Thyroid Disease and Diabetes: Patient Education

Both diabetes and thyroid disorders involve a dysfunction of the endocrine system, which is a group of glands that help regulate various aspects of the body's metabolism and essential biological functions.

Diabetes is a disorder characterized by an overabundance of glucose (sugar) in the blood due to insufficient insulin production by the pancreas (type 1 diabetes) or the inability of the body to utilize insulin to transport glucose into the cells (type 2 diabetes).

THE LINK BETWEEN DIABETES AND THYROID DISORDERS 

• Clinical research has found that diabetes and thyroid disease then to co-occur in patients.

• Almost one third of people with type 1 diabetes have been found to have thyroid disease. This is because type 1 diabetes and the most common thyroid disorders are autoimmune diseases, which are diseases in which the your immune system attacks a gland(s) or organ(s) of the body as it would an infection.

• People with autoimmune disease are more likely than the general population to develop other autoimmune diseases such as Addison Disease, Grave's Disease, Hashimoto's Thyroiditis  Pernicious Anemia,   Rheumatoid Arthritis   or   Lupus  and so on.

• Thyroid disorders are more common in type 2 diabetes patients because both these illnesses  tend to occur more  frequently as people age.

THYROID GLAND BASICS

• The thyroid is a butterfly shape gland at the base of the neck that lies across the trachea most commonly referred to as "the windpide". It produces and releases thyroid hormones.

• Thyroid hormones affect every cell of the body and controls many essential body functions.

• The amount of thyroid hormone made by the thyroid gland is regulated by the pituitary gland and the hypothalamus in the brain.

• The pituitary gland releases thyroid stimulating hormone (TSH) which signals the thyroid to produce more thyroid hormone. When the pituitary gland senses that there is a right amount of thyroid hormones in the body, it then decreases thyroid hormone production.
• Your doctor measures the health of your thyroid gland by measuring thyroid stimulating hormone levels. 

• Too little thyroid hormone production causes a condition known as hypothyroidism.

• Too much thyroid hormone production causes a condition knows as hyperthyroidism.

HYPOTHYROIDISM AND MILD THYROID FAILURE

• When a patient has hypothyroidism, he or she may feel tired and cold most or all of  the time, have a slow heartbeat, or feel depressed. 

• Mild thyroid failure is a mild form of hypothyroidism. In patients who have mild thyroid failure, the thyroid hormone levels are "normal", but the TSH LEVEL IS ELEVATED.

• Patients with mild thyroid failure often don't show any obvious symptoms, but untreated mild thyroid failure may lead to hypothyroidism.

 HYPERTHYROIDISM AND MILD HYPERTHYROIDISM

• Patients with hyperthyroidism may feel jittery and may experience nervousness, a rapid heartbeat or unexplained weight loss.

• Patients with mild mild hyperthyroidism have "normal" thyroid hormone levels, but the TSH LEVEL IS  DECREASED.  

• Untreated mild hyperthyroidism can progress to hyperthyroidism and may lead to potentially serious life threatening consequences such as cardiovascular disorders.

UNDERLYING THYROID DISORDERS CAN IMPACT DIABETES MANAGEMENT

• Thyroid disorders can have a major impact on glucose control, and untreated thyroid disorders can affect how diabetes is managed. 

• Hypothyroidism can decrease the insulin requirements in patients with diabetes. Symptoms of hypothyroidism are common patients with type 2 diabetes.

• Hyperthyroidism may worsen glucose tolerance or control. Symptoms of hyperthyroidism may be attributed to poor diabetic control in patients with type 1 diabetes.

• Underlying thyroid disorders may go undiagnosed because the common signs and symptoms of thyroid disorders are similar to diabetes and can be overlooked and/or attributed to other medical disorders.

TSH TESTING IS RECOMMENDED FOR PEOPLE WITH DIABETES

Because of the link between diabetes and thyroid disease,  the American Diabetes Association has recommended that people with diabetes be tested for thyroid disorders.

1. The TSH test, which measures the amount of thyroid stimulating hormone being produced in the body, is the best test for thyroid function.
2. A TSH test will give your doctor knowledge regarding the extent of thyroid function.
3. An elevated TSH Level may indicate hypothyroidism.
4. A low TSH level may indicate hyperthyroidism. 

HYPOTHYROIDISM TREATMENT BASICS

Hypothyroid patients can be treated with thyroid hormone replacement  therapy, usually with a synthetic thyroid hormone called levothyroxine sodium   

• Treatment will continue for the rest of a patient's life, with the doctor checking TSH levels every six months after the patient is stable and the correct dose is achieved for them. 

• Hypothyroidism may decrease the insulin requirement in patients with diabetes, therefore, a diabetic patient with hypothyroidism may need his/her diabetes medication dose adjusted. 

• Patients on hormone replacement therapy should not switch medication brands without checking with their doctors.

