99: Thyroid Cancer Awareness Month: Early Detection, Surgery & What You Need to Know with Dr. Rashmi Roy

So in honor of Thyroid Cancer Awareness Month being September, I am chatting with another thyroid surgeon where we are going into all things thyroid cancer. Her name is Dr. Rashimi Roy. All she does is thyroid surgery. That's it. End of story. She practices at the Hospital for Endocrine Surgery in Tampa, Florida, and trained at New York Presbyterian Hospital Columbia. Had her endocrine fellowship at Johns Hopkins and started her endocrine practice in Penn Medicine for eight years before now joining the Hospital for Endocrine Surgery in Tampa. She is a delight and brilliant physician. Welcome, Dr. Rashimi Roy. Welcome to Modern Thyroid and Wellness, the podcast that explores the intricate dance between health, wellness, and thyroid. Unraveling the threads that weave our vitality together. I'm your host, McCall McPherson, and I'm so thrilled to guide you on this journey to optimal wellness. I am so grateful for you taking the time out of your busy day to be here and really educate and empower people to be able to navigate this very, very complex topic of thyroid cancer surgery, all the things. So thank you, Dr. Rashmi Roy, for being here today and taking the time.

Absolutely. It's a pleasure to be here, and thank you for the invitation.

Yeah. Tell me a little bit about how you ended up in the world of specifically, like, thyroid cancer. You know, that's such a, a hyper-specific thing. I'm curious if anything led you to that.

Yeah, no, absolutely. So I did my training in general surgery and then did a fellowship in specifically endocrine surgery. And so I was an endocrine surgeon for 8 years where I did all endocrine surgery, meaning thyroid surgery, parathyroid surgery, and adrenal surgery. So I did that for about 8 years. And then there was a program down in Tampa, Florida called the Klayman Thyroid Center. And so Dr. Klayman had left MD Anderson, moved to Tampa to build this center, and recruited me down there. Or down here, I should say, to help build the program. And so the vision of the Thyroid Center to be completely focused on just thyroid surgery and build the surgeons around it, the techs, the nurses, and just to have everyone in the center so focused and to give VIP care to thyroid patients, I thought was amazing. And so I gave up parathyroid and adrenal surgery and just started focusing on thyroid surgery specifically.

Yeah. And I know, you know, that institute is an incredible one. It's highly, highly regarded. I was on a board with, with Dr. Kleiman at one point as well. And I so appreciate and see the value in these hyper-specific niches. I mean, that's what I think where Modern Thyroid Clinic gets, you know, so much depth and knowledge because this is all we do and there's so much power in that. You can truly, truly become an expert, right?

Right.

Tell me a little bit about, you know, risk of thyroid cancer, incidence of thyroid cancer. Are there certain people who are more at risk for it than others?

Yeah, no, absolutely. So women actually are more likely to get thyroid cancer than men, and it's 3 times more likely in women than men, which is kind of shocking. And the women that get it, the peak rise are, you know, 30s to 50s years old. So you're in the prime of your life. You know, you have kids, you have your job, you know, everything's going great. And then all of a sudden, bam, you know, you're diagnosed with thyroid cancer. And so, and it's becoming more and more common. It's now the 5th leading cancer in women.

Wow.

And the incidence for women is 31,000 new thyroid cancers a year. So, and that's, that number is just rising and rising.

Wow. Yeah. And of course it's the women. I mean, that makes sense. That's what I see too in my practice. And I don't know if that's just— never thought if it was women just being more attuned and involved in their health compared to men. But no, it's a true disparity in the actual incidence of it.

Yeah.

Interesting. And if someone's listening and they're like, gosh, I wonder if I have thyroid cancer, are there symptoms associated with this? How do people generally find out? What's the best way? Just be attuned and know if you need to consider a workup for thyroid cancer.

Yeah, so I think this is kind of the most important question, because the fact is, is that thyroid cancer usually, for the most part, has no symptoms. So it's kind of a silent cancer, and it doesn't show up in blood work. So what I hear all the time when patients come in to see me, they say, Dr. Roy, how is it possible that I have thyroid cancer when my thyroid numbers are checked every year? And they're normal, and I don't feel anything. And I say, I know, you know, it's a crazy thing to think about, but patients usually find their thyroid cancer either by a physician, an OB-GYN, a primary care doctor, or even themselves. You know, maybe they're rubbing lotion on their neck, or their doctor is actually doing a physical exam and feel a lump. So that's a common way to find it. And then the other common way is when they get a scan for another reason.

