifestyle choices may help when you have Hashimoto’s, but a specific diet alone is unlikely to reverse the changes caused by the disease. Hashimoto’s thyroiditis develops when your body’s immune system mistakenly attacks your thyroid. It’s not clear why this happens. Some research seems to indicate that a virus or bacterium might trigger the immune response. It’s possible that a genetic predisposition also may be involved in the development of this autoimmune disorder. A chronic condition that develops over time, Hashimoto’s thyroiditis damages the thyroid and eventually can cause hypothyroidism. That means your thyroid no longer produces enough of the hormones it usually makes. If that happens, it can lead to symptoms such as fatigue, sluggishness, constipation, unexplained weight gain, increased sensitivity to cold, joint pain or stiffness, and muscle weakness. If you have symptoms of hypothyroidism, the most effective way to control them is to take a hormone replacement. That typically involves daily use of a synthetic thyroid hormone called levothyroxine that you take as an oral medication. It is identical to thyroxine, the natural version of a hormone made by your thyroid gland. The medication restores your hormone levels to normal and eliminates hypothyroidism symptoms. You may hear about products that contain a form of thyroid hormones derived from animals. They often are marketed as being natural. Because they are from animals, however, they aren’t natural to the human body, and they potentially can cause health problems. The American Thyroid Association’s hypothyroidism guidelines recommend against using these products as a first-line treatment for hypothyroidism. Although hormone replacement therapy is effective at controlling symptoms of Hashimoto’s thyroiditis, it is not a cure. You need to keep taking the medication to keep symptoms at bay. Treatment is usually lifelong. To make sure you get the right amount of hormone replacement for your body, you must have your hormone levels checked with a blood test once or twice a year. If symptoms linger despite hormone replacement therapy, you may need to have the dose of medication you take each day adjusted. If symptoms persist despite evidence of adequate hormone replacement therapy, it’s possible those symptoms could be a result of something other than Hashimoto’s thyroiditis. Talk to your health care provider about any bothersome symptoms you have while taking hormone replacement therapy. Victor J. Bernet, MD, is Chair of the Endocrinology Division at the Mayo Clinic in Jacksonville, Florida and is an Associate Professor in the Mayo Clinic College of Medicine. Dr. Bernet served 21+ years in the Army Medical Corps retiring as a Colonel. He served as Consultant in Endocrinology to the Army Surgeon General, Program Director for the National Capitol Consortium Endocrinology Fellowship and as an Associate Professor of Medicine at the Uniformed Services University of Health Sciences. Dr. Bernet has received numerous military awards, was awarded the “A” Proficiency Designator for professional excellence by the Army Surgeon General and the Peter Forsham Award for Academic Excellence by the Tri-Service Endocrine Society. Dr. Bernet graduated from the Virginia Military Institute and the University of Virginia School of Medicine. Dr. Bernet completed residency at Tripler Army Medical Center and his endocrinology fellowship at Walter Reed Army Medical Center. Dr. Bernet’s research interests include: improved diagnostics for thyroid cancer, thyroidectomy related hypocalcemia, thyroid hormone content within supplements as well as management of patient’s with thyroid cancer. He is the current Secretary and CEO of the American Thyroid Association.