• Symptoms of fatigue, weight gain, cold hands or feet, hair loss, depression or any other new or  unusual symptom should be reported to your doctor as they may indicate your thyroid hormone replacement dose needs to be changed or adjusted.

• Hypothyroid patients should never, ever, stop a thyroid hormone replacement therapy without taking to their doctor.  Extremely low thyroid hormone levels can lead to coma and even death. 

HYPERTHYROIDISM TREATMENT BASICS

Patients with hyperthyroidism have 3 treatment options:

1. Take antithyroid drugs, which will slow down the thyroid's hormone production.
2. Radioactive iodine therapy, which will destroy thyroid cells in order to reduce the amount of thyroid hormone produce.
3. Finally, if all else fails or you are concerned and opposed to radioactive iodine therapy,  surgical removal of the thyroid gland may be recommended. 

Hyperthyroidism has been known to affect control of the amount of glucose in the blood, therefore,  treatment for hyperthyroidism should help control blood glucose levels but following treatment for hyperthyroidism many patients may develop hypothyroidism.

MORE INFORMATION: Patients who have further questions should contact their doctor. 

Interview: Random Acts of Purpose Founder Leslie Ward Umfleet

The Thyroid Cancer Coffee Break welcomes Leslie Ward Umfleet Founder of Random Acts of Purpose a 501(c) 3 Public Charity whose mission is to provide families with the everyday things they need while dealing with cancer.

Leslie is also the mother of a 12 year old boy who is a Pediatric Thyroid Cancer Survivor and she will share with us her journey as a "Thyroid Cancer  Mom" and some great information about her nonprofit organization based in Tulsa Oklahoma.

Listen to internet radio with Calamity Sunshine on Blog Talk Radio

Thyroid Cancer Clinical Trials Update Show 001

Every Monday 10:30 AM Eastern Standard Time The Thyroid Cancer Coffee Break will share information on clinical trials and research studies in the fight to prevent, cure and treat thyroid cancer currently accepting participants nationwide. 

Have a pencil and paper handy to write down the contact information for programs.  Please email questions before the show to info@sjccfthynet.org  subject line: Clinical Trials

Listen to internet radio with Calamity Sunshine on Blog Talk Radio

Interview: Cleaning for A Reason Executive Director Zane King

The Thyroid Cancer Coffee Break welcomes Zane King Executive Director of Cleaning for a Reason, a  nonprofit organization dedicated to cleaning homes for women battling cancer (any kind of cancer) completely free of charge.

Learn how you can apply for FREE CLEANING SERVICES NATIONWIDE and how you can support the wonderful work Cleaning For A Reason provides our growing community of thyroid cancer patients and survivors as well as all women dealing with any cancer diagnosis in all 50 states and Canada!

Listen to internet radio with Calamity Sunshine on Blog Talk Radio

Hereditary Cancer Risk Assessment Basics

The goal of most hereditary cancer programs is to provide individual risk assessment that can be incorporated into the patient’s ongoing medical care. The programs usually evaluates families with multiple members with cancer (of the same or different type) for the purpose of assessing the likelihood of a hereditary cancer syndrome. Patients are usually referred by their physician based upon their personal medical and/or family histories.

Often several sessions are required. The initial session includes a review of the patient’s medical history as well as three generational family history. The counselor will review this information within the context of risk for a hereditary cancer syndrome. The benefits, risks and limitations of testing will be described in detail. Often testing options can be offered at an initial visit. However, sometimes it is necessary to collect medical records on affected family members in order to understand the risk that exists for the patient and family. 

Genetic testing will then be offered if appropriate. If the patient decides to proceed with testing a final appointment is scheduled to review the results in person. This visit includes interpretation of the results a discussion of how this information affects medical management and the impact on the extended family. 

Some important factors that would indicate this type of evaluation include:

• Cancer that developed at an early age, usually less than 50.
• Individuals with rare cancer i.e. male breast cancer.
• More than one primary cancer in an affected individual.
• Other physical signs such as colon polyps, moles, desmoids tumors, thyroid nodules, and fatty tumors.
• Different cancers in a family that are known to be genetically related such as breast and ovarian cancers.
• Several generations in the family affected by cancer.
• Clustering of cancers that are known to be genetically related (such as breast and ovarian, colon and uterine and breast and thyroid).
• Breast or ovarian cancer and Ashkenazi (eastern European) Jewish ancestry.
• An identified genetic mutation in the family.
• Known cancer syndrome in the family (for example Lynch syndrome, Cowden syndrome, MEN and others).

FOR MORE INFORMATION PLEASE TALK TO YOUR DOCTOR OR CLICK HERE 

Interview: GiveForward.com Marketing Director Cate Conroy

The Thyroid Cancer Coffee Break Welcomes Special Guest Cate Conroy of Giveforward.com. Have a pencil and paper ready. This wll be a very  powerful  tool for our growing community of thyroid cancer patients and survivors as well as anyone facing a health crisis or chronic health condition. 