Mm-hmm.

You know, a carotid artery ultrasound or a CT scan for something else, and it's an incidental finding. So that's the most common way that it's found. But I think, you know, my, the push that I've been doing over the past several years is being an advocate for yourself and doing things for yourself to try to find it. And so what I mean by that is, number one, I think that every woman should do self neck checks. You hear self-breast exams, but you never hear about self-neck checks. So I'm actually promoting— it's called— it's a neck check challenge. So it basically, if you go on my videos or my YouTube channel, I show you how to do a neck check. And basically what you do is you just kind of feel around where your thyroid is, and then you carry that circular motion towards the side of your neck, feel your thyroid, feel your lymph nodes. And you just want to get to know your body, right? Just like when you do Self-breast exams, you know what your normal breast feels like, so that if you do that every month, if something pops up, you're like, oh, that doesn't feel right. And then you know what to do. And we can get into that also. But so self-neck checks, I think, are really important. And the second thing is that I think every woman— and I have data to support this— is that at 30 years old should get a screening thyroid ultrasound. It's not invasive.

Amen. Yeah.

You know, it's non-invasive. It takes 2 minutes, and then you know. And if, if you have nothing, then okay, you don't have to do it every year like a mammogram, but then maybe 5 years later, you know, get another one. Because early detection is early cure, just like every other cancer.

Amen. And, you know, we started doing this at Modern Thyroid Clinic several years ago. And I, I know, like, I'm sure insurance doesn't love it because it does— there is a cost. But even if you pay for it out of pocket, it's usually $100, $130. There's no radiation. And I think what people don't necessarily think about is even if you go to your clinician and they do a thyroid palpation of all of your tissue, we're talking about sub-centimeter nodules. These are tiny in a lot of cases, right?

Right.

And I always tell people joking but kind of serious, look, an ultrasound is so much more sensitive than my man hands. Let's get some clarity. Why not? It's not like you're getting radiation from it. So you're the first other person that I've found on board with that. And I absolutely love the idea of self-neck checks, and I'm going to track down your content on that and share it with our people because I think it's so incredibly powerful and empowering to be involved in, in that process. So hats off to you. Absolutely. So take me through— if people do a self-neck check or they get an ultrasound, something's found, let's say it's a nodule, talk to me a little bit about what happens after that. What are next steps, and are all nodules cancer? Like, does everyone need to be so terrified about this?

Right. And so that's the first thing. If you find a nodule, if it's in the center of your neck or a lump on the side of your neck, don't panic. Take a deep breath. You know, most thyroid nodules are benign, but if you find a nodule or a lymph node, your next best step is an ultrasound. Don't go and get a CT scan and a full-body PET scan. You know, people just kind of jump down that road. the best test for the thyroid is actually an ultrasound. And then on ultrasound, if it has suspicious characteristics, you know, so things that we look for, irregular borders, microcalcifications, you know, increased blood flow or vascularity. So those are some key buzzwords that you might see on an ultrasound report. If there's anything like that on the report, then the next step is a biopsy. And then if it's worst-case scenario, it's a cancer, again, don't panic. You know, take a deep breath. We can, it's still curable for the most, for most cases. And I could potentially just take out half your thyroid and you may not even need thyroid medication. So, you know, just take the proper steps if you find a nodule.

If you've been listening and thinking, finally someone gets what I've been going through, my new book, Take Back Your Thyroid, was written for you. When you preorder a hardcover copy, you'll choose one of 2 bonuses that are entirely free. Either my $399 Thyroid Empowered course or $150 off a new patient visit at Modern Thyroid Clinic. Preorder your copy, then head to book.modernthyroidclinic.com to claim your gift. Again, that's book.modernthyroidclinic.com. And then if it's a nodule and it doesn't have concerning characteristics, right? Doesn't mean they necessarily have to get it out, their thyroid removed, et cetera. What can those people who don't fall under the umbrella of thyroid cancer, what does their next steps look like?

So yeah, so it depends on size and it depends on symptoms. So if it's a smaller nodule, it's 1.5 centimeters, you're not having symptoms, it looks benign, or you had the biopsy and it's benign, okay, so you monitor it. That's the majority of patients. And so every year you get an ultrasound, and if it's If there's no changes, you don't even repeat a biopsy unless there's changes. If you have a nodule that's larger and it's causing you symptoms, and when we talk about symptoms, we talk about compressive symptoms like trouble swallowing or an increased effort to swallow or clearing your throat a lot when you're not sick, things like that, then there's non-operative interventions like radiofrequency ablation. And so you maintain your thyroid, you just, you know, kind of shrink the nodule using a heated probe.

