Dr. Steve Martinez joined hosts Shannon O’Kelley, Physical Therapist and President of Integrated Rehabilitation Group, and Maury Eskenazi, radio personality from Fox Sports radio on Health Matters radio, KRKO 1380am, with thanks to Integrated Rehabilitation Group physical and hand therapy. He talked about thyroid and parathyroid surgery.
Read the transcript of Dr. Steve Martinez' talk on thyroid surgery on Health Matters radio or listen here.
Health Matters: Welcome back to Health Matters. Maury Eskenazi, Shannon O'Kelley, and we are happy to have joining us from The Everett Clinic, he is a surgeon, Dr. Steve Martinez.
Health Matters: So, we are gonna talk about thyroid surgery and problems with thyroids, and, so let's talk about your specialization.
Dr. Martinez: Sure. Well, I'm trained as a general surgeon, and then, in addition to my training in general surgery, I also have some specialty training in surgical oncology. As part of that training in surgical oncology, or cancer surgery, I trained with some people who are pretty expert in doing endocrine or thyroid and parathyroid surgery, so that's sort of how I've come here to The Everett Clinic.
Health Matters: So, remind us what the function of the thyroid is.
Dr. Martinez: Your thyroid gland really works to help lots of systems function. You can think of it almost like the engine of your metabolism. If you consider your body like an engine, your thyroid is going to produce some hormones that really help drive that engine. And, your thyroid can over perform or drive the engine hot, in which case people can have an overactive thyroid, or it can run the engine cold, in which case you can be in a low thyroid condition or hypothyroid.
Health Matters: If your thyroid is too fast, then what happens to you?
Dr. Martinez: You just imagine. Being that engine in the red, your heart can be beating 100 times plus a minute. So, fast heart rate.
Health Matters: RPMs are way up.
Dr. Martinez: And you can be sweaty, even in an air conditioned room.
Dr. Martinez: If you think about that, even the gastrointestinal, the gut, starts working overtime and you can have problems with diarrhea, sweats, and people can have weight loss. And, if the condition lasts too long, well you can even start losing muscle and bone.
Health Matters: And, it's a little tiny gland. Tell us where it's located anatomically.
Dr. Martinez: It's right over your windpipe, just right below your Adams apple or your voice box. It's a butterfly-shaped gland. Usually, it’s about the size of a small butterfly in the normal state, but it can be abnormally enlarged in people. That's a condition called goiter.
Health Matters: So, we heard what happens if your thyroid moves too fast. What if it's like really slow, what happens? Dr. Martinez: So, engine’s running cold. All the opposite things. You can have a slow heart rate. And, even though you're in a nice heated environment, you can feel cold all the time. You can hang onto the pounds. You can gain weight. And, instead of diarrhea, constipation. That can be equally miserable.
Health Matters: My question is the thyroid is this small, yet very important gland that we have in our body. What drives the thyroid and what communicates the thyroid to rev your body up or slow your body down?
Dr. Martinez: Sure. The thyroid's main purpose, or one of the main purposes is to produce hormones. There are a couple of different hormones that it produces. We'll call them T3 and T4, and they really function to drive all these systems in our body. They work on helping all the cells in your body use oxygen at different levels, really drive the metabolism, and it's the effect of those hormones that give all the effects of too high or too low...
Health Matters: And, we sometimes hear about parathyroid. Tell us about parathyroid.
Dr. Martinez: Parathyroid. It's a very good name, para meaning next to, so these are glands that are next to the thyroid gland. There are four of them in most people, and these are normally about pea-sized glands. They are really pretty small and tucked in behind the thyroid gland, two on the top, two on the bottom. And, their main function also is to produce a hormone cleverly called parathyroid hormone, and the main function of that hormone is to help keep calcium at a constant level in your bloodstream, so it really helps raise the level of calcium in your bloodstream. Everything is in a really nice balance in our bodies if things are working fine. If the calcium in our bloodstream is low, the little detectors on our parathyroid glands will sense that, start producing hormone, which sends signals to our body to absorb more calcium from what we eat in our diet through our intestines, and will help us reabsorb calcium from the #1 store in our bodies, the bones, and so we can raise the calcium level in our bloodstream by those two mechanisms. Once it gets to a certain level, those sensors kick in and our parathyroid hormone will shut down so everything is always in a nice balance.
Health Matters: We're talking to Dr. Steve Martinez from The Everett Clinic about thyroids and parathyroids. So, when would you have to have your thyroid removed?
Dr. Martinez: There are a couple of reasons. One is they have a biopsy that shows cancer, and that's, you know, a relatively common occurrence. It happens to be a very easily treated cancer in most cases. That's one reason. Another reason we talked about earlier, enlargement of the thyroid gland, or a goiter, and not just any goiter, but a goiter that really is causing symptoms…difficulty breathing, pressure sensations, difficulty swallowing liquids or solids. If any of those things are occurring, it's probably due to compression from this large thyroid gland.