GiveForward.com  "personal" fundraising pages help  friends and family send love and financial support to help ease a loved one's out of pocket medical expenses as they navigate a medical crisis such as cancer and post cancer treatment follow-up.

Listen to internet radio with Calamity Sunshine on Blog Talk Radio

Faces of Thyroid Cancer: Lorna Brunelle

LORNA Brunelle: will be honored at the Massachusetts
General Hospital's The 2012 One Hundred Gala Event.  

MIDDLEBORO MASS — Middleboro native Lorna Brunelle was nominated and selected for The Massachusetts General Hospital Cancer Center's fifth annual the one hundred event. Planned for Thursday, June 7 at the Boston Westin Waterfront at 7 p.m., the one hundred gala will honor 100 individuals and groups from across the country whose diligence and discoveries, philanthropy and passion and messages of hope have helped advance the fight against cancer.

Funds raised at the gala support research, patient care, education and community outreach programs. Since 2008 the one hundred has raised nearly $3 million to support the Cancer Center's innovative research, comprehensive suport care prorams, and community outreach initiatives. Academy Award winner Matt Damon will be returning to the event this year as a special guest.

Lorna Brunelle was diagnosed with thyroid cancer seven years ago at the age of 33. During her recovery, she became a thyroid cancer patient advocate. Upon invitation of her thryoid surgeon Dr. Gregory Randolph, she has spoken several times at The Massachusetts Eye and Ear Infirmary, was featured in a national Nerve Monitoring PSA to educate thyroid cancer patients, was featured in several of the M.E.E.I. documentaries, can be seen in a testimonial in the M.E.E.I. website, has sung at M.E.E.I. benefits and has shared her story in several Massachusetts Eye and Ear CONTACT magazine articles.

Lorna has raised over $35,000 for The Chernobyl Children Project USA (a Boston based group that helps children with cancer and other medical problems) and served as a community coordinator and member of the management team.

For three years Lorna helped place children from the contaminated Chernobyl region in the care of host families in Massachusetts while they received free treatments and surgery in Boston. She has raised and donated money to the Dana Farber arts enrichment program to provide theatrical performances for the children undergoing treatments in the Boston hospital.

As a consultant/coach in the Miss America Organization, Ms. Brunelle has volunteered to help raise thousands of dollars for the Children's Miracle Network Hospitals. She has participated in the Making Strides Walk and co-produces the Designer Couture For A Cure fashion show twice a year to raise money for Team Chuckel of the Pan Mass Challenge, The Make- A -Wish Foundation and The Gregory Randolph Thyroid Cancer Research Fund.

Through her website www.dirtybombshell.net, Ms. Brunelle has fostered relationships with cancer patients from all over the globe. In 2011 she released her book "Dirty Bombshell - From Thyroid Cancer Back to Fabulous." As a volunteer, Ms. Brunelle speaks at colleges, hospitals and women's groups on the topic thyroid cancer and patient care. Last June, she was the key note speaker at Good Samaritan Hospital in Brockton and was part of the Healing Garden ceremony.

For the past six years she has opened the Relay for Life ceremony in Bridgewater by singing The National Anthem. In December she was featured in South Shore Woman magazine. She is featured in the spring issue of Living with Cancer magazine. Lorna has been seen on FOX CT and heard on several local radio shows.

Tickets to the one hundred 2012 gala event are $500 per person. To purchase tickets or to make a donation to support Mass General's mission to eradicate cancer visit http://www.theonehundred.org or call Raquel Morales, assistant director, special events at the Mass General   617-724-2818.

Faces of Thyroid Cancer: Beth Munelly

Beth Munnelly, a breast and thyroid cancer survivor, who
will be running in Ridgefield's annual Run Like a Mother Race,
is photographed Wednesday, May 2, 2012. Photo: Carol Kaliff / CT

Ridgefield, CT- For her entire adult life, Ridgefield resident Beth Munnelly has been a runner. She ran in seven half marathons, three triathlons, and many smaller races. Yet, the race she is running May 13 -- the Run Like a Mother 5K in Ridgefield CT -- holds the most meaning for her. This 3.1 mile race, which is held every year on Mother's Day, symbolizes not only that she is a runner but also a mom. There was a time in her life when she wasn't so sure she would be one.

"Cancer runs in my family. My grandmother died at 50 from breast cancer. My aunt died of ovarian cancer at 66. My mother died from breast cancer at 48. I was diagnosed with breast cancer when I was 33 -- which was the same year my mother was diagnosed. 

When I first heard the diagnosis, I thought it meant I would die like my mother had. I felt sad that I might not have the chance to be married and be a mom," said Munnelly, who is now 50. Munnelly had a bilateral mastectomy.

