This show is for thyroid patients determined to improve their quality of life, with the best information available.
You will gain insight from those who have discovered improved well-being regardless of setbacks, and hear from leading healthcare professionals, including endocrinologists, surgeons, functional medicine practitioners, and radiologists.
97: What You Must Know About Hashimoto's Disease with Dr. Brittany Henderson
Brittany Henderson, MD, ECNU is board-certified in internal medicine and endocrinology, with advanced training in thyroid disorders, including Hashimoto’s thyroiditis, Graves Disease, thyroid nodules, and thyroid cancer. Originally from Cleveland, Ohio, she graduated in the top 10% of at her class at Northeastern Ohio Medical University, where she received the honor of Alpha Omega Alpha (AOA). She completed her endocrinology fellowship training under a National Institutes of Health (NIH) research-training grant at Duke University Medical Center. She then served as Medical Director for the Thyroid and Endocrine Tumor Board at Duke University Medical Center and as Clinical Director for the Thyroid and Endocrine Neoplasia Clinic at Wake Forest University Baptist Medical Center.
Topics discussed in this episode include:
How to interpret my thyroid results? Why did I get this? Is it something I did? Thyroid controls nearly all body systems: heart, weight, brain, bowel. Testing and diagnosis: beyond blood-work TSH is the most common check TSH is like the reading of your electric meter: it tells you big picture for a month, not daily — it is not a fluid system, it changes by the hour TSH is not the cure all for reading thyroid health Full thyroid panel: Free T4 and Free T3 is important — highest in morning, lowest around 2p or 3p in the afternoon There is no one size fits all to Hashimoto’s — there are different types Blood tests: preparing for lab tests ‘Normal’ TSH but a patient does not feel normal Normal TSH range is controversial — .5 to 3 TSH is normal — if on thyroid replacement target 1.5 Suppressed TSH Dangers of suppressed TSH for thyroid cancer replacement or those on too much on thyroid replacement — heart failure, osteoporosis T3 symptoms of TSH is kept too low for too long The T4 — T3 relationship T4 is money in savings account — but you cant use it now — T3 is money in your pocket and available now Preferred thyroid replacement — but, issues with synthetic and desiccated The goal — T4 and T3 as stable as possible throughout the day — in light of absorption and interfering food Compounded medications A doctor must listen to the patient Generic levothyroxine and fillers — who is the manufacturer What is better, Nature or Armour? Why do some people do better on various thyroid replacement formulations? Gut biome The environment and thyroid disease Defining leaky gut Avoid foods that gut inflammation thereby worsening auto-immune disease Three food foes: processed foods, sugar, and iodine disruptors Is adrenal fatigue real? Supplements: vitamins and Hashimoto’s Nutrients needed to produce thyroid hormone, such as optimizing iron and selenium Anti-inflammatory vitamins and Vitamin A and Vitamin D Anti-oxidant vitamins — Vitamin B1, Vitamin C, and Glutathione What time of day to take to thyroid replacement medication What happens if you miss a day of thyroid replacement hormone? What does an endocrinologist feel about a patient seeing a Naturopath or an integrative medicine specialist? NOTES
57: The Gut⎥Antibiotics Danger, Fixing Inflammation, and Thyroid Health, with Dr. Lisa Sardinia
42: Flame Retardants Connected to Thyroid Cancer, with Dr. Julie Ann Sosa from Duke University
Exposure to flame retardant chemicals and occurrence and severity of papillary thyroid cancer: A case-control study.
LGR5 is associated with tumor aggressiveness in papillary thyroid cancer.
Hedgehog signaling in medullary thyroid cancer: a novel signaling pathway.
