Dr. Bryan McIver, a seasoned expert in endocrine diseases at Moffitt Cancer Center, delves into the complexities of thyroid cancer management. He emphasizes the importance of taking a measured approach, ensuring patients don't rush treatment decisions. The podcast discusses advancements in diagnostics, reducing wait times from months to mere hours, and highlights personalized care strategies. Dr. McIver shares insights on the shift towards less aggressive surgeries and the crucial role of calm decision-making in navigating a thyroid diagnosis.
35:17
forum Ask episode
web_stories AI Snips
view_agenda Chapters
auto_awesome Transcript
info_circle Episode notes
insights INSIGHT
Nodules Are Common But Cancer Is Rare
Most adults over 50 are likely to have a thyroid nodule, but only a very small fraction are cancerous.
Clinicians must separate a few cancers from a vast majority of benign nodules to avoid overtreatment.
volunteer_activism ADVICE
Use Ultrasound And Molecular Tests
Use ultrasound risk classification to decide which nodules need biopsy and which can be observed.
Adopt standardized cytopathology systems and molecular testing to guide management decisions.
volunteer_activism ADVICE
Run Molecular Classifiers Before Surgery
Run gene expression classifiers like Afirma on indeterminate biopsies to avoid unnecessary surgery.
Use mutation-based tests like ThyroSeq to predict aggressiveness and tailor surgical extent.
Get the Snipd Podcast app to discover more snips from this episode
Dr. McIver contributes to Moffitt Cancer Center almost 20 years of clinical experience in the care of patients with endocrine diseases, specializing in the evaluation of patients with thyroid nodules and thyroid cancer. He has a particular interest in the management of patients with advanced and aggressive forms of cancer and the role of genetic and molecular techniques to improve the accuracy of diagnosis; to tailor appropriate treatment to a patientdisease. Dr. McIver has a long-standing basic research interest in the genetic regulation of growth, invasion and spread of thyroid tumors of all types. His primary research focus is the use of molecular and genetic information to more accurately diagnose thyroid cancer and to predict outcomes in the disease. Dr. McIver received his MB ChB degree from the University of Edinburgh Medical School in Scotland. He completed an Internal Medicine residency at the Royal Infirmary of Edinburgh, followed by a clinical fellowship and clinical investigator fellowship in Endocrinology at the School of Graduate Medical Education at Mayo Clinic in Rochester, MN. Prior to joining Moffitt, he was employed as Professor and Consultant at the Mayo Clinic and Foundation in the Division of Endocrinology & Metabolism. Amongst his most proud accomplishments, Dr. McIver counts his two commitment to education of medical students, residents and fellows; his involvement as a founding member of the World Congress on Thyroid Cancer, an international conference held every four years; and his appointment as a member of the Endowed and Master Clinician Program at the Mayo Clinic, recognizing excellence in patient care.
In this episode, the follwoiung
By sixty years old, more common to have nodule than not
Most nodules are benign
When to do a biopsy
How to interpret the results of biopsy
Advances in thyroid cancer
Ultrasound technology advancements
Molecular markers
Cytopathology categorizations
Molecular marker technologies
Gene expression classifier
Afirma
Identifying aggressive cancer
Types and sub-types of thyroid cancers
Invasive and aggressive thyroid cancers
Papillary versus anapestic thyroid cancer
Biopsy results in 2 - 3 hours
Clinical studies that have transformed thyroid treatment
Less aggressive surgery and less radioactive iodine
Targeted chemotherapies
Immunotherapy
The importance of clinical trial environments, or thoughtful philosophy
Doctor Thyroid