¿Cómo sabemos si usted tiene hipotiroidismo? ¿Qué significa si es difícil concentrarse o enfocar la mente? ¿Qué significa si usted tiene altos niveles de TSH? ¿Cómo se diagnostica el hipotiroidismo? ¿Qué es Hashimotos? ¿Cuál es el tratamiento para el hipotiroidismo? ¿Puede la dieta ayudar con el hipotiroidismo? ¿Cuándo es el mejor momento del día para tomar su medicina de hipotiroidismo? ¿Dónde puede encontrar un médico para tratar el hipotiroidismo? Dra. Sandra Daniela Licht de Hospital General de consultorio particular y en INEBA ( Instituto de Neurociencias de Buenos Aires) Endocrinologia ESPECIALIDAD Establecimiento: General de Agudos J. M. Ramos Mejía. Título: Clinica Medica. Establecimiento: Hospital General de Agudos Carlos G.
Durand. Titulo: Endocrinologia ACTIVIDAD ACADEMICA Y DOCENTE Instructora de Residentes de Endocrinología, Htal Durand (1993-1995) Docente de la Diplomatura en Enfermedades Tiroideas de la Facultad de Medicina de la Universidad Nacional de Tucumán SOCIEDADES CIENTIFICAS • Miembro Titular, Sociedad Argentina de Endocrinología y Metabolismo. • Miembro Titular, Sociedad Latinoamericana de Tiroides. • Miembro Titular, The Endocrine Society. • Miembro Titular, American Thyroid Asociation. • Miembro del Comité de Asuntos Internacionales, The Endocrine Society (2005-2006). • Miembro del Comité Hormone Foundation, The Endocrine Society (2007-2010). • Miembro del Comité Patient Education and Advocacy Committee, American Thyroid Association (2008). • Miembro del Comité Clinical Affaires, American Thyroid Association. • Miembro del Comité Working Group on Disparities in Clinical Trials, The Endocrine Society. • Miembro del Comité de Publicaciones, The Endocrine Society. • Miembro del Comité Clinical Guidelines, The Endocrine Society. • Asesora médica de ACTIRA. • Asociación de Pacientes con Cáncer de Tiroides de la República Argentina. • Miembro del Medical Advisory Panel of Thyroid Cancer Alliance (desde el año 2011). Asociación Americana de la Tiroides - Español

This episode details the medical approach to thyroid nodules.  Topics include: • 60% of the U.S. population has thyroid nodules • Discovered when evaluating other neck issues such as an unrelated pain • What happens when you are told you have a thyroid nodule? • How to know if your thyroid nodule is cancerous? • When is surgery done despite the nodule being benign? • Decreasing patient anxiety with quick biopsy results • The American Thyroid Association as a resource for patients and physicians • A word of caution about sourcing medical information from online resources Dr. M Regina Castro is an endocrinologist in Rochester, Minnesota and is affiliated with Mayo Clinic. She received her medical degree from Central University of Venezuela and has been in practice for more than 20 years. Dr. Castro accepts several types of health insurance, listed below. She is one of 78 doctors at Mayo Clinic who specialize in Endocrinology, Diabetes & Metabolism. She also speaks multiple languages, including Spanish and French. NOTES: M. Regina Castro, M.D. THYROID NODULES —  Thyroid nodule size larger than 4 cm does not increase the risk of false negative biopsy results or the risk of cancer   American Thyroid Association   

Cuando planifique la gestación hable antes con su ginecólogo sobre la suplementación de la dieta con yodo.

Dr. 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.  Dr. Larian's Center For Head and Neck Surgery is located in Beverly Hills, California. In this episode, Dr. Larian discusses his experience treating thyroid disorders, including his medical missions to Central America.  During this interview, you will hear greater detail about the following topics: The most recent American Thyroid Association’s guidelines and updates to treating thyroid cancer compared to past approaches Minimally invasive thyroid surgery, which results in less scarring and less discomfort Breaking away from the old tradition of a large incision  Testing for parathyroid imbalance What might it mean when the patient feels anxious, has to urinate during the night, impaired mental function, and calcium imbalance?  Which blood test reveals possible parathyroid issues? The common denominator in patients who recover post thyroid cancer surgery A parathyroid trend in women 40 - 60 years old The importance of staying in tune with your body and its signals NOTES: Dr. Babak Larian http://www.larianmd.com/ P: 310.461.0300 American Thyroid Association Guidelines http://www.thyroid.org/professionals/ata-professional-guidelines/

According to the American Thyroid Association, women are more likely than men to have thyroid disorder. One in eight women will develop thyroid problems during her lifetime.Listen in as Dr. Priya Menon, Endocrinologist with Hendricks Regional Health, discusses Thyroid disorders and the treatments available that can help to dramatically increase your quality of life.

