Thyroid Health Problems Overview

The thyroid gland is located on the front part of the neck below the thyroid cartilage (Adam's apple). The gland produces thyroid hormones, which regulate body metabolism. Thyroid hormones are important in regulating body energy, the body's use of other hormones and vitamins, and the growth and maturation of body tissues.

Diseases of the thyroid gland can result in either production of too much (overactive thyroid disease or hyperthyroidism), too little (underactive thyroid disease or hypothyroidism) thyroid hormone,thyroid nodules, and/or goiter. All types of thyroid problems in women are much more common than thyroid problems in men.

• Production of thyroid hormones: The process of hormone synthesis begins in a part of the brain called the hypothalamus. The hypothalamus releases thyrotropin-releasing hormone (TRH). The TRH travels through the venous plexus located in the pituitary stalk to the pituitary gland, also in the brain. In response, the pituitary gland then releases thyroid-stimulating hormone (TSH) into the blood. The TSH travels to the thyroid gland and stimulates the thyroid to produce the two thyroid hormones, L-thyroxine (T4) and triiodothyronine (T3). The thyroid gland also needs adequate amounts of dietary iodine to be able to produce T4 and T3.

• Regulation of thyroid hormone production: To prevent the overproduction or underproduction of thyroid hormones, the pituitary gland can sense how much hormone is in the blood and adjust the production of hormones accordingly. For example, when there is too much thyroid hormone in the blood, TRH and TSH production are both decreased. The sum effect of this is to decrease the amount of TSH released from the pituitary gland and to reduce production of thyroid hormones from the thyroid gland to restore the amount of thyroid hormone in the blood to normal. Defects in these regulatory pathways may result in hypothyroidism (underactive thyroid problem) or hyperthyroidism  (overactive thyroid problem).
  
  
• Thyroid goiter: Thyroid goiter is any enlargement of the thyroid that can occur with hyperthyroidism or hypothyroidism but also with benign and malignant (cancerous) nodules. Worldwide, the most common cause of goiter is iodine deficiency. Although it used to be very common in the U.S., it is now less common with the use of iodized salt. Multiple nodules in the thyroid are very common, but only about 5% of the nodules are a thyroid cancer. Thyroid cancer is diagnosed after a thyroid ultrasound exam and a needle aspiration biopsy of the nodule.

Pregnant? Talk To Your Doctor About Thyroid Health Conditions Today

Hypothyroidism in Pregnancy

Newly diagnosed hypothyroidism in pregnancy is rare because most women with untreated hypothyroidism do not ovulate or produce mature eggs in a regular manner, which makes it difficult for them to conceive.

It is a difficult new diagnosis to make based on clinical observation. The signs and symptoms of hypothyroidism (fatigue, poor attention span, weight gain, numbness, and tingling of the hands or feet) are also prominent symptoms of a normal pregnancy.

Undiagnosed hypothyroidism during pregnancy increases the chance of stillbirth or growth retardation of the fetus. It also increases the chance that the mother may experience complications of pregnancy such as anemia, eclampsia, and placental abruption.

Probably the largest group of women who will have hypothyroidism during pregnancy are those who are currently on thyroid hormone replacement. The ideal thyroxine replacement dose (for example, levothyroxine [Synthroid, Levoxyl, Levothroid, Unithroid]) during pregnancy may rise by 25% to 50% during pregnancy. 

It is important to have regular checks of T4 and TSH blood levels as soon as pregnancy is confirmed; and frequently through the first 20 weeks of pregnancy to make sure the woman is taking the correct medication dose.

Hyperthyroidism in Pregnancy

Newly diagnosed hyperthyroidism occurs in about 1 in 2,000 pregnancies. Grave's disease accounts for 95% of cases of hyperthyroidism newly diagnosed during pregnancy.

As with hypothyroidism, many symptoms of mild hyperthyroidism mimic those of normal pregnancy. However, anyone experiencing symptoms such as significant weight loss, vomiting, increased blood pressure, or persistently fast heart rate should have blood tests to evaluate whether hyperthyroidism is present.

Untreated hyperthyroidism does cause fetal and maternal complications including poor weight gain and tachycardia (an abnormally fast heart rate).