Two years later, when she got married and was planning a family, her surgeon and oncologist were reluctant for her to become pregnant because there was an increased likelihood the cancer could return. So, she and her husband, Kevin Munnelly, adopted two boys -- Brendan, who is now 13, and Conor, who is now 11.

"When I held both of my sons for the first time, I truly felt that I was meant to be their mom. It was an incredible feeling and a dream come true," said Munnelly, who works as a public relations account executive.

In 2010, Munnelly was faced with yet another health scare when she learned she had thyroid cancer. She had her thyroid removed, and now takes a synthetic thyroid hormone every day.

Turning 50 was a milestone for her because neither of her parents lived to be that age. Her father died unexpectedly of a heart attack at 47.

"The week before I turned 50, my Sunday morning running friends threw a surprise 50th party for me -- at 6:30 a.m.! On a cold, dark February morning, they managed to surprise me with balloons, party favors and a plan to run an 8-mile training run from Ridgefield to Bedford, N.Y., where they had a beautiful brunch to celebrate my birthday at the Bedford Post (a restaurant). 

They created signs and placed them every half-mile along our run. The signs featured photos of me from my childhood, marriage, motherhood, and with friends. It was such an important part of celebrating this milestone birthday.

"I'm always thankful for my life and my boys. Whenever I run a race, they are my motivation. To me, the RLAM race is a celebration of life, motherhood, turning 50, and 17 years of being a survivor."

Munnelly is one of about 1,700 women expected to run today's RLAM race, which is an annual women's-only race held every year on Mother's Day since 2008. The race was founded by Ridgefield resident Megan Searfoss. Its mission, according to Searfoss, "is to fuel a woman's journey toward health and wellness." Each woman who is participating in it has her own story, and each story is special.

Article by Sandra Diamond Fox a freelance writer in Connecticut. 

She can be reached at Sandraifox@aol.com.

About Run Like a Mother:

Run Like a Mother The RLAM race is now held in ten cities across the United States. There is also a virtual race, where women who don't live near a race location can still sign up and run on their own. The RLAM in Ridgefield is May 13 at 8:30 a.m. beginning at 90 Prospect St. There is a kids' one-mile race at 8 a.m. There are women running in the race who live as far away as Canada, Arizona, California, Michigan, Wisconsin, and Pennsylvania. Proceeds from the Ridgefield RLAM race are going to Family & Children's Aid in Danbury. 

RLAM founder Megan Searfoss, 47, has run in 14 straight marathons and six Ironman competitions, as well as many triathlons and smaller races. She lives in Ridgefield with her husband Chon, 50, and their three daughters, ages 12, 15 and 19. She has run more than 20,000 miles throughout the country. "I developed Run Like a Mother because I wanted women to experience the same feeling I get when I cross any finish line. That invincible, 'I did it myself' feeling, that feeds the brain and fills the soul. I think as women and mothers we often lose sight of this. To accomplish a goal like a race gives you the strength to push when the going gets tough. It gives you the bit of mental edge to dig deep, whether it is a death or cancer or other obstacle," Searfoss said. Mother's Day 2012 

This year, Mother's Day is not only a celebration of moms, but also the kickoff to National Women's Health Week. The event is designed to encourage women to start getting serious about their health. According to a recent survey, although moms are overworked and stressed, they just really want to spend the day with their family. Mom will feel great when lacing up those tennis shoes, not only because it's healthy for her, but also for the entire family. Parents are role models for their kids when it comes to health, and kids are more likely to participate in activities when they know it's important to their family. Finn Partners, part of the Ruder Finn Group, an international public relations firm.

For More Information visit www.runlikeamotherrace.com 

Faces of Thyroid Cancer: Kelsey Waters

Brad McClenny/ Staff photographer

Kelsey Waters with her family -from right Dad Jerry,

Mom Donna and brother Weslee in Keystone Heights

KEYSTONE HEIGHTS — When she first heard the words from the doctor, that she had thyroid cancer, Keystone Heights center fielder Kelsey Waters didn't cry or scream. She turned to her mom and said, “I don't really know why this happened, but God has a reason.”

Seven months ago, Waters took on cancer and won. In three days, on Mother's Day, the junior will play the biggest softball game of her career when Keystone Heights (19-7) takes on Tallahassee Florida High (21-6) in the Class 4A state semifinals in Clermont.

The Indians are on quite a roll, winners of 10 straight and 18 of their last 19 games. And Waters has been the inspirational leader throughout, an exceptional outfielder with incredible range (no errors) and a consistent hitter (.549, 9 triples, 5 homers, 28 RBIs) whose power is pretty much back.

“The cancer is completely gone because it was removed in surgery,” she said. “So right now, I'm doing great, just focusing on softball and school. It couldn't be better.”