Dr. Brittany Henderson
Facebook, Instagram, and Twitter: @DrHendersonMD, @charlestonthyroid, @hashimotosbook
Websites: www.charlestonthyroid.com and www.drhendersonmd.com
96: Thyroid and Prostate Cancer — Surgery Outcomes Sometimes Worse Than No Surgery — Weighing Risks and Outcomes with Dr. Allen Ho
Allen S. Ho MD is Associate Professor of Surgery, Director of the Head and Neck Cancer Program, and Co-Director of the Thyroid Cancer Program at Cedars-Sinai Medical Center. As a fellowship-trained head and neck surgeon. His practice focuses on the treatment of head and neck tumors, including HPV(+) throat cancers and thyroid malignancies. He leads the multidisciplinary Cedars-Sinai Head and Neck Tumor Board, which provides consensus management options for complex, advanced cases. Dr. Ho’s research interests are highly integrated into his clinical practice. His current efforts lie in cancer proteomics, HPV(+) oropharyngeal cancer pathogenesis, and thyroid cancer molecular assays. Dr. Ho has published as lead author in journals that include Nature Genetics, JCO, JAMA Oncology, and Thyroid, and is Editor of the textbook Multidisciplinary Care of the Head and Neck Cancer Patient (Springer 2018). Dr. Ho serves on national committees within the AHNS and ATA, and leads a national trial on thyroid cancer active surveillance (ClinicalTrials.gov ID: NCT02609685). He maintains expertise in transoral robotic surgery (TORS), minimally invasive thyroidectomy approaches, and nerve preservation techniques. Dr. Ho’s overarching aim is to partner with patients to optimize treatment and provide compassionate, exceptional care.
In this interview — a discussion about Dr. Ho’s research; Parallels Between Low-Risk Prostate Cancer and Thyroid Cancer: A Review. Topics include:
prostate and thyroid cancer parallels prostate cancer and practical acceptance of active surveillance randomized and followed patients through true active surveillance overall survival, comparing thyroid and prostrate cancer tolerance of risk Older versus younger patient priorities Younger patient thought process Weighing quality of life and risk Hypothyroidism, parathyroidism, laryngeal nerve risk in thyroidectomy… asymptomatic patients being made symptomatic due to treatment Physicians have embraced active surveillance for prostate cancer more than thyroid The patient leans on physician for guidance The Finland study: 17M in U.S. have thyroid cancer Extrapolation — Patients who die of other conditions, in autopsies very small thyroid cancers found in 36% of patients A lot of small cancers that need not be diagnosed The physicians perspective and influencing the active surveillance decision Shared decision making process Terminology… some people choose active surveillance even when nodule is greater than 2cm Jury is still out on what is considered safe size Size and lymph node spread is still being defined Moving away from Gleason system Some cancers are aggressive Some cancers are slow and not lethal Incidental cancers The word cancer or the c word… and shifting away from fear Radiology guidelines The Cedars Sinai active surveillance program 50% of patients who are offered surveillance accept it… which mirrors Japan Alienation of active surveillance patients Anxious, calm, and risk and prioritize risks of surgery Thyroid cancer tends to strike younger patients. Prostrate cancer tends to be older. Prostrate cancer may not improve survival Surgery in thyroid versus prostate is safer Radiation ad toxicity NOTES
Parallels Between Low-Risk Prostate Cancer and Thyroid Cancer: A Review
50: Regarding Thyroid Cancer, Are You a Minimalist or a Maximalist? with Dr. Michael Tuttle from Sloan Kettering
89: Your Patient ‘Type’ May Determine Your Thyroid Cancer Treatment → Dr. Michael Tuttle from Sloan Kettering
77: Broadway Performer Says No to Thyroid Cancer Surgery → Surveillance Instead
87: Is There a Stigma to Choosing Active Surveillance? → Dr. Louise Davies from The Dartmouth Institute
Vigilancia activa en el tratamiento del microcarcinoma de tiroides.
Dr. Allen Ho
94: Everything You Need to Know About Thyroid Nodules with Dr. Regina Castro from Mayo Clinic
M. Regina Castro, MD is a consultant in the Division of Endocrinology at the Mayo Clinic in Rochester, MN. She is an Associate Professor of Medicine. She is the Associate Program Director for the Endocrinology Fellowship program, and Director of Endocrinology rotation for the Internal Medicine Residency. She is also a member of the Thyroid Core Group at Mayo Clinic. She served from 2009 to 2015 as Thyroid Section Editor for AACE Self-Assessment Program and has authored several chapters on Hyperthyroidism, Thyroid Nodules and thyroid cancer. She has served on various committees of the ATA, including Patient Education and Advocacy committee, the editorial board of Clinical Thyroidology for Patients (CTFP), Trainees and Career Advancement committee and is at present the Chair of the Patient Affairs and Education Committee. She currently serves on the ATA Board of Directors. Her professional/academic Interests: Clinical research related to thyroid nodules and thyroid cancer, clinical care of patients with various thyroid diseases, and medical education.