Health Matters: What are the symptoms for cancer?
Dr. Martinez: Most people with cancer aren't going to have elevated thyroid hormone, they're not going to have low thyroid hormone. Usually, it's within the normal range when we measure it. They usually present with either a palpable lump in the front of their throat, or if they had a CAT scan, a CT scan of the chest, or ultrasound of their neck for another reason, with thyroid nodules or lumps. We become concerned about those nodules when they are one centimeter in size or greater, which is about the size of your small fingernail. Anything that's a centimeter or greater in size we believe should be biopsied because the risk that that nodule may harbor an underlying malignancy becomes higher the larger that nodule grows.
Health Matters: Statistically speaking, is there is a time in one's life that they should be looking for this? And is it gender specific, more female than male?
Dr. Martinez: Thyroid and parathyroid conditions are more common in females. But, certainly, men can have the conditions with their thyroid as well, more commonly in the middle of life — in the 40s to the 60s. That said, the youngest person I have treated for a papillary thyroid cancer was somebody 6 years old, and other types of thyroid cancer can even occur in people younger than that. But, that is, not the norm.
Health Matters: So, thyroid cancer, you said, is very treatable and the survival rate is good if you catch it in time?
Dr. Martinez: Right. There are three main types of thyroid cancer. The most common type are so-called well-differentiated thyroid cancer or papillary and follicular thyroid cancers. They make up the bulk of the thyroid cancer that we see, and the survival rate is outstanding. Usually, in cancer we talk about how many people survive five years. We can't do that with this type of thyroid cancer, because everybody lives five years. We have to talk about 20-year survival, and it's really outstanding and very easily treated with surgery.
Health Matters: Has it changed in the last 10 years?
Dr. Martinez: There have been some improvements in treatment, but the overall survival rate has not improved that much. It was so good to begin with.
Dr. Martinez: The one thing that has changed that has driven things a little bit in a positive or good direction is more commonly now when people have a thyroid cancer, they e will now have a total thyroidectomy or all of the thyroid will be removed rather than just the half that has the nodule.
Health Matters: What replaces all those regulatory hormones that the thyroid produces if you take it out?
Dr. Martinez: Just a little pill a day. Usually, that pill a day, the initial dose is given by your doctor and based on your weight, and then about six weeks later, once we get some time for that medicine to sort of equilibrate in your bloodstream, then we check the hormone level again and we adjust it from there. But, really, it's just a pill a day and we can duplicate the effects of that thyroid hormone.
Health Matters: Interesting. Is there a self-exam that one should know or do?
Dr. Martinez: There are a couple of things that you can look out for. Certainly, we talked about a nodule that you can feel. Sometimes, people can even see the nodule when they are looking at you and talking to you, or an enlargement of the thyroid. They'll say, "Hey, you know, have you gotten that checked out?" I don't know how many mothers have brought in their daughters and sons and said, "Well, I noticed it, when taking pictures.” Also, some hoarseness in the voice that is new or unexplained can also be a sign of a growing nodule that is sort of stretching the vocal nerve.
Health Matters: You are listening to IRG Health Matters right here on FOX Sports 1380 KRKO radio. So what happens to the parathyroid after your thyroid is removed?
Dr. Martinez: Hopefully nothing.
Health Matters: So, you don't take the parathyroids when you take the thyroid.
Dr. Martinez: The ideal situation, if the parathyroids are normal, is to leave them in place when we're doing thyroid surgery. But, they’re pretty sensitive glands. I They are very small, usually the size of a pea or a raisin normally. Their blood supply, when the thyroid is removed, can get damaged, and sometimes that damage will cause those glands not to work anymore. The good news in that bad scenario is, in most cases, you only need part of one of your parathyroid glands to continue working in order to maintain normal function. It’s pretty unusual for all four of the parathyroid glands to be damaged.
Health Matters: Is there any future in transplants, or growing thyroid in a lab and then retransplanting it?
Dr. Martinez: Sure. Actually, both of those have been tried and done. The most common thing that I will do when I am operating on somebody's thyroid is after the thyroid is removed I'll take a look at all of the parathyroid glands, and if any of them look a little bit blue or sort of dusky or beat up, I'll simply remove that gland, mince it up into little pieces, and I will transplant it into the muscles in the neck. It's called an autotransplantation. About 90% of the time that gland will maintain normal function.
Health Matters: That's unbelievable. Is that a new process?
