Author: Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

Thyroid Physiology and Pregnancy

May 27, 2019 Rodrigo Arrangoiz MS, MD, FACS, FSSO

Relative+changes+in+maternal+thyroid+function+during+pregnancy+-

Significant changes in thyroid physiology take place during pregnancy that can make the interpretation of thyroid function tests challenging.
Tyroxine binding globulin (TBG) levels:
- Increase by 50% by the end of the first trimester of pregnancy:
  - Which greatly increases the protein-bound levels of T4 and T3:
    - Resulting in an apparent elevation of measured T4 and T3.
- The changes in TBG are thought to be due to:
  - The direct effect of estrogen:
    - With an increase in the liver production and glycosylation of TBG.
- Despite the elevation of protein-bound thyroid hormones during pregnancy:
  - The active or free levels of T4 and T3 remain normal in euthyroid patients:
    - As reflected by a normal serum TSH level.
During the first trimester:
- The placental human chorionic gonadotropin (hCG) increases:
  - And peaks at approximately 12 to 14 weeks of pregnancy and then decreases to a lower plateau in the second and third trimesters in the euthyroid individual.
- hCG has a weak TSH-like activity:
  - Resulting in a small increase in free T4:
    - Which usually remains in the normal range, and a concomitant decrease in TSH.
Up to 13% of women during the first trimester have unmeasurable TSH levels (< 0.1 mud/L) with a normal or slightly elevated FT4I and are clinically euthyroid:
- This suppression of TSH usually normalizes after the first trimester of pregnancy.

Rodrigo Arrangoiz MS, MD, FACS a head and neck surgeon / endocrine surgeon / surgical oncologist and is a member of Sociedad Quirúrgica S.C at the America British Cowdray Medical Center in Mexico City:

He is an expert in the management thyroid cancer

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

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#CirugiaEndocrina

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#CirujanodeCabezayCuello

http://www.cirugiatiroides.com

http://www.sociedadquirurigca.com

http://www.hiperparatiroidismo.info

Reconsidering the Treatment of Multifocal Papillary Thyroid Carcinoma

May 24, 2019 Rodrigo Arrangoiz MS, MD, FACS, FSSO

Presentation1

In sporadic papillary thyroid cancer (PTC):
- Multifocal tumors are common, particularly in familial PTC syndromes (such as those driven by PTEN mutations).
Initially thought to be genetically distinct tumors:
- It is now recognized that a mixture of individual clones and intrathyroidal metastases can be present in sporadic multifocal PTC.
Historically:
- The presence of multifocal disease has been interpretedas conveying an increased risk for disease recurrence.
- And has been used to determine the extent of surgery and the use of adjuvant radioiodine administration for individual patients.
Current National Comprehensive Cancer Network (NCCN) guidelines list macronodular multifocal PTC (one tumor focus >1 cm) as a clinicopathologic factor that can supportthe use of radioiodine (RAI).
American ThyroidAssociation (ATA) guidelines state that the presence of multifocal micronodular PTC:
- Is a low-risk feature and should not prompt the use of RAI:
  - However, they do not comment on macronodular multifocal disease.
The current study sought to clarify theassociation of multifocal PTC with disease-specificrecurrence and long‐term outcomes using a novel propensity score–matching analysis (6).

https://www.liebertpub.com/doi/pdf/10.1089/ct.2019%3B31.204-206