A first-team all-area player since she was a freshman, Waters has played her summer ball with Florida Select. It was last summer, after a tournament, when she started not to feel well and was looking pale, she said. Within a few days, she had severe throat pain and her lymph nodes were severely swollen. She thought it was strep throat because she normally gets it once a year.

But a strep test at a local doctor's office came up negative. Eventually, an ultrasound on the thyroid was done and a small bump was discovered. Waters then went to see Dr. Sujata Wagh, an endocrinologist in Gainesville. Another ultrasound was administered and two nodules were discovered in her thyroid.

“We had another choice, like my original doctor, wait six months or do a needle biopsy,” Waters said. “Now that freaked me out because I do not like needles. They (her parents, Donna and Jerry) did go with the needle biopsy. The doctor took a three-inch needle and inserted into my thyroid, into one of the nodules twice to get cell samples. They said they would call us within a week with the results.”

When Donna Waters, a fourth-grade teacher at Keystone Heights Elementary, got the voice mail message at home a week later (Sept. 21, 2011), she knew it wasn't good news.

“Jerry was at work, so I had to call him,” she said. “They wouldn't tell us anything over the phone. I just remember sitting there at the table and started crying because I knew. We didn't tell Kelsey anything. We let the doctors tell her just in case we were wrong and worried her unnecessarily. I am always going to remember that date.”

Kelsey Waters, 16 at the time, had surgery a few weeks later on Oct. 7, 2011. She said she will never forget the car ride to the hospital before surgery. She found divine strength on the trip.

“I have a lot of trust in a lot of things,” she said. “I have trust in my family and my friends. But the biggest thing I trust in is my Lord and Savior Jesus Christ. I never realized how merciful he was until he gave me that. And I felt that I wasn't scared because he was going to bring me through it. On the way to the hospital was the first time I actually was starting 

to freak out, ‘Oh my gosh, I am going to have surgery for cancer.'

“I had my Bible with me. And I flipped it open just to a random page and my eyes came to Psalms 103, Verse 3. And it says, ‘He will heal all your iniquities and cure you of your diseases.' I actually smiled and started laughing, and my mom gave me a funny look. I shook my head because I knew that God made me flip to that page for a reason. With the support of my friends and family, and the strength that I got from God, that's what kept me through it. I knew I was going to be OK. I wasn't scared.”

Kelsey received support from all three of her families (home, softball, school) who visited her at North Florida Regional Medical Center. That support, she said, is something she will never forget.

“There was so much family, and so many friends, I probably won't know exactly how much support I had, but it was definitely enough to make me see how many people love me,” she said.

It wasn't long after surgery that she returned to school, determined not to let people think what she went through bothered her. She instead had a message she wanted to share — of faith, belief and the power of the strength within.

“She handled it better than any family member did,” said her father, Jerry, an assistant chief at the City of Starke Fire and Rescue. “It was extremely hard for me. Because of my profession, I'm used to dealing with problems immediately when they arise. This is something that I had to rely on other people in the system. That made it incredibly hard for me to deal with.

“Fortunately the family we have, including the softball family and the school family and friends, made everything tolerable during an intolerable time.” Keystone Heights coach Belinda Phillips said Kelsey has been an inspiration to her teammates. “She has been a leader on this team,” Phillips said. “I think a lot of things have impacted this team, and that was one of them. It has definitely made her stronger. She is able to share that, and the girls do respond to it.”

“I look at her and I see strength,” Donna Waters said. “Spiritually, physically, emotionally, maturity beyond her young years, without a doubt. She always said something good is going to come out of this.” As to Kelsey's prognosis, she said her doctor said the odds of the cancer returning are “as close to zero percent as there can be.” Kelsey still has routine health check-ups. She is scheduled to have another ultrasound later this month.

This group of Keystone Heights teammates have played a lot of softball games together, and on Sunday can give their moms a wonderful Mother's Day gift — advancement to Monday's Class 4A state championship. “If we put our minds to it, and if we make the routine plays along with some awesome plays, and hit like we have been hitting, we can do this,” Waters said. “We are strong enough mentally and we are definitely strong enough physically and have enough natural talent to pull this out. We are confident we can do this.”

Article by  Larry Savage. He can be reached  at  larry.savage@gvillesun.com.

Faces of Thyroid Cancer: Linda Fox

NORFOLK CT -- When Linda Fox was told by doctors that she would heal better from her cancer treatments if she was in better shape, she set a lofty goal.  She decided to run 1,000 races. The thyroid cancer survivor will run race number 258 this Saturday when she does the Walk On The Wild Side 5k put on by Lee's Friends at the Virginia Zoo.

"And I used to run, but I didn't run nearly as much. And now I feel like Forest Gump Jr. 'Run Forest run'" laughed Fox.    