During this interview, the following topics are addressed:
What is a thyroid nodule? A lump that could be benign or cancerous The prevalence depends on how you search for them 60% of people in the U.S. will have nodules 90% are benign Sometimes done during routine physical exam Sometimes the patient discovers it Usually is discovered when imaging is done for other reasons — during CT scan Medical history of radiation to head or neck as a child, family history of thyroid cancer, size of nodule, abnormal lymph nodes in the neck Usually patients with a nodule are asymptomatic Best test to look at the nodule is an ultrasound of the nodule Features in the ultra sound determines how suspicious a nodule is A biopsy is ordered based on appearance, if nodules are clearly defined are more likely to suggest they are benign If nodule looks dark or borders are irregular, or increased blood flow within the nodule may cause concern Quality and resolution of thyroid ultra sound is high resolution and provides a clear look Coaching patients through the anxiety through a possible biopsy The majority of nodules can be observed ATA guidelines suggest observation based on the result of the biopsy Suspicious nodules that are less than 1cm are sometimes determined to best observe and not remove Cancer will be in only 5% of biopsies A smaller, low risk cancer should warrant a lesser surgery — and reduce the chance of surgical complications When to remove a nodule even if no cancer? If other structures are being obstructed, such as breathing or swallowing, sometimes surgery relieves symptoms regardless if cancer or not Observation — and follow up recommendations 15% are labeled indeterminate If surgery, surgeon needs to be experienced — many surgeons conducting thyroid surgery are low in experience The Mayo Clinic thyroid cancer team Biopsy results in two hours versus two weeks NOTES
The American Thyroid Association
Dr. Regina Castro
64: Managing Indeterminate Thyroid Nodules, with Dr. Kimberly Vanderveen from Denver Center for Endocrine Surgery
95: Hypothyroidism and Combination Therapy of T3 and T4 with Dr. Martin Milner from Portland, Oregon
Dr. Milner is well published with texts, medical journal articles and studies in cardiology, endocrinology, pulmonology, oncology, and environmental medicine. Dr. Milner calls his practice “integrated endocrinology” balancing all the endocrine hormones using bio-identical hormone replacement and amino acid neurotransmitter precursors.
Dr. Milner’s articles include treatment protocols for hypothyroidism, ”Hypothyroidism: Optimizing Medication with Slow-Release Compounded Thyroid Replacement” was published in the peer review journal of compounding pharmacists, International Journal of Pharmaceutical Compounding.