Okay.

So it's not always mean surgery. It could be monitoring, it could be nonsurgical interventions.

Right. And what percentage of nodules, in your experience or in the data, are benign versus cancerous?

Yeah, so it's 90 to 95% of thyroid nodules are benign. So that's why I say, for— don't panic. For the most part, statistically speaking, it's gonna be benign. Of course, my data, personal data is—

Right.

Because of what, who I see. But for the general population.

Very good point. Yeah. And I, I have the same experience where people, they get very nervous and very, very afraid. And I'm like, look, listen, I see nodules every day, all day. Very rarely do I see ones that are concern for cancer. And so there's a lot of hope in that for sure. Talk to me about actual thyroid cancer. Are there different types? Does that determine how aggressive they are, the timeline for surgery or the approach, et cetera?

Yeah, so there's 4 main types of thyroid cancer. The main type and the most common and most curable is papillary thyroid cancer. So that's what you're going to hear about all the time. Then there's something called follicular thyroid cancer or a Hurthle cell thyroid cancer. Sometimes those are grouped together as just called an oncocytic cancer. So sometimes patients get confused about that, but they're all essentially in the same category. Then the more rare one is called medullary thyroid cancer, and then the most rare and the most aggressive is anaplastic thyroid cancer. And so when I talk to patients and they have a nodule, their first, you know, they've gone on Google and they all, they think they have anaplastic thyroid cancer because that's just where the mind goes. And, and so, you know, anaplastic thyroid cancer is the most rare, you know, definitely don't Put your mind there. But that is the only cancer that's an emergency. You know, everyone else, you know, I say you, whenever it fits in your schedule, we'll take care of it. Anaplastic thyroid cancer, you know, I get you in within a week if it's a, if it's operable.

Wow. And then in that subset of people, even though it's rare, are people younger more at risk for that, older more at risk for that? It, does it not really stratify with any particular characteristics?

So it's usually older patients. So patients over 55. And I mean, the history is so typical and it's just a mass that has grown so significantly within 3 weeks that it's now— it went from this to a grapefruit. So it's the history is very, you know, you can just, you just know before the patient comes in and now they've, and they've lost their voice in 3 weeks because that cancer has invaded the nerve to your vocal cords. So it's a very, it's the most aggressive cancer in mankind. So if you think of all cancers, anaplastic thyroid cancer is the most fatal.

You just taught me something new. I mean, that is absolutely mind-blowing. I had no idea it was that aggressive. So thank you for that. I'm so grateful it is the most rare, obviously.

Mm-hmm.

Um, this might be hard to know, and we might not even have an answer in medicine yet, but I'm curious to pick your brain. Are there risk factors in general for any form of thyroid cancer?

So, if just talking about papillary thyroid cancer, the most common risk factors, there are 2 of them. One is a history of radiation. So, when I say radiation, I mean, like, the Chernobyl event. So, that's a known risk factor, or radiation as a child for whatever reason, or even occupational exposure to radiation over prolonged periods of times. So, history of radiation, and then the second one is family history. That being said, I will tell you that 90% of my papillary thyroid cancer patients have neither one of those. So, we ask just because it's been proven to be a risk factor, but most patients don't have it. I personally think, and there's been no science to prove it, there's no causative link or studies that have proved it yet, but I think there has to be some sort of link to estrogen with papillary thyroid cancer just because it's 3 times more likely in women. So, that just— Makes sense to me, but, you know, there hasn't been a, a study to prove that. And then if we're talking about medullary thyroid cancer, that can be hereditary. So you get, you know, genetically tested for a specific mutation, and obviously if you have that, then, you know, you're at risk for the medullary thyroid cancer.

Interesting. Okay. Yeah. Very, very interesting. Tell me about when someone is confirmed, like with a biopsy, for cancer, I know it varies the timeline, but tell me about the surgical options or the treatments for these cancers. What, what goes into the next phase? What does life look like after the biopsy, et cetera?