Always mindful of community spirit. Linda spent 12 years as NJROTC instructor at Maury High School.  That was after her 21 years in the Navy.   And for 32 years she's been married to Bill Fox. He, too, is a retired master chief. A master chief married to a master chief?

"That's kind of hard. That's kind of hard, you know.  It's kind of one or the other way or the hard way, "said Bill Fox.   

Bill's a skin cancer survivor and appreciates what Linda has to go through in battling thyroid cancer. Run number 258 will be for Lee's Friends at the zoo Saturday.  Lee's friends knows a lot of courageous survivors.

"There are. Lee's Friends likes to remind people that our tag line is 'helping people live with cancer' and I think that our friend Linda Fox defines that," concluded Carol Olsen, Executive Director of Lee's Friends. 

The race starts at 8:00 a.m. Saturday May 12^th at The Virginia Zoo.  Registration starts at 7:00 AM   For more information, visit the website of Lee's Friends.

Staging and risk stratification of thyroid cancer improved with SPECT/CT

The use of single positron emission computed tomography (SPECT)/computed tomography (CT) has been reported to change clinical management in a significant number of thyroid cancer patients according to research presented in the May issue of The Journal of Nuclear Medicine. Information obtained from these scans not only helps determine the need for radioiodine therapy or alterative options, but also impacts the long-term follow-up strategy.

"In this article I aimed to highlight the role of radioiodine imaging in risk stratification of patients with thyroid cancer and to assess the contribution it brings to the completion of staging and the decision to omit or proceed with I-131 therapy," said Anca M. Avram, MD, author of "Radioiodine Scintigraphy with SPECT/CT: An Important Diagnostic Tool for Thyroid Cancer Staging and Risk Stratification." She continued, "The new technology of SPECT/CT has substantially improved the interpretation of planar studies and can be implemented in the post-operative management protocols of thyroid cancer patients."

SPECT/CT has commonly been used for imaging thyroid cancer patients after radioiodine therapy, with the advantages of substantially reducing the number of equivocal foci seen on planar imaging alone, determining lymph nodal status more accurately than planar imaging and improving anatomical localization of activity foci seen on planar imaging. Studies cited in the article report on the high diagnostic value of radioiodine SPECT/CT, resulting in changes in risk stratification and clinical management in a substantial number of patients (ranging between 25 – 47 percent of patients).

More recently, SPECT/CT has been utilized prior to radioiodine therapy to better identify and characterize focal activity seen on planar scans for differentiating between metastatic lesions and benign uptake in residual thyroid tissue or normal organs. Information acquired with pre-ablation SPECT/CT scans can be used in addition to histopathology information to complete staging and risk stratification prior to radioablation. The pre-ablation scans can reveal unsuspected regional and distant metastatic lesions, resulting in changes in the prescribed I-131 activity, either by adjusting empiric I-131 doses or performing dosimetry calculations.

The article reports that SPECT/CT changed post-surgical staging in 21 percent patients, modified the treatment approach in 36 percent patient with disease, and led to avoidance of unnecessary I-131 therapy in 20 percent patients without disease. The findings on pre-ablation scans altered the recommended I-131 therapy in 58 percent patients as compared to therapy based on histopathologic risk stratification alone, by appropriately prescribing higher activities for treatment of regional and distant metastases and minimizing the activity prescribed for thyroid remnant ablation.

SPECT/CT is also very useful for evaluating unusual radioactivity distributions in thyroid cancer patients; accurate anatomic localization of radioactivity foci permits rapid exclusion of physiologic mimics of disease, or confirmation of metastatic lesions to unexpected sites.

"Diagnostic radioiodine scintigraphy with SPECT/CT provides a clear advantage for the management of patients with thyroid cancer," said Avram. "By integrating clinical, pathology and imaging information, the nuclear medicine physicians are able to offer an individualized treatment plan, bringing the nuclear medicine community a step closer to the goal of personalized medicine."

The incidence of thyroid cancer has increased 2.4 times since 1975. The U.S. National Cancer Institute estimates that in 2012 more than 56,000 cases of thyroid cancer will be diagnosed and nearly 1,800 individuals will die from the disease.

Source: Society of Nuclear Medicine

Diagnosis Disparities in Minorities Study

Results from one study show that despite a lower overall rate of thyroid cancer, African-Americans are generally diagnosed with a higher grade of cancer than in Caucasian populations.

Other studies have been published indicating economic issues chiefly underlie the differences in cancer stage upon diagnosis.

Lower levels of access to medical care due to economic constraints, or the inability to take time off from work have been linked to a longer time between the first symptoms of cancer and the beginning of cancer treatment.