We all know about the importance of eating a healthy, balanced diet; however, let's be real here, at times, following a well-rounded diet can be challenging (and boring). This reality is leaving adults deficient in critical nutrients, such as vitamins A, D, and E, and calcium and magnesium. To fill nutritional gaps, many are increasingly using vitamins and supplements, which can be beneficial, but at the same time, if not taken correctly, can be dangerous to one's health. Romy Block, MD, (endocrinologist) and Arielle Levitan, MD, (internist), are helping clear up vitamin confusion for consumers in their new book, “The Vitamin Solution”. Romy Block, MD, is a board-certified specialist in endocrine and metabolism medicine, member of American Thyroid Association, and the cofounder of Vous Vitamin, LLC. Arielle Miller Levitan, MD, is a board-certified internal medicine physician and the cofounder of Vous Vitamin, LLC. Both of these doctors are the co-authors of The Vitamin Solution: Two Doctors Clear Confusion About Vitamins and Your Health.  

Join the Real Food Mamas on our second Q&A episode where we answer your questions about thyroid health in the postpartum period, food sensitivities in kids, and real food snack ideas. [0:52] Steph’s Updates [2:58] Aglaée’s Updates [5:38] Question #1: Can you discuss hormonal imbalances and Hashimoto’s that manifests postpartum and what to do about it?  [20:02] Question #2: What do you do when your child becomes allergic to foods she used to enjoy? What can cause extreme highs/lows in my child’s behavior?  [32:48] Question #3: What are healthy snack ideas that pack a lot of calories for nursing mamas following a real food diet? SHOWNOTES: Postpartum thyroiditis information: 2011 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum Grass-fed gelatin Great Lakes Gelatin green one = to dissolve in hot or cold liquids (smoothies) orange one = to make gummies Vital Protein Gelatin Homemade bone broth recipe Soil-based probiotics: Prescript-Assist Aglaée's favorite muffins try the chocolate, coconut & raspberry version! Primal Pacs Protein powder Fat bomb recipe you can also try the blueberry version!

