ThyCa Salivary Gland Survey 12-6-2010

1. Introduction

Dear Thyroid Cancer Survivor:

The purpose of this survey is to identify whether or not you had several side effects from your last 131-I therapy and to help identify factors that may have increased, decreased, or prevented these side effects.

The results of this survey may be very valuable in the future management of 131-I therapies. Your responses are voluntary, anonymous, and will not affect your relationship with MedStar Health, Washington Hospital Center, Mayo Clinic, Carolina Medical Center, and/or ThyCa: Thyroid Cancer Survivors' Association, Inc.

If you are a guardian of a minor or another individual who received an 131-I therapy, please complete this survey for that individual.

In advance, thank you for your participation.

The ThyCa Survey Committee

Financial Disclosure: None of the members of this survey committee have received any funding from any organization for the development of this survey.

Committee Members are:

Gary Bloom, Executive Director and Co-Founder
ThyCa: Thyroid Cancer Survivors' Association, Inc.
Washington, D.C.

Douglas Van Nostrand, MD, FACP, FACNM
Committee Chair
Director, Division of Nuclear Medicine
Washington Hospital Center
Professor of Medicine, Georgetown University Hospital Center
Washington, D. C.

Bryan McIver, MB PhD
Consultant and Chair, Thyroid Group
Division of Endocrinology,
Mayo Clinic
Rochester, Minnesota

Michael T. Brennan, DDS, MHS, FDS RCSEd
Associate Chairman
Director, Sjögren’s Syndrome and Salivary
Disorders Center
Carolinas Medical Center
Charlotte, North Carolina

Gauri Khorjekar, MBBS
Nuclear Medicine Research Coordinator
Washington Hospital Center
Washington, D.C.

Pejman Kharazi, MD
Nuclear Medicine Research Coordinator
Division of Nuclear Medicine
Washington Hospital Center
Washington, D.C.
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