The figure shows the thyroid cancer incidence rates by race and ethnicity for the US male and female in 2007. The thyroid cancer incidence rates are per 100, 000 US population and are age-adjusted to the 2000 US Standard Population 

Results from the study show that African Americans had double the rate of anaplastic thyroid cancer, an advanced and aggressive stage of thyroid cancer, when compared to Caucasian thyroid cancer patients.  African American patients were also twice as likely as Caucasian patients to have tumors larger than four centimeters.

Ask your doctor about screening tests for Thyroid Cancer.

The study used the National Cancer Institute’s database to look at data for the years 1992-2006, tracking five year survival rates of thyroid cancer patients in 17 states. Study data examined the cases of 26,902 patients diagnosed with thyroid cancer during that time.

“We think that the mortality rate is probably due to an access to care issues,” said Christopher Hollenbeak, PhD and lead study author.

“African-Americans were more likely to present with tumors larger than four centimeters, which implies that the tumors sat there and grew a lot longer,” he said.

Papillary and follicular cancer are the most common forms, and usually diagnosed in susceptible populations such as Caucasian or Asian groups. Complete treatment success for papillary and follicular thyroid cancers is close to 90 percent.

Anaplastic thyroid cancers, on the other hand, which were shown to be more commonly diagnosed in African American patients with thyroid cancer, can be fatal much more frequently.

One surgeon interviewed agreed that the difference could be amount of time elapsed from the cancer developing, to being treated. If caught early thyroid cancer treatment usually involves a small surgery, with some patients needing to take a small amount of radioactive iodine to completely destroy the cancer.

"The prevailing theory today is that anaplastic is thyroid cancer that goes haywire from not being treated,” said David Goldberg, MD, co-author of the study and currently a professor at Penn State.

The study was published in the journal Ethnicity & Disease. Authors denied any financial conflict of interest arising from the publication of their results.

Wanted: Event Development Assistant Volunteer

Volunteer Job Title:   Event Development Assistant

Purpose: Assists Development Director in the area of special events development and coordination as needed for the 2012-2013 Fiscal Year

Location:  Flexible Telecommute (Virtual Job) Northern/Central New Jersey

Key Responsibilities:  Prepares correspondence as needed.  Helps prepare bulk mailings. Makes and confirms appointments on behalf of Development Director. Follow up phone calls to  sponsorship and gifts-in-kind solicitations/proposals and silent auction item requests. Prepares and maintains sponsor, donor and  vendor database. Records donations that come and enters in database. Follow up phone calls to other who are assigned to other event development projects as needed. Other duties as assigned.

Reports To:  Development Director

Length Of Appointment:  Event Development Assistant is assigned to one day per week for a  minimum  period of three months. After three months, the Event Development Assistant may be reappointed for another three months at the discretion of the supervisor. After six months, the person who is serving may rotate to another position within the agency or be hired as a paid staff member.

Time Commitment:  One day per week (M, W, or F) for six hours (9AM -12 PM  or 1PM to 4PM), for a minimum of three months.

Qualifications:  Dependability. Problem solving ability, pleasant disposition and manner. Basic knowledge of computer and data entry. Basic customer service or call center knowledge.  Bi-Lingual preferred but not required.

Support: Training for this position will be available. In addition the Program Manager/ Development Director will be available for questions and/or assistance.

Age Requirements:  21 and over

Dress Code: Business Casual

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Faces of Thyroid Cancer: Reggie Deal

Thyroid Cancer Survivor Reggie Deal is Blind

From his seat in an upper-reserved section of Rangers Ballpark on Sunday night, Reggie Deal couldn't see the ballgame the Rangers and Rays were playing.  But he could hear it, he could smell it, he could sense it. For Deal, baseball provides a pull that goes beyond the boundaries of the blindness he's been inflicted with virtually all of his 39 years. Baseball is his passion, if not his outright obsession.

"There are a lot of things you're able to experience," he said, "when your faculties take over and supplement what's not there."  Simply being there -- in the stands, with the game playing out in front of him, his fellow fans beside him and the sounds of the sport surrounding him -- is an experience that means a lot to Deal.And that's why Sunday was the start of something special.

In the span of 30 days, Deal is going to visit each of the Major Leagues' 30 ballparks. He'll traverse the country, mostly on his own, via bus and plane, taxi and train, all with an end goal of fulfilling a lifelong dream while simultaneously showing others his is a life without all the perceived limits.

Crazy? Sure, it's a little crazy.

But having survived a thyroid-cancer scare a few years back, having married a woman who's a big believer in scratching items off life's "bucket list" and having spent weeks poring over team schedules and laboring over the logistics, Deal, an Afton, Wyo., resident, realized this little dream of his was just crazy enough to come true.

"I want people to have a different visual of what blindness entails," he said. "People get caught up in the negative, but there are ways to work around it."

Deal has had to work around it essentially from the beginning. He was born prematurely in 1973, and doctors told his parents his odds of survival were one in four. He was placed in an incubator that helped his lung tissues develop and heal, but the environment was 90 percent pure oxygen, or roughly 4 1/2 times the typical atmospheric setting. The prolonged exposure caused Reggie's retinas to hemorrhage and detach from his eyes, permanently blinding him.