  Dr. Jane Cases is a board certified endocrinologist and leader in regenerative medicine.  Her work focuses on endocrinology, diabetes and metabolism as well as stem cell therapy, platelet-rich plasma (PRP) therapy, aesthetics and much more. Her passion for total wellness and weight management led her to start Wellness 360 Comprehensive Lifestyle Center in Marietta, Ohio, where she serves as Chief Medical Officer.   The development of Healing Saint™ products came from her passion for regenerative medicine to help patients who want to fully address or prevent lifestyle diseases. After a horrific road bike accident, Dr. Jane was left with terrible scars on her face and arm. Unwilling to settle for the traditional approach to wound care which would have had less-than-desirable results, Dr. Jane was driven to learn even more about wound healing technology and to better understand its ability to enhance the body’s self-repair and self-renewal potentials. The result was the Healing Saint Luminosity Skin Serum, a proprietary formula to better heal damaged and aging skin.   A leading researcher on cell medicine, Dr. Jane offers American Medical Association approved training courses for fellow physicians and has authored dozens of peer-reviewed articles and studies in numerous scientific and medical journals. She holds active professional memberships with the American Board of Internal Medicine, Endocrine Society USA, American Thyroid Association, American Association of Clinical Endocrinologists, European Association for the Study of Diabetes, American Academy of Anti-aging Medicine and the International Cell Medicine Society. In addition, she has served as an Assistant Professor at Ohio University’s School of Osteopathic Medicine.   JJ Flizanes is an Empowerment Strategist. She is the Director of Invisible Fitness, an Amazon best-selling author of Fit 2 Love: How to Get Physically, Emotionally, and Spiritually Fit to Attract the Love of Your Life, and author of Knack Absolute Abs: Routines for a Fit and Firm Core. She was named Best Personal Trainer in Los Angeles for 2007 by Elite Traveler Magazine.     JJ vividly reminds us that the word ‘fitness’ is not just about the state of one’s physical body, but also the factors which determine a person’s overall well being.   And, for JJ, the key components in all these areas are ‘invisible’ — balanced support structures of nutrition, emotional centeredness and health. A favorite of journalists and the media for her depth of knowledge and vibrant personality, JJ, a contributing expert for Get Active Magazine, has also been featured in many national magazines, including Shape, Fitness, Muscle and Fitness HERS, Elegant Bride, and Women’s Health as well as appeared on NBC, CBS, Fox 11 and KTLA. She is also a video expert for About.com and regular contributor for The Daily Love.   JJ launched her professional career in 1996 as the Foundations Director for the New York Sports Club, where she designed curriculum and in-house certification for new and previously uncertified fitness trainers. She has also been certified by the American Council on Exercise (ACE), International Sports Science Association (ISSA), and the Resistance Training Specialist Program (RTS).       With a focus on biomechanics, JJ has lectured for The Learning Annexand as a featured speaker for New York Times Bestselling Author of The Millionaire Mind, T. Harv Ecker’s Peak Potentials seminars, as well as corporate clients, including Pacific Gas and Electric, Hanson Engineering, and Jostens, Inc. She is the Wellness Expert for KFC International, the Health and Fitness Expert for the National Association of Entrepreneur Moms, and a Fitness Expert for Nourishing Wellness Medical Center.    She has been working in the health and wellness industry for 15 years, as a fitness trainer with a knack for helping her clients become more self-aware and self-empowered through her ability to quickly identify and pinpoint problem areas, and then create simple solutions involving exercise, nutrition and mindset changes. She is the Host of the new iTunes Podcast Show Fit 2 Love: Physical, Emotional and Spiritual Fitness for the Happy Life You Deserve which is six day a week video and audio show.   What sets JJ apart from her Celebrity Fitness counterparts is the holistic approach to getting results. Over the last fourteen years she has studied, used and applied Positive Psychology, Neuro-Linguistic  Programming (NLP), Eye Movement Desensitization and Reprocessing (EMDR), Emotional Freedom Technique (EFT), Law of Attraction, Quantum Physics, Non Violent Communication, Imago Therapy, and Hypnotherapy. JJ Flizanes has proven that she’s not only an expert in matters of the body and fitness—she’s an insightful and provocative author who delivers a timely message about matters of the heart.  