So you get the biopsy, and then once it's proven to be thyroid can— papillary thyroid cancer, we'll just go with the most common, the next step is you need to have your lymph nodes evaluated. So thyroid cancer can spread to all the lymph nodes in the sides of your neck. Usually if you have a right-sided thyroid cancer, If it's going to spread, first it spreads to the lymph nodes underneath the thyroid gland, and then it would spread to the right side. Some— I mean, I have seen it spread contralaterally, but for the most part, that's the normal progression. So the next step after a biopsy-proven thyroid cancer is to get an ultrasound to look at your lymph nodes, because you want to make sure when you're going into that operating room, you're getting the only operation that you need, not missing cancer and then needing a second surgery. So that's the next step. And then it's finding an expert high-volume thyroid surgeon because thyroid surgery is so delicate. You need to do your research and find an expert.

Absolutely. And then once you do find an expert for you, for example, like tell us about options for partial thyroidectomy, full thyroidectomy, like what percentage of people are able to actually keep Half of their thyroid gland in your experience?

So I would say 80%. Oh wow! Yeah, so 80%. Again, early detection is early cure. But you know, at our center, I'll speak for our center specifically just of how we do things here. So we want to save as much thyroid as possible, and so if we can cure your thyroid cancer by saving half your thyroid and potentially you not needing medication, I mean that's a win, right? And so the way that we can determine if you're You're done and you're cured with just taking out half your thyroid is what we find in the operating room. So let's say you have a right-sided thyroid cancer. So then I would take out the right side of your thyroid gland, and then, but most importantly, I remove the lymph nodes behind the right side of your thyroid gland. And the reason why I do that is because, number one, those are the only lymph nodes I cannot see on the ultrasound because they're behind your thyroid. And number 2, like I mentioned earlier, if this cancer is going to spread, that's the first place it's going to go to. So I remove those lymph nodes and I test them while the patients are asleep to see what's going on with them. If those lymph nodes are okay, then you're done. You're cured with a 99.8% cure rate with just taking out that right side, and you could save the left side. But if those lymph nodes have significant cancer in it, That's the indication to take out the whole thyroid. I do it at that time. I don't wake you up. There's no second surgery. So we're able to do intraoperative pathology to make sure, again, your first surgery is your last surgery.

I love that. And I love the whole concept too of when you can going in with the expectation of, hey, let's try and spare half of this person's thyroid. Because I think thyroidectomies are necessary. People need to have them in some cases. But I do think so much of medicine still doesn't appreciate what the thyroid necessarily necessarily brings to the table, and they don't think it's a big deal to take out the whole thing. And I think there are long-term quality of life, you know, related issues too. So thanks on behalf of so many of us for saving half of people's thyroids. So at least trying to when you can, right? And not just assuming it's not a big deal, we'll just take it out and everything will be fine, right? Tell me about secondary issues, side effects, things that can happen with thyroid surgery that are pretty common. I know the parathyroid issue can be certainly be an issue. Kind of take us through what life looks like postoperatively.

Sure. So, you know, the 2 known risks or inherent risks to thyroid surgery is the nerves that go to your vocal cords, number one, and second are the parathyroid glands. So first, the nerves that go to your vocal cords, they travel— we have one on each side— they travel right underneath the thyroid glands. So those nerves need to be identified early, preserved. We actually stimulate them at the end of the operation to confirm their function. So I expect patients to wake up with the same voice they go to sleep with. You know, 99% of our patients do. But hoarseness is a known risk to thyroid surgery that should resolve unless there was a nerve injury in the operating room. So something patients should ask their surgeon is, you know, what is your nerve injury rate? What is your complication rate with, with the nerves? And then secondly, the parathyroid glands, of course. So the parathyroid glands, just to kind of get everyone on the same page, the parathyroid glands are small glands next to the thyroid. So para means next to thyroid, so next to thyroid. So we have 4 parathyroid glands, 2 on each side of the thyroid. Those are in charge of your calcium levels in your body. Now, even though we have 4 parathyroid glands, all you actually need is 1 normal one to maintain normal calcium levels.

Okay.

We have 3 extra built in.

Wow.