Treatment of hyperthyroidism during pregnancy is primarily medical.Propylthiouracil or methimazole (Tapazole) are the usual first-line agents to block the synthesis of thyroid hormone. They appear to be equally effective and have the same rate of side effects. The rate of side effects of each medication is not increased in pregnancy.

Iodine will cross the placenta, so its use in either a thyroid scan or in treatment with radioactive iodine is prohibited in pregnancy. One positive note for women with hyperthyroidism is that those with Grave's disease or Hashimoto's thyroiditis may have improvement in their symptoms during pregnancy.

Goiter in Pregnancy

It is common for a goiter to enlarge slightly during pregnancy. It is more common when the mother lives in an area of iodine deficiency. In the United States, the average intake of iodine is adequate but can be low if someone avoids consumption of milk, eggs, and iodized salt. Not all prenatal vitamins contain iodine, but it is recommended that only prenatal vitamins that contain iodine should be used during pregnancy.

Postpartum Thyroid Disease

Some women may have thyroiditis that usually occurs within 3 to 6 months after giving birth. It also may occur after miscarriage. The classic clinical picture is a woman who will first have symptoms of hyperthyroidism, followed by hypothyroidism, culminating in normal thyroid function.

Women with type I diabetes have a 25% risk of developing postpartum thyroid dysfunction.  Consult your doctor if you have symptoms of hypothyroidism or hyperthyroidism after pregnancy or miscarriage.

AWARENESS VIDEO: Life with Thyroid Disease

The first ever International Thyroid Awareness Week (25 - 31 May 2009) aims to raise awareness and educate people about the critical role the thyroid gland plays in our wellbeing.  There are millions of people across the world who may be suffering needlessly because they are unaware of the symptoms or impact of thyroid problems. 

To Learn More Visit: www.thyroidweek.com. 

Long Term Risks of I-131 RAI Treatment

In general, RAI (radioactive iodine) is a safe and effective treatment for the thyroid disorders mentioned in the prior blog posts. When RAI is used as treatment for hyperthyroidism, it is difficult to avoid development of hypothyroidism. Hypothyroidism is, therefore, watched for by your medical team and quickly treated with thyroid hormone pills.

Your doctor should discuss with you the risk of a small increase in the risk of developing thyroid cancers after RAI treatment for hyperthyroidism, although this has not been seen in all studies conducted, enough variables have been documented to warrant an informed discussion about the risk versus the individual benefits of RAI treatment for hyperthyroidism.

Although radiation kills cancer cells, it can also damage normal tissues and, over time, transform a small percentage of normal cells into cancer cells. This "second cancer" (if you are a thyroid cancer patient) develops in or near the previously treated radiation field, usually ten years or longer after initial radiation treatment has ended. The most common type of radiation induced cancer is sarcoma.

Importantly, then is that you must always remember that once you have been treated with RAI for any reason at all you need to have regular exams by your physician for the rest of your life. If you change doctors, see a dentist or have any emergency room treatment you must make sure you advise the treating provider that you have received RAI and when.

Doses of RAI used to treat thyroid cancers can cause permanent problems with the salivary glands leading to loss of taste and dry mouth. However, precaustions are taken to try to prevent these issues (i.e. using lemon drops or sour candy regularly for the first 14 days after RAI treatment). Temporary or permanent decreases in blood cell counts can also occur.

SPECIAL CONCERNS FOR WOMEN 

RAI, whether I-123 or I-131, should never be used in a patient who is pregnant or nursing. RAI given during pregnancy can damage the fetus (baby) thyroid gland. RAI given to a woman who is nursing can get into the breast milk and therefore expose the baby to radiation. Also, pregnancy should be put off a minimum of 6 months and preferably 12 months after RAI treatment since the ovaries are exposed to radiation during RAI treatment. Women who have not yet reached menopause are asked to fully discuss these precautions about the use of RAI with their doctors. There is no clear evidence that RAI leads to infertility.

SPECIAL CONCERNS FOR MEN

Men who receive RAI treatment for thyroid cancer may have decreased sperm counts and temporary infertility for periods of roughly 2 years. A doctor may discuss sperm banking with male patients who are expected to need several doses of RAI for thyroid cancer treatment.