"They're much more watchful for signs of issues now than they were back then," Deal said. "While it's still a threat for kids born that early, it's something they can mitigate now, more than 35-40 years ago."

He's never felt cheated, never felt wronged. His blindness is all that he's known, and it certainly didn't stop him from earning his bachelor's degree in journalism at Texas A&M or his master's in education counseling from Texas State University-San Marcos. Yet it wasn't until the cancer diagnosis four years ago when Deal truly gained perspective on life's fickle and fleeting nature. And that only further fueled his desire to do the 30-in-30 tour.

"I had planned to meet a friend in California, and we were going to go to a Padres game and then an Angels game," he said. "But I had to cancel that at the last minute because I had not been feeling well. Only a couple weeks after that, the doctors noticed I had an enlargement on the thyroid. They said, 'This has got to come out.'"

The cancer diagnosis came in late June of 2008, and the surgery was performed on July 14. One week post-op, Deal met with his doctor and was given a green light to start traveling again. He went straight from the doctor's office to the airport, hopped on a flight to Philadelphia and took a train to New York to see consecutive games at Yankee Stadium and Shea Stadium.

Yep, it's an obsession, all right.

"With everything that went on that summer, baseball was the one distraction that I had," he says. "It kept me halfway sane." And so when Deal, now cancer-free, met his wife, Lorna, through an online dating service in 2010, she quickly caught on that baseball is part of the package. "He picks up on so many aspects of the game," she said. "He can explain to you everything that's happening, and he just has an intense passion."

The passion to experience every park became a little more realistic when Deal left his job in student affairs at a Texas community college to move to Wyoming to be with Lorna, a teacher. He'll be looking for a new job in the fall, but in the meantime, he's taking full advantage of the time off. And when he inherited some money after his father passed away last year, he had funding to apply to the trip.

So Reggie plotted his Major League map as soon as the 2012 schedules came out. His travels will involve some tight turnarounds, late nights and early flights. And though he'll be meeting up with several friends along the way, he'll largely be flying solo.

"It makes me a little bit nervous," said Heather Compton, a friend of Reggie's who accompanied him to the Rangers game, "because it's so easy for somebody to take advantage of him. But he's pretty aware. He's learned how to handle himself, and he's one of those people that it only takes a few minutes to become friends with him. You can be perfect strangers one minute and friends the next."

Deal plans to make many new friends on this trip. At each game, he'll have the local radio broadcast playing in one ear -- loud enough to follow the action but quiet enough to interact with those around him. He'll be recapping his experiences on his MLBlog and on his Facebook page, and he'll also be wearing a wristband and shirt promoting ThyCa (the Thyroid Cancer Survivors' Association) -- a cause that's obviously grown near and dear to his heart.

Why would a blind man go to such great lengths to experience and document something he'll never see? Easy.  Because he can, and because he wants you to know he can. "People ask me, 'How can you enjoy the game without seeing it?'" he said. "I say, 'You don't realize how much of the game you can pick up on until you close your eyes.'"

Article by Anthony Castrovince is a reporter for MLB.com. Read his columns and his blog, CastroTurf, and follow him on Twitter at @Castrovince. This story was not subject to the approval of Major League Baseball or its clubs.

WHEre IS REGGIE? 30 PARKS, 30 DAYS

A blind fan's journey through the Major Leagues

Date/Stadium
April 29: Rangers Ballpark, Arlington
April 30: Minute Maid Park, Houston
May 1: Turner Field, Atlanta
May 2: Busch Stadium, St. Louis
May 3: Kauffman Stadium, Kansas City
May 4: Tropicana Field, St. Petersburg
May 5: Citi Field, New York
May 6: Nationals Park, Washington, D.C.
May 7: Oriole Park, Baltimore
May 8: Citizens Bank Park, Philadelphia
May 9: Yankee Stadium, New York
May 10: Fenway Park, Boston
May 11: Target Field, Minneapolis
May 12: Chase Field, Phoenix
May 13: The Coliseum, Oakland
May 14: AT&T Park, San Francisco
May 15: Dodger Stadium, Los Angeles
May 16: Petco Park, San Diego
May 17: Angel Stadium, Anaheim
May 18: Rogers Centre, Toronto
May 19: Comerica Park, Detroit
May 20: Coors Field, Denver
May 21: Safeco Field, Seattle
May 22: Miller Park, Milwaukee
May 23: Progressive Field, Cleveland
May 24: Great American Ball Park, Cincinnati
May 25: PNC Park, Pittsburgh
May 26: Marlins Park, Miami
May 27: U.S. Cellular Field, Chicago
May 28: Wrigley Field, Chicago