Simply put it is the engine that runs your body. We are talking about your thyroid.
You may know of it, but what you may not know if something is going on with your body that needs attention.
Dr. David Terris – the Surgical Director of the Augusta University Thyroid / Parathyroid Center – helps us to understand thyroid disease and the recent increase in thyroid cancer diagnosis.
He breaks down treatments and the research that is going on in that fiend as an innovator in the thyroid field himself.
Brad Means: Let’s welcome David Terris. Dr. Terris is a thyroid specialist. I was gonna try to say otolaryngologist. Did I do it right?
Dr. David Terris: That was fantastic. But you can stick with thyroid specialist. That pretty much captures it, so.
Brad Means: A close second was a man with a plan for your gland. But I just.
Dr. David Terris: I might have to use that one.
Brad Means: Okay. But seriously, an innovator. A pioneer in the field. Your research, your treatment making headlines all over the world. And we appreciate the hard work that you do on behalf of people with thyroid issues.
Dr. David Terris: Well thank you Brad. It’s you know, I’ve sort of coned down what I do and sort of super specialized so I can focus on just one thing. And so it’s been fun the last 10 or 15 years.
Brad Means: Try to slowly walk us through this. Let’s just start off with a general understanding of what the thyroid is. You know if you Google it, it’ll say that it’s the engine for most intents and purposes runs your body. Tell us what a thyroid does.
Dr. David Terris: Well that’s exactly right. So it sits in the front of the neck. It’s relatively small. But it controls the metabolism. So how fast our engine runs. It has effects all throughout the body. So it’s a very critical organ.
Brad Means: All right, so what happens if that engine goes too fast or too slow? What does your body do?
Dr. David Terris: Yeah, so too fast, we call that hyperthyroidism. And you will feel jittery. You’ll have trouble sleeping. You’ll feel like you had eight cups of coffee. And so that’s an overactive thyroid. If it’s underactive, of course the opposite. You’ll put on weight. You’ll feel sluggish. You’ll be sleepy all the time. You’ll feel cold most of the time. And so that’s the underactive hypothyroid state.
Brad Means: All right, more Americans have thyroid issues than do diabetes or heart disease. You were talking about it last check, some 30 million of us are dealing with thyroid problems. Other than the symptoms you just listed, or considering the symptoms you just listed, how do we know if we have it? You know, how do you know if I’m just tired because I’m tired or I’m tired because something’s wrong with me?
Dr. David Terris: Sometimes it could be difficult to sort that out. But generally a blood test will answer the question. There’s two important ones. A thyroid stimulating hormone. We call it TSH. And then a free T4. And so those two blood tests will answer the question if you’re sluggishness, your tiredness is related to the thyroid. ‘Cause sometimes it is and many times it’s not. So, a blood test will answer the question.
Brad Means: And so what happens if you find out that something is wrong with your thyroid? Is hormone related treatment still the way to go?
Dr. David Terris: Yeah for a hypothyroid state, meaning too low.
Brad Means: Hypos too low.
Dr. David Terris: Hypos too low. And so replacing that function is a relatively simple matter of a once a day pill. You take it early in the morning and that will overcome that issue.
Brad Means: Who are we talking about here? Old people, young people, men, women?
Dr. David Terris: It can happen to anybody. But generally it’s women who are kind of midlife or later in life are the most prone to have hypothyroidism.
Brad Means: What about the treatments of radioactivity. Radioactivity, and again I have a deeply lay person’s understanding of this. Radioactivity is used to treat thyroid problems. But it also can cause them.
Dr. David Terris: Well yes, and so, radioactive iodine, which is very targeted radiation can be used to treat an overactive gland and basically it’s burning the thyroid to reduce the function of it. So that’s very specific radioactivity. On an unrelated note, so exposure to radiation of various types can cause the thyroid to develop nodules. And not only nodules but cancer. So it’s kind of, it’s a little bit confusing but we use radiation sometimes to treat thyroid conditions. But at a higher dose, radiation can cause thyroid problems.
Brad Means: If I’ve had a lot of X-rays in my life, if I’ve been in that MRI machine a ton, am I more likely to have thyroid problems down the road?
Dr. David Terris: Probably not. It’s a relatively low dose that you would be getting with for example dental X-rays and CT scans. But if you had a lot of CT scans, especially at a young age, that can predispose to thyroid issues. And so there’s been recognition of that and an effort to reduce the number of CT scans, again, especially in kids. That’s when our thyroid is most vulnerable to the effects of radiation.
Brad Means: Thyroid disease used to be deadly. Talk about the progress. I mean the mortality rate used to be a lot higher than it is now. Talk about the progress that’s been made and the treatment just in your career.
Dr. David Terris: Well so recognition of the disease is an important one. And identifying it early. So that always helps. And then the management, the surgical management has gotten much better, much easier, more thorough removal of the thyroid gland. But despite that, we can do it through smaller incisions and have less impact on the patient. The additional treatments that we use are radioactive iodine once again for the treatment of cancer. Okay, so sometimes that’s an important modality that we use. And then more recently, we have additional agents that can be useful in more advanced disease when people have spread elsewhere. And there’s like a new agent coming out every year. So there’s other opportunities to improve our treatment of the disease.