But we want to save all 4 parathyroid glands when we're doing thyroid surgery. You always— the kind of motto of thyroid surgery is treat every parathyroid gland like it's the last one because they're so important. So if you're getting half your thyroid removed, you know, those ideally, those 2 parathyroid glands on that side should be saved, but the other 2 haven't been touched. So, you know, That because you have two parathyroid glands that haven't been touched, you're really not at risk for any parathyroid issues afterwards. Parathyroid issues come into play when you've had your whole thyroid gland removed because now all four parathyroid glands are at play. And so, even if they've been saved, they can go into shock after surgery. And so, you know, 20% of patients in our practice will need temporary. Calcium and vitamin D supplementation for up to 4 weeks until those parathyroid glands recover because it takes up to 4 weeks for them to recover. However, in some situations, you know, I've seen patients from other surgeons or just, you know, in Facebook groups or whatever where they have permanent parathyroid issues. And so that happens when all 4 parathyroid glands have been damaged, they've been removed, whatever combination. And that's an awful, awful way to live. You can still live, but these patients need calcium and vitamin D every day. And I'm not just talking one pill a day. It is multiple pills every 3 or 4 hours every single day of your life. So it's a really devastating complication.

What percentage would you say of your people have parathyroid issues that are, you know, consistent and ongoing? Because I Strangely, I mean, for years I saw a lot of people that had that for forever, and I'm just wondering if the incidence in that at your clinic is probably much less than others.

Yeah, so ours is less than 1% of patients. So, you know, at, at our— so we do about 2,000 thyroid operations a year collectively at this, at the Institute. So less than 1%, but 20% will need it temporarily.

Right. And this is why it's so important to find a surgeon that specializes in this particular thing. Tell us about, one, who all can even perform thyroid surgery and how to find the best surgeon, how to find the right person to partner with on this journey that people can feel confident in.

Right, right. So there's 2 ways that you can, or 2 pathways that a surgeon can become a thyroid surgeon. One is they are trained as a general surgeon, and then they have an endocrine surgery fellowship. So they focus on just endocrine surgery. The second is you do the ENT pathway, so an otolaryngologist pathway, and then they do a head and neck fellowship. So the first thing is make sure that your surgeon has done some sort of specialty fellowship in the thyroid area. So that's the first thing. The second thing is Look at Google reviews. I mean, medicine is a business and patients are clients. And just like at a restaurant, you know, clients or customers leave reviews. It's the same thing in medicine. So look at Google reviews. You know, we have over 500 5-star Google reviews. Patients will let you know. Go to Facebook groups. Facebook groups will let you know where to go. So you— it's really doing your research. And then once you've Chosen 3 surgeons, let's just say for conversation's sake, you have every right to interview your surgeon. Do not feel intimidated that you cannot ask them questions. I love when patients ask me, what's your complication rate? How many of these do you do? You know, because I know that that is an informed patient. They're an advocate for themselves. So, Yeah, do, you know, do your research and be an advocate for yourself.

Yeah, I think too, putting a pin— I love that. Like, I advocate for that in every aspect of thyroid care. I think it's so important, and in medicine in general, but I feel like especially in the world of thyroid. And I think putting a pin in how many of these do you do, right, is so incredibly important because if you're going to someone that does 1, 2, 3 of these a month, right? That's not what we're looking for, right? Like, you want someone that does these all day, every day. This is all they do. This is their life's work. This is their passion, because that's where nuances developed, right?

And, you know, and the— so the literature shows, or literature says, anyone is a high-volume thyroid surgeon if they've done 100 a year. I will tell you that I wholeheartedly disagree with that. So I probably do more thyroid surgeries than anyone in the country. I do about 600 a year. I would say that— I mean, I'm not expecting anyone to do 600 a year like I do, but I would say that if you're looking for a thyroid surgeon, they should be doing 300 or more. And then in my opinion, that's a high-volume surgeon.

If you're listening to this podcast thinking, this is me, I've been tired, dismissed, and I just want my life back, I wrote Take Back Your Thyroid for you. And because I want to help you take the next step, if you pre-order a hardcover copy today, you get to choose one of 2 exclusive gifts. You can either get my full Thyroid Empowered course, a $399 program designed to help you truly understand Your Thyroid: Take Control of Your Health. Or if you are ready for personalized care, you can choose $150 off of a new patient visit at Modern Thyroid Clinic. We are open virtually in 48 states. Just pre-order your hardcover copy and then head to book.modernthyroidclinic.com to claim your gift. I cannot wait for you to read it. I truly believe this book is going to change lives. And one more time, in case you missed it, book.modernthyroidclinic.com is your hub to select whatever freebie works best for you. I love it. Yeah, I could not agree more. We refer exclusively to people who specialize. Like, look for someone who literally just does thyroid. Like, look for a thyroid surgeon. That is what we are going for, right? Like, because there are other surgeons that can do it, but again, if that's all they do, If that's their stick, they're gonna be really good at it. You can count on it.