Dr. Martinez: It's not new. It's been done for a fair number of years, but there are newer techniques of doing it where instead of mincing it up you can really sort of make almost like a parathyroid soup, you mince it up very fine, mix it up with some salt water or saline, and then use a syringe and inject it into the muscle, but the same idea holds - you need to put it into some muscle so it gets a good blood supply.
Health Matters: So, hang on here. So, you're basically, facilitating these parathyroid cells and injecting them in this person's muscle, and then the body recognizes those cells and that grows a parathyroid?
Dr. Martinez: That's exactly right.
Health Matters: The body's amazing, isn't it?
Health Matters: Well, what's neat about modern medicine is just everything that's going on and all the minimally invasive surgical techniques, and just with this cancer we're talking about, thyroid cancer. And, if you go back 100 years or 50 years, what were the options for people versus today?
Dr. Martinez: First of all, it was usually diagnosed relatively late, when it's very palpable, where it's large enough to see. Now what do we have? We have folks that can be tested with ultrasound, so you can find these cancers earlier, when they are smaller and easier to treat. In terms of minimally invasive techniques, and specifically for parathyroid glands, we can make a very small incision, really no wider than my thumb, and look at all four of the parathyroid glands and remove the abnormal one. That entire process can be done in really no longer than 20 minutes, half an hour. It's really quite remarkable. We have tests now that can before the operation localize which gland is the abnormal one.
Health Matters: Another one of your specialties is in breast cancer. Is it getting better? Breast cancer?
Dr. Martinez: Absolutely. I mean, if I look at even from the time I started my medical training to now, survival has improved. We have more drugs to treat it. We have better ways of treating it. There are new surgical techniques. There are less invasive techniques to treat it. So, absolutely, it is getting better and I have always told my patients that this is one type of cancer where I could see within my lifetime we can potentially medically treat, where we perhaps may no longer need to do surgery at one point.
Health Matters: Tell us the process. You're a general surgeon. What is the educational process for general surgeons?
Dr. Martinez: The typical length of time of a general surgery residency is five years. The first year of that is an internship, and that's really the most brutal year. That's where you're doing all the dirty work and taking care of patients on the floor and learning about the medications, and learning how to assist in the operating room, learning about problems and complications that can arise.
Health Matters: Where did you do this at?
Dr. Martinez: I did my general surgery residency at SUNY Stony Brook out in Long Island, New York.
Health Matters: Is that when you like work like 27 hours in a row, that type of thing?
Dr. Martinez: Well, my wife, Mrs. Martinez, she counted the number of hours that I was working so late...and, she tells me it was much higher than that. Some of the weeks, they were 125-hour work weeks.
Health Matters: Are they still doing that now?
Dr. Martinez: They are not.
Health Matters: What do you think about that?
Dr. Martinez: It’s good and bad. It's certainly not great to keep somebody in the hospital that long in a condition of fatigue. It's not safe for patients. We know it's not safe for patients. On the other hand, I saw the value in having that prolonged period of time of patient contact. There's a book out that talks about people getting good at things, it takes 10,000 hours to really obtain proficiency in anything, whether you're a guitar player or a carpenter. In this case, being a physician, it takes time to get good at any craft so you have to put in the time. If you're going to trade off not doing long hours, I think we have to increase the length of time of residencies in the future, or get smarter about different ways of teaching that same information.
Health Matters: After your internship, do you have 4 years or 5 years of surgical residency?
Dr. Martinez: The standard length of time is to do an additional 4 years. I did an additional 5 years because I did a year of research in residency as well, some oncology research, and then, after that you can further specialize. If you wanted to, say, become a surgeon that does colon surgery or plastic surgery or heart surgery, you have to do some additional specialty training on top of that. In my case, I did surgical oncology, or cancer surgery.
Health Matters: You were drawn to this surgical oncology side of the business because?
Dr. Martinez: Well, if I look back, the patients that I enjoyed dealing with the most were really the cancer patients. Why? Because, they didn't want to hear any story from you, they just really wanted to know what their situation was, what the plan was, and what I could do to make it better. I liked the fact that for most of the patients what we did as surgeons really helped. It was usually the critical part of their treatment. That's not always true, unfortunately, but I really loved the intervention and seeing the result.
Health Matters: Good stuff. And, real quick, as we wrap up, why Everett?
Dr. Martinez: Why Everett? You know, this is just a fantastic group of providers. I think we have everybody here from the specialists in medical oncology, or we're talking about thyroid and parathyroid. We have great endocrinologists here. It was really the group of people and the opportunity to really primarily take care of patients first, and it's really done so efficiently with this group. I have just been really happy.
Health Matters: everettclinic.com is where you go and find out all information, and that's how you get a hold of Dr. Steve Martinez. Thanks so much for coming on with us.
Dr. Martinez: Thanks for having me.
Health Matters: Surgeons are pretty cool.