Brad Means: If you take your thyroid out though, what happens? How does your body work? You’ve removed the engine.
Dr. David Terris: So you cannot live without a thyroid or that thyroid function. So the replacement of that function as we said, very simple. Once a day pill, first thing in the morning. And we’re fortunate that it’s widely available because that allows us to be aggressive in taking out the thyroid when it’s necessary.
Brad Means: What about outpatient versus inpatient procedures? Have you in recent years seen the opportunity for folks to get treated and go home same day?
Dr. David Terris: Yes sir, and so we have been fortunate to be on kind of the front edge of that movement. And at this point, it’s about something like 95 to 98% of my patients can be safely managed on an outpatient basis. And when we first started doing it because it was new, there was some reluctance and some confusion about hey we can do outpatient surgery. Now, my patients come in expecting it. And if for some reason we can’t do it, they’re disappointed. Most patients would rather recover in their own bed eating their own food, surrounded by their loved ones, rather than in a hospital bed where it’s sort of a sterile environment, or sometimes not so sterile, especially during flu season and so forth. So this is something that is beneficial to the patients health-wise in most cases, and they prefer it.
Brad Means: What distinguishes someone’s ability, or someone’s qualifications for being an inpatient versus an outpatient? Is it just the severity of the disease?
Dr. David Terris: Rarely does it have anything to do with the thyroid, the extent of their disease. Mostly it’s about the health of the patient. If it’s a particularly elderly patient, has a lot of medical problems, heart disease and so forth. Those would be patients where we may consider keeping them overnight. But the vast majority are well enough to go home.
Brad Means: When we continue on the Means Report, we’re gonna talk about the thyroid some more, especially diet, lifestyle changes, or habits you can develop that might help you stay healthier thyroid-wise. Also if you do have to have a surgical procedure. What about scarring? What has Dr. Terris learned on that front and how can he help you maybe get out of surgery without too many signs that you ever had an operation. Great news on that front as the Means Report continues.
Brad Means: Welcome back to the Means Report. We are talking about the thyroid gland today in depth. Dr. David Terris is our special guest. He is the surgical director of the Thyroid Parathyroid Center at MCG and does a lot of research and a lot of treatment to make sure that we stay on the cutting edge of thyroid disease and taking care of people who have it. And we appreciate him taking time out of his busy schedule to be with us. Dr. Terris, before we went to break we were talking about diet. And really I was just getting that the importance of iodine. So what’s the best way and what’s a good amount of iodine for us to ingest to try to ward off thyroid issues?
Dr. David Terris: Yeah, we don’t need a lot in this country. There are countries that are iodine deficient. And when that occurs, patients can get a very significant enlargement of their thyroid, and big goiters, and we sometimes see these in underdeveloped countries with these big massive goiters. In the US, because there’s so much salt, if you eat a Mcdonalds french fry, you’re probably getting enough in one day. So most people don’t need to worry about it. As long as they’re eating a balanced diet, they’re gonna get sufficient iodine in their diet to not have these problems.
Brad Means: Okay good. Can you feel those nodules? I thought of that when you mentioned it in the first segment. Can you feel them developing on your thyroid?
Dr. David Terris: You can’t feel them when they’re small. And so that’s what’s changed in this industry in the past 10 years. Used to be we discovered them when you could see them from across the room or the physician or the patient themselves could palpate, could feel the nodules. Nowadays we’re finding them even earlier because of all the imaging, that sort of explosion of imaging. Whether it’s ultrasound, or PET scans, or CT scans, or MRI scans. There’s a lot of imaging that patients have done for other reasons. And they incidentally discover a thyroid nodule. So we find them quite early nowadays.
Brad Means: Talk about the increase in cases of thyroid cancer. Have you noticed that those diagnosis have been on the rise of late?
Dr. David Terris: Absolutely, so.
Brad Means: Why is this happening?
Dr. David Terris: So you know, in the ’90s, the incidents doubled. It’s doubled again in the previous decade. So there’s been an explosion in the number of cases being diagnosed. Most of it probably is due to what we call over detection. Meaning, the disease was kind of sitting there not causing any issues until we found it. And so now as I mentioned, we’re finding it earlier and earlier with all this imaging. And that’s a little bit of a conundrum for us as clinicians. Because much of it, even though it’s caner and everybody of course is concerned about having cancer, this cancer mostly behaves in a very indolent way. And so for many people, if we never found it, they’d be just as well off. Which is sometimes hard for people to wrap their minds around. But in fact, we’re having to balance finding a very small cancer against the impact of the treatment that we would do for that cancer. Surgery, maybe radioactive iodine. So we’re actually trying to step back a little bit and find less cancer believe it or not and reduce the intensity of the treatment that we apply when somebody is discovered to have a thyroid cancer.