Mm-hmm.

Is there anything— I guess 2 facets to this question. If you could debunk 3 myths in regards to thyroid in any, any way, shape, or form, or 3 things, you know, that you wish people would know about thyroid cancer, thyroid surgery, what would, what would those be?

So the one thing that I hear all the time is thyroid cancer is the best cancer to get. And I can't stand hearing that.

Amen.

Yes, it's very curable, but people hear that and they wait and they wait and they wait, or they try, you know, holistic therapies instead. And I'm, you know, I'm all for all different types of therapies, but I'm also obviously all science, so I think they should be used appropriately. I just have seen thyroid cancer do such bad things. And when thyroid cancer is— when you wait too long, your morbidity of your— in your lifestyle is significantly affected. You're— you may not be able to talk anymore. You may not be able to eat the foods that you want to— that you want to eat. And what are the 2, you know, greatest joys in life, right? Sharing a meal with someone and chatting with your friends or your family.

Mm-hmm. Emily.

So yes, thyroid cancer is very curable, but don't take it for granted is number one. I would say the second is that, oh, it's— I just need a lobectomy. I just need half my thyroid removed. Anyone can do it. I'll just go to the local surgeon. Anyone can do it. No, because it's still your nerve to your voice. I mean, there's such delicate structures there, which is why I love the surgery so much. It's just so delicate and technical. You know, it's not just anyone can do it. So a lot of people think that, you know, anyone can do it. You know, I disagree with that. And then a third. So there's, I might get a little bit of heat for this, but I'll just—

Totally fine. You can bring the heat.

You know, there's, there's a large group of people that think you can monitor thyroid cancers. And there are many institutes that monitor small thyroid cancers. And I think, and every patient can do whatever there is right for them and whatever feels good for them. But I will say that the majority of those patients that wait, we usually end up seeing. And now this, the cancer has spread, and instead of us just being able to take out just half the thyroid, it has now spread to the lymph nodes. And now I need to take out your whole thyroid, do a neck dissection, and it's a much bigger operation. So, we're not fans of monitoring thyroid cancer. So not that that's a myth, but it's a little bit controversial.

You know, I love that. And what was really kind of enlightening for me about this is that people are waiting to address it, like either just monitoring it or just like, oh, I don't need to deal with this. I— we haven't seen that really. We haven't had that experience at Modern Thyroid Clinic. So I didn't know that that's actually a real issue. I, I feel like My perspective was always, oh gosh, these people want to go have a thyroidectomy and they have a benign nodule. Like, I got to make sure that they don't do that, you know? But it's so interesting to hear the other side that maybe people are being swayed to almost be too passive during this process.

Yeah. And there's, you know, big academic institutions that have an observation group of patients. And again, you know, these are small— I'm not— they're not monitoring these huge cancers by any means. They're monitoring small thyroid cancers. But I mean, I took out a 5-millimeter thyroid cancer the other day that spread to lymph nodes. So yes, it's small, but they could be small and mighty and spread. And how do you know that your sub-centimeter thyroid cancer is not the one that's going to spread?

Right. Totally. And even like, I mean, not to get too controversial here, but I even feel like the monitoring of nodules sometimes that people are waiting at recommended timelines way too long. I'm like, we need to go on the shortest possible timeline to obviously enough time to actually notice if it's growing, but let's not wait 2 years to do another benign ultrasound. Like, why don't we do a year or maybe even 6 months? You know? So dare I say that out loud?

We both might get a lot of heat after.

I know. I know you're going to be like, bury this episode, McCall, bury it. Don't ever release it. I love it. One question I have for you just to kind of pick your brain, and I know this is a developing science and aspect, and, you know, I'm just curious about your thoughts on where it's going. What do you think the likelihood that RFA could potentially treat these smaller tumors, these smaller nodules that are in fact cancer in the future?

Yeah. So it's not so much the future. People are doing it now. I don't agree with it. But people are doing it. They're treating small, sub-centimeter, even up to 1.5-centimeter thyroid cancers. It's not FDA approved, but people are doing it. And again, I disagree with it. So I don't think, personally, that radiofrequency ablation is the way to treat a thyroid cancer. I think there's great uses for radiofrequency ablation in nodules that are proven to be benign, on patients that are poor surgical candidates.

Mm-hmm.

