55: Thyroid Cancer Treatment and Surgery Explained⎥Dr. Gerard Doherty from Harvard Medical School

Dr. Gerard Doherty, an acclaimed endocrine surgeon, is a graduate of Holy Cross and the Yale School of Medicine. He completed residency training at UCSF, including Medical Staff Fellowship at the National Cancer Institute.  Dr. Doherty joined Washington University School of Medicine in 1993, and became Professor of Surgery in 2001. In 2002 he became Head of General Surgery and the Norman W. Thompson Professor of Surgery at the University of Michigan, where he also served as the General Surgery Program Director and Vice Chair of the Department of Surgery. From 2012 to 2016, Dr. Doherty was the Utley Professor and Chair of Surgery at Boston University and Surgeon-in-Chief at Boston Medical Center before becoming Moseley Professor of Surgery at Harvard Medical School, and Surgeon-in-Chief at Brigham and Women's Hospital and Dana-Farber Cancer Institute. 

Dr. Doherty was trained in Surgical Oncology, and has practiced the breadth of that specialty, including as founder and co-director of the Breast Health Center at Barnes-Jewish Hospital.  His clinical and administrative work was integral in the establishment of the Siteman Cancer Center at Washington University.  Since joining the University of Michigan in 2002, he has focused mainly on surgical diseases of the thyroid, parathyroid, endocrine pancreas and adrenal glands as well as the surgical management of Multiple Endocrine Neoplasia syndromes. He has devoted substantial effort to medical student and resident education policy.  His bibliography includes over 300 peer-reviewed articles, reviews and book chapters, and several edited books.  

He currently serves as President of the International Association of Endocrine Surgeons, Past-President of the American Association of Endocrine Surgeons, Editor-in-Chief of VideoEndocrinology and Reviews Editor of JAMA Surgery.  He is a director of the Surgical Oncology Board of the American Board of Surgery.

In this episode, the following topics are discussed:

• Imaging has increased thyroid nodule discovery.
• Following patients with small thyroid cancer — analogous to prostate cancer.  Better followed than treated.
• Tiny thyroid cancers can be defined by those nodules less than 1/4 inch in size. 
• Less RAI is being used as a part of thyroid cancer treatment. This means, less need to do total thyroidectomy or thyroid lobectomy.   
• Dry mouth and dry eyes are risks to doing RAI.  Also, there is risk to developing a second malignancy.   Most of the secondary cancers are leukemia.
• Risks to operation include changes to voice and calcium levels.  Thyroid surgery is a safe operation but not risk free.
• Best question for a patient to ask is, who is my treatment team?
• The quarterback of treatment team is often the endocrinologist .
• Cluster of issues can happen after RAI, such as the need to carry water and eye drops for life.
• For some patients taking thyroid hormone replacement, their blood levels are correct, but still does not feel well on standard treatment protocol.
• By the end of two weeks, most people go back to what they were doing before surgery with a relatively normal state.
• Scarring reduction; massage, aloe, Vitamin E.

NOTES:

American Association of Endocrine Surgeons

American Thyroid Association