Brad Means: When you do have to make an incision and treat a thyroid issue, what kind of scarring does it leave? And what have you been able to do? I know this has been a big part of your job is to try to reduce that scarring and let people walk out of your office feeling good about their appearance.
Dr. David Terris: It is one of my passions. And that’s an important thing that has changed in the last 10 years. In the old days, more than 10 years ago, it was a big long incision low in the neck, and often didn’t heal well, and was an obvious mark on a patient walking around that oh I’ve had something done. And as it happens, as we said earlier, thyroid disease more commonly occurs in women, especially younger women. And so they’re particularly sensitive to having scars that are visible. So we’ve been able to shrink the size of that incision. In many patients it’s three quarters of an inch. So it’s quite small, heals well, low in the neck. And it’s had a big impact on patients accepting thyroid surgery. And the recovery is faster. And I would say overall the impact on them from having the thyroid surgery is much lower than it once was. So small incisions, outpatient surgery. We don’t use any stitches or clips anymore, no drains, just glue for the skin, little Band-Aid embedded in the glue. It’s really, it’s remarkable what we’re able to do for patients.
Brad Means: Are you doing it yourself? Or are you doing it robotically or both?
Dr. David Terris: So for selected patients, we do use the robot. For some individuals who just don’t want a scar at all that can be seen, we can come from behind the ear, tunnel down to the thyroid compartment and remove it that way. And that does require the use of the robot. And again, it would be models and television personalities that are worried about it like yourself, Brad, and others that really just don’t want a scar at all.
Brad Means: When did the behind the ear thing come onto the scene? Tell me about that, fascinating.
Dr. David Terris: So yeah. So we actually were able to develop that here in Augusta. There have been a number of remote access we call it ways of getting to the thyroid. But many of them involved coming under the arm, through the breast. And that’s an approach that was popular in Asia. But we recognized it was probably not gonna be embraced in the US. And so we developed an approach where we come, we call it the facelift approach because it’s similar to a facelift incision coming from behind the ear so that the incision is completely hidden behind the ear. And then we tunnel down to the thyroid compartment. And so it takes a little bit longer. Recovery is a little bit longer. But when it’s all said and done, there’s no scar that can be seen by anybody else.
Brad Means: Do the plastics docs have to get involved? Or are you doing all this?
Dr. David Terris: I do it. We have a team approach. But I do it. And again, in this approach, even if the scar isn’t perfect, it doesn’t even matter ’cause nobody can see it anyway. It’s in the hair, it’s behind the ear. Nobody sees it.
Brad Means: When you come up with this kind of innovation right here at home, how do you get the word out other than what we’re doing right now obviously, to the rest of the medical profession that hey this is something you should try. And in fact, of course, they are trying it and they are doing it. But how do you sort of make that announcement that we’ve done something that’s changed medicine?
Dr. David Terris: Yeah, so mostly it’s through our peer reviewed publications in the medical literature because we carefully study it and we started with cadaver dissections first and then move into patients gradually. And once we can demonstrate that not only is it feasible but it’s safe for patients, then we publish our findings. Other people recognize that it’s a useful approach and begin to embrace it. Not just here in the US, but abroad as well. Now it’s being done in Europe, Asia, and elsewhere.
Brad Means: What do you see going forward as far as treatments? It seems as if you especially are already on the cutting edge, constantly looking for new ways to help people with thyroid issues. What’s next?
Dr. David Terris: I think ultimately, there’s gonna be an even less invasive, sort of a non invasive way of managing thyroid nodules, thyroid cancer. High intensity ultrasound, that’s done transcutaneously, has shown some promise for certain conditions. Maybe just a needle poking into a thyroid lesion and shrinking it with alcohol, maybe lasers. That’s probably the way we’re heading in that field.
Brad Means: Why are you so into this? What made you so laser focused on people especially with thyroid issues? And when I say people I mean you could have been living the cushy administrative life by now. But you said no, I want to be down there with my patients helping them heal, why?
Dr. David Terris: So I very much enjoy taking care of people. I find it gratifying when they have a good outcome. And they’re grateful. It makes my day when I get a little text that says gosh I’m doing great and I really appreciate it. I sometimes get emails a couple years later. Patients remember me and they say gosh, I just want to let you know that things are doing well. And that I really enjoy. And when you focus down to one single operation, and you do a lot of it, it becomes very straightforward for me individually. And so it’s nice to be able to do something well and repeatedly.
Brad Means: Well, you do it very well. And we appreciate it so much. There’s so many exciting things going on at MCG. And you’re the personification of that. And I appreciate everything you’ve done.
Dr. David Terris: Well thank you, Brad.
Brad Means: Absolutely, Dr. David Terris. Play this interview back. Listen to those symptoms he mentioned in our first segment. If you have any signs, any symptoms, any indication that something may be wrong, mention it to your doctor. Take advantage of the treatments that Dr. Terris and his team have developed so you can get better as well.