Where radiofrequency ablation would be great. I just don't think it's the definitive oncologically safe treatment for a thyroid cancer. Good.

Thank you for that. I was so curious of your input. One other question, just so I can pick your brain while I'm here. I see people, I hear people even on my social media and things that have had a thyroidectomy, been offered a thyroidectomy, literally for things like They're having difficulty managing their medication and their hormones. They have Hashimoto's. What are your thoughts on a thyroidectomy for these types of things?

So I am a big proponent for a total thyroidectomy for certain Hashimoto's patients. And so what I mean by that is patients that, and I'm sure you've seen it and heard it, Patients that have Hashimoto's thyroiditis, that there's 2 subgroups of patients. One that have tried everything. They've tried gluten-free diet, lifestyle changes, Armour Thyroid, NP Thyroid, Synthroid, Tiros. They've tried everything. They've tried combination therapy, and nothing works. And their life is awful. There, it's devastating. They have high highs, low lows. They can't function. They're, you know, they can't spend time with their kids. All the things. And their quality of life is dramatically affected. And so these patients have failed medical management. And so when there is nothing else that you can do, those patients dramatically benefit from the thyroid being removed because you're removing the offending organ. And so the effect— the thyroid is producing the antibodies, the antibodies are circulating through your system, which is giving you all these systemic Symptoms. And so once you remove the offending organ, after 3 months, those antibodies leave your body and those symptoms all improve. Will they 100% improve? I can't guarantee that, but they dramatically improve. So that's one group of patients where they've tried—

Send those people to us. Send those people to us beforehand. Please do.

Okay. Yeah.

Let, let us give us— give it a shot. Let us try.

Absolutely. Yeah, absolutely. Absolutely. And then there's so that's there's that group of patients that have tried everything and just surgery is their last option. And then the other group is where they are on medication, their thyroid numbers are normal, but they still feel awful. So again, I feel like those patients have failed medication. So first, I'm going to send them to you, and then deal. And then if if they still feel awful after that, I think surgery would be beneficial.

Yeah. Okay. Thank you for that. And then the other people too, I really— I actually do think it is potentially necessary, is those people that it's so swollen, so enlarged, they can't breathe, they can't eat, they're having anxiety, that, you know, they're feeling like they're choking. Of course, those people I think as well. What do you think about the concept? Because this is what I see. Didn't know it was so pervasive, but we see about 30% of people with Hashimoto's post-thyroidectomy with persistent antibodies for years, decades, for the rest of their life. What do you think about that? Any thoughts there?

So I tell patients that the antibody levels scientifically should go down to zero, but they can persist. And we've seen them persist, but they're definitely less than they were, obviously, with the thyroid intact. So the goal is to try to get the antibodies as low as possible, and then your body is going to do what it's going to do.

Yeah. And I love that you recognize the usefulness and the applicability of lifestyle changes to see if we can improve Hashi, because truly, there There is. I mean, I've personally been in remission for over a decade. I used to have a massive goiter. It's true that we can reduce this antibody burden. We can reverse, in some cases, completely put it into remission, and that has big impacts in our long-term health and our quality of life, right?

Absolutely. I mean, if you— that's why I say surgery is the last option for Hashimoto's patients, but for those patients that have tried everything.

Yeah.

Some of my Hashimoto's patients are my most grateful patients, more than cancer patients, because they get their life back. Yeah.

Well, thank you so much for your work, for your dedication to women with thyroid issues. Men too, but women, we need all the support, dedication, and expertise that we can get. So I just admire that and am so grateful to have you as a resource for our people. Please tell everyone where they can find more about you and your work or social media, wherever you like to, to hang out.

Yeah, absolutely. So again, it's Dr. Rashmi Roy, and I operate exclusively at the Hospital for Endocrine Surgery in Tampa, Florida, at the Clayman Thyroid Center. I have a YouTube channel, it's called Goiter Guru, because one of my, you know, favorite things to do is to take out these huge, huge goiters that go down under the chest that nobody else can do. So along with the big thyroid cancer surgeries, the big goiter surgeries are always fun. Patients always ask, am I going to be on YouTube? And I'm like, ah, it's not big enough. You're not going to make it.

I love it.

So yeah, Hospital for Endocrine Surgery, Kleiman Thyroid Center, and Goiter Guru on YouTube.

I love it. Well, thank you so much for your time today and your work, and I'm just excited to share this with my people.

Awesome. Well, thank you so much. This has been really fun.