When Dr. Jane Cases relocated to Marietta, OH in 2005, she started her practice in Endocrinology, Diabetes, and Metabolism and became part of the Faculty of Ohio University, College of Medicine where she continued basic science research in the field of Insulin Resistance, Obesity, and Diabetes. Her interest in this field had been tremendous since her time at Einstein College of Medicine in New York where she had been part of the research team on Diabetes, Obesity, Aging, and Longevity. After a year of basic science research and clinical practice, she decided to focus on her clinical practice and became the Medical Director of the Diabetes Center for the Marietta Health Systems.  Her passion for total wellness and weight management served as the driving force when she started Wellness 360 Comprehensive Lifestyle Center. Now pursuing cutting-edge technology in the field of Regenerative Medicine, she yearns to provide total care to patients who want to fully address or prevent lifestyle diseases (e.g., Diabetes, some cancers, obesity, chronic joint pain and heart disease). She knows the potential use of cell medicine in clinical practice and has continuously sought out the optimum way to isolate adipose-derived stem cells and platelet-rich plasma (PRP) by collaborating with biotech companies and various clinicians.  A leading researcher on cell medicine, Dr. Jane offers American Medical Association approved training courses for fellow physicians and has authored dozens of peer-reviewed articles and studies in numerous scientific and medical journals. She holds active professional memberships with the American Board of Internal Medicine, Endocrine Society USA, American Thyroid Association, American Association of Clinical Endocrinologists, European Association for the Study of Diabetes, American Academy of Anti-aging Medicine and the International Cell Medicine Society. In addition, she has served as an Assistant Professor at Ohio University’s School of Osteopathic Medicine.       JJ Flizanes is an Empowerment Strategist. She is the Director of Invisible Fitness, an Amazon best-selling author of Fit 2 Love: How to Get Physically, Emotionally, and Spiritually Fit to Attract the Love of Your Life, and author of Knack Absolute Abs: Routines for a Fit and Firm Core. She was named Best Personal Trainer in Los Angeles for 2007 by Elite Traveler Magazine.     JJ vividly reminds us that the word ‘fitness’ is not just about the state of one’s physical body, but also the factors which determine a person’s overall well being.   And, for JJ, the key components in all these areas are ‘invisible’ — balanced support structures of nutrition, emotional centeredness and health. A favorite of journalists and the media for her depth of knowledge and vibrant personality, JJ, a contributing expert for Get Active Magazine, has also been featured in many national magazines, including Shape, Fitness, Muscle and Fitness HERS, Elegant Bride, and Women’s Health as well as appeared on NBC, CBS, Fox 11 and KTLA. She is also a video expert for About.com and regular contributor for The Daily Love.   JJ launched her professional career in 1996 as the Foundations Director for the New York Sports Club, where she designed curriculum and in-house certification for new and previously uncertified fitness trainers. She has also been certified by the American Council on Exercise (ACE), International Sports Science Association (ISSA), and the Resistance Training Specialist Program (RTS).   With a focus on biomechanics, JJ has lectured for The Learning Annexand as a featured speaker for New York Times Bestselling Author of The Millionaire Mind, T. Harv Ecker’s Peak Potentials seminars, as well as corporate clients, including Pacific Gas and Electric, Hanson Engineering, and Jostens, Inc. She is the Wellness Expert for KFC International, the Health and Fitness Expert for the National Association of Entrepreneur Moms, and a Fitness Expert for Nourishing Wellness Medical Center.    She has been working in the health and wellness industry for 15 years, as a fitness trainer with a knack for helping her clients become more self-aware and self-empowered through her ability to quickly identify and pinpoint problem areas, and then create simple solutions involving exercise, nutrition and mindset changes. She is the Host of the new iTunes Podcast Show Fit 2 Love: Physical, Emotional and Spiritual Fitness for the Happy Life You Deserve which is six day a week video and audio show.   What sets JJ apart from her Celebrity Fitness counterparts is the holistic approach to getting results. Over the last fourteen years she has studied, used and applied Positive Psychology, Neuro-Linguistic  Programming (NLP), Eye Movement Desensitization and Reprocessing (EMDR), Emotional Freedom Technique (EFT), Law of Attraction, Quantum Physics, Non Violent Communication, Imago Therapy, and Hypnotherapy. JJ Flizanes has proven that she’s not only an expert in matters of the body and fitness—she’s an insightful and provocative author who delivers a timely message about matters of the heart.  

WHO CAN YOU TRUST THESE DAYS? One might think you could trust expert endocrinologists of The American Thyroid Association. But, beware of industry bias. Here paraphrased is one of their bad guidelines: "Levothyroxine is the one and only best medicine for millions dealing with the current low thyroid epidemic." That guideline could be an ad for the levothyroxine company, plus it ignores recent research about other good remedies. Health consumers deserve better than this.This show is broadcast live on W4WN Radio – The Women 4 Women Network (www.w4wn.com) part of Talk 4 Radio (http://www.talk4radio.com/) on the Talk 4 Media Network (http://www.talk4media.com/)

Welcome to the second edition of SPOTLIGHT: The Podcast of Clinical Endocrinology News, a series of six podcasts. This episode discusses the revised thyroid cancer guidelines from the American Thyroid Association, the retinopathy prevalence in impaired fasting glucose, and the new European guidelines that address cardiovascular risk.