GENERAL PRECAUTIONS FOR EVERYONE

Since I-131 RAI produces radiation, patients must do their best to avoid radiation exposure to others, particularly pregnant women and children under the age of 18, especially infants and small pets. Therefore, there are certain precautions that patients who have been treated with RAI are expected to follow after their treatment. These guidelines comply with the Nuclear Regulatory Commission and will be reviewed with patients by the medical institutions giving treatment on a case by case basis according to the dose used for individual patients.

Importantly, the amount of radiation exposure markedly decreases as the distance from patients increases. Patients who need to travel within six months from the time after receiving I-131 treatment and/or expect to visit federal government buildings are advised to carry a letter of explanation with them from their doctors. This is because radiation detection devices used at airports or in federal buildings may pick up even radiation levels considered safe and non-harmful to others.

I-131 Basics: Radioactive Iodine in the Treatment of Thyroid Cancer

As you probably already know, as a follower of my blog and facebook pages, my baby girl (22 years old, but forever my baby anyway) is a metastatic thyroid cancer patient. Most people simply assume that since thyroid cancer is generally referred to as a type of cancer with high cure rates and survival statistics, it is not a cancer we need to concern ourselves with much.

Well I hate to be the one to have to wake you up from the "fantasy" of a cancer many insensitive medical professionals and ill informed people call the "best cancer you can have".

~~Cancer~~ a devastating word to hear, and a phenomenally frightening diagnosis to deal with emotionally, physically and financially no matter the type, stage or age at onset.

In the case of thyroid cancer, the fastest increasing newly diagnosed cancer in America today, the many long term unknowns for the growing number of young survivors is not as reassuring as orignally thought of. A growing number of young people are developing persistent and/or recurrent cancer in the thyroid bed, many are developing metastatic disease like my daughter. Some may be genetically predisposed to the condition, many others will never know why they hit "the thyroid cancer lottery" at all. Yet another small percentage of survivors will develop another type of cancer somewhere down the line as result of the treatmetn they receive to treat the original thyroid cancer at an early age.

In this section/article I will share with you what nobody told me and you should know about I-131 RAI Treatment for thyroid disorders is the isotope used to destroy both normal and cancerous thyroid tissue.

1. NORMAL THYROID TISSUE:

Small doses of I-131 (5 t0 30 millicures, mCi) are given to destroy or "ablate" overactive thyroid tissue. This usually turns an overactive thyroid gland, with time, into and underactive thyroid gland. Doses of I-131 in the middle range (25 to 75 mCi) may be used to shrink large thyroid glands or goiters that are functioning normally but are causing breathing problems because their large size my compress the trachea (windpipe).

Patients must go directly home after I-131 RAI treatment, although they are asked to follow certain precautions. Temporary worsening of hyperthyroid symptons may occur within the first two weeks of I-131 treatment for hyperthyroidism, which can be easily treated with medicines called beta blockers. This medicine will be prescribed by your doctor. It is also common for patients to experience some temporary discomfort in the thyroid gland or lower neck area within 1 to 14 days after I-131 treatment for hyperthyroidism.

The discomfort may mimic the feeling of a sore throat. Aspirin, Ibuprofen (Advil) or Acetaminophen (Tylenol) may be used to treat discomfort. These side effects may last up to two weeks. The RAI treatment may take up to one to six months to have it's full effect. A small percentage of patients may require a second course of treatment.

2. THYROID CANCER TREATMENT:

Ablative doses of I-131 RAI (50 to 120 mCi) are usually given to destroy any remaining normal thyroid tissue that is commonly left following thyroidectomy. Because of the vital structures in the area of the thyroid gland, the surgeon may leave a small amount of thyroid tissue or gland behind, specially to preserve the tiny parathyroid glands that are embedded along the posterior (back side) of the thyroid gland. The remaining thyroid tissue will usually out-compete any thyroid cancer for the I-131 uptake ! Therefore, any residual thyroid tissue must be removed before persistent thyroid cancer or spread of thyroid cancer (metastatic disease) may be evaluated.

