Episode 38: Dr. Mark Lupo discusses thyroid nodules and cancer

Thyroid cancer is one of the fastest growing cancers in the United States, especially among women. In Florida, thyroid cancer trails only melanoma skin cancer as the state’s fastest rising cancer.

Today’s guest on episode 38 of STEM-Talk has made it his mission to not only treat thyroid cancer, but also raise awareness about the disease.

Dr. Mark Lupo is founder and medical director of the Thyroid and Endocrine Center of Florida which is based in Sarasota. A graduate of Duke University, he went on to earn his medical degree at the University of Florida where he worked with the world-famous thyroid expert, Dr. Ernie Mazzaferri. Dr. Lupo also did his internship and residency in internal medicine at Florida and then won a fellowship in endocrinology, metabolism and nutrition at the University of California San Diego and the Scripps Clinic.

Dr. Lupo’s research and practice are particularly focused on thyroid nodules, which are abnormal growths of thyroid cells that form a lump within the thyroid gland. Although the vast majority of thyroid nodules are benign, a small proportion do contain thyroid cancer. His practice is centered on diagnosing and treating thyroid cancer at the earliest stage and helping people avoid unnecessary surgeries.

He also is very involved in teaching neck ultrasound, thyroid cancer and general thyroid disease to other physicians at the national level.  He has published book chapters and several articles on thyroid disease and thyroid ultrasound.  In addition to his work as the medical director of the Thyroid and Endocrine Center of Florida, he also is a clinical assistant professor on the faculty of the Florida State University College of Medicine.

Dr. Lupo also was named the 2017 recipient of the Jack Baskin Endocrine Teaching Award, which is annually presented by the American Association of Clinical Endocrinologists. 

You can learn more about the Thyroid and Endocrine Center of Florida by visiting http://www.thyroidflorida.com.

Show notes:

3:21: Ken and Dawn welcome Mark to the show and ask him what led him to study medicine at Duke.

4:52: Dawn asks Mark how he ended up choosing endocrinology with a particular interest in thyroid nodules and cancer as a specialty.

6:40: Dawn asks Mark how he found the time to go on incredible adventures, such as climbing Mount Kilimanjaro as he worked to establish a practice.

8:40: Mark provides an overview of the thyroid.

9:46: Dawn asks Mark to clarify about whether a thyroid nodule is the same thing as a goiter.

10:25: Ken comments on how thyroid nodules and cancer seem to be epidemic and how there has been an increase of instances in the United States. He asks Mark if there is a greater incidence of disease or if there is just better detection or a combination of both.

14:33: Dawn asks if we know why thyroid nodules and cancer seems more prevalent in women.

15:01: Dawn inquires about the survival rate for those diagnosed with thyroid cancer, and whether or not it has changed over the years.

17:45: Dawn comments on how she has been looking forward to this interview as a result of a thyroid scare she had in graduate school where there was an inconclusive biopsy. She asks Mark how common it is to have an inconclusive finding and unclear results about a sample.

20:52: Ken comments on his personal experience with thyroid nodules that led to surgery and a positive outcome, and how he met Mark early in this experience after hearing him on a podcast discussing fine needle aspiration. After hearing this podcast, Ken concluded that he most likely needed this procedure. Ken asks Mark to talk about this.

23:37: Dawn asks Mark how often the thyroid nodules are discovered incidentally.

27:34: Dawn asks if there are certain characteristics you can see by ultrasound that give you an idea as to whether you are looking at a benign or malignant nodule.

29:53: Dawn asks what the histological differences are between a benign adenoma and a malignant nodule.

31:16: Ken brings the discussion back to the topic of indeterminate diagnosis, and comments that more of the biopsies are being read as being indeterminate, which leads to more surgeries. Ken asks Mark to discuss this phenomenon.

39:28: Dawn asks which institutions are doing specialized tests.

41:11: Break

41:38: Dawn asks Mark to go into further detail about what we are looking at when we do testing for molecular subtypes.

44:48: Dawn asks Mark if there is a genetic predisposition to any types of thyroid cancer.

48:13: Since positron emission tomography has been helpful in diagnosing metastatic disease in hurthle cell carcinoma, Ken asks if it makes sense to use a ketogenic diet as a supplemental approach to managing the cancer.

52:26: Dawn asks Mark what his thoughts are on the current interest and understanding that cancer is at least partially a metabolic disorder.

53:21: Dawn asks Mark to discuss the different treatment options for thyroid cancer.

1:04:20: Dawn asks Mark to describe the treatment of immunotherapy and how it relates to thyroid cancer.

1:05:56: Dawn asks Mark if thyroid cancer metastasizing varies by subtype.

1:06:58: Mark talks about how lifestyle and environmental exposures might impact the prevalence of thyroid nodules and cancer.

1:09:48: Dawn comments again about her thyroid scare, and the doctors believing that it may connect to her soy intake as a result of her being a vegetarian.

1:10:43: Ken asks Mark about the impacts of dental x-rays.

1:12:20: Ken comments on how thyroid shields should be used in dental x-rays.

1:12:39: Dawn asks Mark what, if any, prophylactic measures we can take to minimize our risk of thyroid nodules or cancer.

1:13:41: Ken asks Mark to talk about the correlation, and possible causation, between insulin resistance and the development of nodules.

1:15:27: Dawn asks Mark about his thoughts on screening individuals for thyroid cancer, since roughly 50 percent of the population has thyroid nodules.

1:18:21: Ken asks Mark if observation should be the standard care for non-palpable thyroid nodules under ten millimeters.

1:20:07: Dawn asks Mark what the quality of life consequences are for patients who are unnecessarily treated for thyroid cancer.

1:21:38: Dawn asks Mark to talk about the options for people who end up with benign nodules.

1:23:52: Dawn asks Mark if the ionization of salt backfired and contributed to the increase in thyroid nodules, cancer, and autoimmunity.

1:27:20: Ken discusses a New York Times article about doctors reclassifying a thyroid tumor, where they reported that noninvasive follicular thyroid neoplasms with papillary-like nuclear features are no longer considered a type of cancer. Ken asks Mark to discuss this shift in categorization and its consequences.

1:31:46: Dawn asks Mark about his work travelling around the country teaching surgeons and endocrinologists how to use clinical features to minimize unnecessary surgeries and about using ultrasound to risk stratify the nodules.

1:33:15: Ken asks Mark about receiving the 2017 Jack Baskin Endocrine Teaching Award from the American Association of Clinical Endocrinologists.

1:34:20: Dawn asks Mark what else he likes to do in his spare time other than his mountain adventures.

1:35:09: Dawn and Ken thank Mark and sign off.