In this interview, the following topics are discussed:
Starving in the midst of plenty Slow release T3 and T4 Hypothyroidism Hyperthyroidism or Graves Disease Often RAI leads to hypothyroidism Visiting a naturopath while being treated by traditional endocrinologist TSH suppression for thyroid cancer patients Ordering blood tests of TSH, Free T4, Free T4, and reverse T3 Converting T4 into T3 Slow released T3 Manufactured T3 is not slow release 2005 article was published 150,000 pharmacist in U.S., and about 5,000 are compounding Slow release blends are the same T4 from Synthroid and T3 from Cytomel Slow release agent is hydroxypropyl melanose Side effects of too much T3 or T4 The risk is compounder error or inconsistency Binder sensitivity is another reason for compounding Desiccated thyroid hormone compared to slow release Auto-immune disease and desiccated treatment Overwhelming response to slow release is when patients symptoms of hypothyroidism alleviate A small percentage of people do not do better on slow release Basel body temperatures 96.5 temperature in the morning, and hypothyroid symptoms is a concern in regard to treatment Testing temperature in the morning, ideally done using mercury thermometer How to use temperature testing as an indicator of hypothyroidism Body temp should be over 97.8 first thing in the morning Hypothyroidism will be overweight and difficult to lose weight, and brain fog, sluggish, dry skin, hair loss, Eating well, active, and weight gain Hypoglycemic or adrenal overload and low body temperature High cortisol levels Standard of care of Cytomel in contrast with conventional endocrinologist T3 has a short half life Half life — How long does it take a drug to bring blood levels to normal levels? Half life of T3 is up to 70 days Starving in the midst of plenty with T4 Insurance coverage of slow release T3 — T4 Cost of slow release T3 — T4 is approximately $40 monthly Most important testing for TT patient is checking parathyroid gland status — and their role in calcium function Important to measure calcium for TT patients Caution about soy, broccoli, brussel sprouts, cauliflower, and calcium and thyroid hormone When to thyroid replacement hormone — first thing in the morning, 1 hour before eating, T4 replacement before bed — advantages to more stable levels Slow release, combination therapy, should be taken in the morning Estrogen deficiency Brief summaries of the following symptoms: painful feet, dizziness, fatigue, hair loss, iron deficiency, chronic pain, tyrosine turning into dopamine and then adrenaline, sleep problems and anxiety and hypothyroidism, insomnia and cortisone and adrenaline at nigh and DHEA, cortisol measured throughout the day, muscle spasms, Avoid refined sugar and high amounts of alcohol Drink more water Caution: food and its importance: smoothies and soluble fiber — fiber interacts with nutrients. Avoid this, as it effects absorption of medications Emotional attachment to disease — fixation and complaining without making changes. NOTES
International Academy of Compounding Pharmacists
75: Fat, Foggy, and Depressed After Thyroidectomy? You May Benefit From T3, with Dr. Antonio Bianco from Rush University
93: Has anything changed in the past 50 years of treating thyroid disease? (including thyroid cancer) The answer is yes. → Dr. Leonard Wartofsky from MedStar
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
92: Treinta años después y más de 5000 pacientes con cáncer papilar de tiroides → y solo dos murieron, con el Dr. Jorge Calvo desde Panama
Dr. Jorge Calvo
Lugar de estudio:
U. de Panamà, Hospital de la Caja de Seguro Social, Fundaciòn Santa Fe (Colombia) U. Del Norte (Argentina), Sistema Integrado de Salud (Veraguas)
Laparoscopía, Curso de postgrado de Cirugía Gastrointestinal, Curso de postgrado de Cirugía de Cabeza y Cuello
En este episodio, se tratan los siguientes temas:
¿Cómo será la vida después de la cirugía? Embarazo después del cáncer de tiroides Parálisis de las cuerdas vocales Las complicaciones incluyen voz e hipo-calcio Sangrado durante la cirugía Tratamiento para hypo-calcium Vitamina D Embarazo y radiación TSH elevada después de la cirugía Problemas de TSH suprimido Número uno de miedo del paciente cuando se le diagnostica cáncer de tiroides y antes de la cirugía 32 años como cirujano tiroideo - cáncer papilar de tiroides Vigilancia activa Tasas de mortalidad del cáncer papilar de tiroides Recurrencia La mejor hora del día para tomar un reemplazo de tiroides Más información:
Customer ReviewsSee All
Episode 93 Dr. Wartofsky
This was a very well done episode. A lot of good information. The only unfortunate thing is that the doctor follows the school of thought that there is a one size fits all method of thyroid medication management.
I was recently diagnosed with PTC and upon diagnosis I started to search for resources to inform me and help me navigate my journey. One resource was Philip James, Doctor Thyroid. I have listened to many of his episodes to hear about his perspective along with the perspective of authorities and patients. The insights have helped me broaden my thinking on this subject along with giving me HOPE! I can’t thank Philip enough for his time and efforts in providing a very specific set of resources to a very specific topic that has a huge importance to anyone affected by this diagnosis. Best wishes to Philip and everyone participating!
Episode 5 is not what is described.
I was very interested in hearing this episode about best way to take thyroid meds but instead the episode is about cancer. Is there some way to get the episode described?