A post ablation thyroid scan is performed 10-14 days after thyroid ablation therapy which may show a large thyroid tumor, but mainly serves as a baseline study for future comparison. Larger doses of I-131 (80 to 200 mCi) are used to destroy residual thyroic cancer or any spread of the tumor to other sites or internal organs (metastatic disease). I-131 has been referred to as the "magic bullet" for treating most common types of thyroid cancer but as with any cancer early detection and early treatment are key in the race to cure theses types of cancers. In the case of my daughter Stevie JoEllie, but rarely in most cases, even higher doses of I-131 are given and most hospitals will generally keep you isolated in a special room anywhere from 24 hours to a few days to avoid exposing other people to radiation.

Please remember unless you receive unusually high doses of I-131 you will be allowed to return home the same day you receive your treatment, although precautions should be taken if you have small children or pets in your home, it is perfectly safe for most patients receiving small to medium I-131 doses to rest at home for a few days before returning to their regular activities. Keep in mind that since salivary glands weakly concentrate iodine, no matter what dose of I-131 you receive, there may be discomfort and swelling of the salivary glands. This can be prevented or greatly reduced by sucking on lemon drops or sour candies for up to 2 weeks after your I-131 treatment.

3. RADIATION EXPOSURE PRECAUTION INSTRUCTIONS AFTER I-131

This list outlines radiation exposure precautions to observe to minimize risks for your family, friends and co-workers after treatment. Please remember to consult your doctor and follow his instructions for YOU -- the precaution durations vary according to the dose of I-131 you receive.

ACTION DURATION

• Drink 12 -8oz glasses of fluids daily 2 to 7 days
• Do not prepare food for others 2 to 7 days
• Do not share utensils with others 2 to 7 days
• Flush toilet 2 to 3 times after each use 2 to 7 days
• Keep a distance of 6 feet from children 2 to 7 days
• Keep a distance of 6 feer from pets 2 to 7 days
• Sleep in a separate bed or room 2 to 11 days
• Avoid close physical contact such as hugs 2 to 11 days
• Avoid kissing and/or sexual activity 2 to 11 days
• Limit time in public places 2 to 7 days
• Delay return to work or school 2 to 7 days
• Do not travel by airplane of public transportation a minimum of 7 days but up to 14 days
• Do not travel on prolonged car rides or bus rides a minimum of 7 days but up to 14 days

FOR MORE INFORMATION TALK TO YOUR DOCTOR ABOUT HIS PERSONAL RECOMMENDATIONS FOR YOUR SPECIFIC CASE.

About the Author: Wilma Ariza is the founder of Stevie JoEllie's Cancer Care Fund a thyroid cancer awareness, access to care and free supportive services for thyroid cancer patients and survivors nonprofit 

Radioactive Iodine in the Diagnostic Process: Understanding I-123 Scans

When my then 21 year old diabetic daughter (pictured here) was formally diagnosed with thyroid cancer after a radical thyroidectomy on March 31, 2008 I had no idea what that would mean for her and her dreams as a young woman already dealing with a chronic health condition. She went into surgery to have thyroid nodules removed that had grown over the course of 4 years (after a number of inconclusive fine needle biospies) making it difficult for her to swallow and breathe.

The recovery room nurse whom I had met a year earlier and had come to know well when my daughter's father was diagnosed with stage IV esophageal cancer called me in to my daughter's bedside and explained that the surgeon performed a "more extensive surgery" than originally planned because "the thyroid was obviously malignant". Soon the surgeon came in and explained that waiting for the pathology report would be a formality for clinical confirmation but that the oncology department would have an endocrine oncology specialist consult the "case" during the course of my daughter's hospital stay.

I had never, before that moment, heard of 'thyroid cancer' in someone so young but we had "experienced" her fathers stage IV esophageal cancer treatment the year before and, in 2006, provided in-home hospice care for my father (her grandfather) diagnosed with terminal cancer after surviving leiomyosarcoma in 1998. Questions flooded my mind at the speed of lighting as I cried quietly while the doctors voice faded away and I could hear him no more; Would she have chemotherapy ? or radiation ? How about her voice ? Would she be able to talk ? Could she swallow again or would she need a feeding tube for survival like her father after receiving treatment for esophageal cancer. How about wound care ? How long would it take for her to heal as a diabetic ?

A ferocious maternal instinct kicked in almost instantly and I set out to learn as much as I could as fast as I could to take control of the situation and save my daughter from all the patient care and advocacy mistakes I made years earlier as my father's primary caregiver and healthcare proxy. Here I will share a summary review of what I learned about radioactive iodine uses for diagnostic testing of thyroid diseases (I-123) and the treatment of thyroid cancer (I-131).

Let's begin with I-123 in the diagnostic process also known as thyroid scan or radioactive iodine uptake test (RAIU)

1. THE THYROID GLAND & IODINE:  

Iodine is essential for proper function of the thyroid gland, which uses it to make the thyroid hormones our body relies on for proper metabolic function and other systematic biological functions such as heart rate, body temperature, calcium absorption, the reproductive system and more. The thyroid is equipped with an active system or "pump" for moving iodine into it's cells. Thyroid cancer cells usually take up iodine also, "although they do not this as well as normal thyroid cells".The ability of thyroid cells to take up iodine has been used by medical professionals to treat various thyroid diseases for decades.

2. WHAT IS RADIOACTIVE IODINE (RAI)? 

A radioactive isotope is a substance that gives off radiation. Iodine can be made into two radioactive isotopes for medical uses: I-123 and I-131. These isotopes can be given by mouth to patients with suspected thyroid conditions. RAI is then concentrated inside the thyroid cells exactly like iodine and can be used to diagnose or treat thyroid problems. The radiation that RAI gives off can either be harmless to the thyroid cells (I-123) or the radiation my destroy the thyroid cells (I-131). RAI that is not concentrated in the thyroid gland is eliminated from the body through sweat and urine. RAI is safe to use in individuals who have had an allergic reaction to seafood or X-Ray contrast agents, since the allergic reaction is to the compound continaing iodine, not the iodine itself.

3. RAI FOR THYROID IMAGING: 

I-123 is the isotope used to take the pictures of the thyroid gland during a Thyroid Scan. A very small "tracer" dose of I-123 is given to the patient, who then returns 3-8 hours later so "pictures" of the thyroid gland can be taken using a "camera" that picks up the radiation emitted by the RAI. The "camera" is part of a machine that looks similar to an X-Ray or CAT Scan machine. In addition to getting the scan or picture, the amount of radiation being given off can also be counted to determine how "active" the thyroid gland is also know as a Radioactive Iodine Uptake (RAIU). Since the radiation emitted by I-123 is harmless, no special precautions are necessary after a thyroid scan or RAIU. The total radiation iodine dose that you receive during a thyroid scan is less than you would get if you had a routine chest x-ray. There are usually no side effects to I-123.

FOR MORE INFORMATION TALK WITH YOUR DOCTOR


About The Author: Wilma Ariza is the Founder of Stevie JoEllie's Cancer Care Fund a thyroid cancer awareness, access to care and free supportive services for thyroid cancer patients and survivors nonprofit. 

VIDEO: Ultrasound-Guided Thyroid Biopsy Explained

FOR MORE INFORMATION VISIT:

                                                         http://southsoundradiology.com

South Sound Radiology

3417 Ensign Rd. NE

Olympia, WA 98506

Phone: (360) 493-4646 / Toll-Free: (800) 624-9759

Nuclear Medicine in Thyroid Health Diagnostics

An example of a potential course of testing and treatment.
Written, shot and edited by students at Triton College. 

Diagnosis & Treatment of Thyroid Nodules

If you discover a nodule or tumor in your neck are only a series of diagnostic tests can determine if it's benign or malignant (cancerous) and can help to guide treatment decisions. There are several diagnostic tests; each provides unique information about the nodule. It is important to know that tests are ordered based upon a patient's medical history, symptoms, and physical examination.

Often, a diagnostic test will provide a definitive answer about the type and cause of a nodule. In other cases, a test may be inconclusive and further testing will be required. Your doctor or nurse can discuss with you  the reason for each test and explain what the results mean.

Physical Examination

— Diagnosis may begin with questions about a patient's medical history and a physical examination. A clinician may be able to distinguish nodules by carefully palpating (feeling) the thyroid gland. However, some nodules are too small to be felt, and some lie in areas that cannot be felt during examination. Physical examination alone cannot determine if a nodule is benign or malignant or if it is producing excess thyroid hormone.

Certain features increase the likelihood that a nodule is malignant. These features include rapid growth of a large, solid nodule; a nodule that is hard and cannot be moved; symptoms suggesting that the esophagus or trachea is narrowed or obstructed; swelling of the lymph nodes in the neck or under the jaw; and hoarseness.

Among all people with thyroid nodules, several factors may also increase the likelihood that a thyroid nodule is malignant.

• Age — A thyroid nodule occurring in a child or in an adult under age 20 or over age 60 is more likely to be malignant.

• Gender — Thyroid cancer is found in 8 percent of men and only 4 percent of women who have thyroid nodules.

• Previous radiation treatment to the head or neck — In the past, radiation was used to treat acne, inflamed tonsils and adenoids, and an enlarged thymus gland. It was later recognized that radiation exposure increases a person's risk of thyroid nodules and thyroid cancer. A healthcare provider should closely monitor the thyroid gland in people who have had radiation treatment. Patients who have had radiation treatment to the head or neck should discuss this with their clinician.

Laboratory Testing:

Blood tests — Blood tests are routinely performed in the process of evaluating a thyroid nodule. These blood tests measure the levels of hormones and antibodies (proteins) in the blood.

• Thyroid stimulating hormone — Low levels of thyroid-stimulating hormone (TSH) may indicate that a nodule is producing high levels of thyroid hormone. High levels of TSH may indicate autoimmune inflammation of the thyroid (called Hashimoto's thyroiditis).

• Anti-thyroid peroxidase antibodies — The presence of anti-thyroid peroxidase antibodies may also indicate autoimmune inflammation of the thyroid gland.

• Calcitonin — High levels of calcitonin can indicate a specific type of thyroid cancer, called medullary thyroid cancer. However, high calcitonin levels can also be found in people who do not have this cancer. This test is typically reserved for patients with a family history of medullary cancer. However, some studies suggest that it should be ordered more often.

Radiology Testing

• Thyroid ultrasound — Thyroid ultrasound provides the best information about the shape and structure of the thyroid gland and thyroid nodules. It can identify very small nodules and can differentiate between solid and cystic (fluid-filled) nodules. Ultrasound can also identify features that are potentially suspicious for cancer. However, ultrasound does not provide information about the function of a nodule.

• Thyroid scan — A thyroid scan can help to determine if a nodule is autonomous ("hot") or non-functional ("cold"). The scan is performed after a patient is given a small dose of a radioactive substance (either iodine or technetium) by pill or injection. In a person with hyperthyroidism (low levels of thyroid stimulating hormone (TSH)), nodules that absorb the radioactive substance are usually not cancerous (called autonomous, hot, or toxic). Nodules that do not absorb the radioactive substance are called cold, and have a 5 percent risk of being cancerous. Approximately 95 percent of nodules are cold.

Sometimes the results of thyroid scan are indeterminate. In this case, the test may be repeated after treatment with synthetic thyroid hormone (T4). This approach can help to define a nodule's status.

The risk of exposure to radiation is small compared to the benefit of knowing the test's results. Women who are pregnant or breastfeeding should not have this test. Following a thyroid scan, patients should take care to flush the toilet and wash their hands after urinating; the radioactive substance is eliminated in the urine.

BIOPSY

• Fine Needle Biopsy -- Fine-needle aspiration biopsy is the most sensitive way of diagnosing the cause of a thyroid nodule. It uses a thin needle to remove small tissue samples from the nodule. These samples are examined with a microscope. Ultrasound is frequently used to guide the needle to smaller nodules. Aspiration can also be used to remove a sample of fluid from cystic (fluid-filled) nodules.

FNA biopsy can be performed in the office with a local anesthetic (numbing medicine). A patient usually feels mild discomfort as the anesthesia is injected, but will not feel pain during the biopsy.

This test is very accurate in identifying cancer in a suspicious nodule, although sometimes the results are indeterminate and surgery is necessary. Surgery can definitively determine if a nodule is benign or malignant.

The results of the biopsy can be one of the following:

• Benign (noncancerous)
• Malignant (cancer)
• Indeterminant or suspicious
• Nondiagnostic or insufficient

TREATMENT OF THYROID NODULES

The appropriate treatment for a thyroid nodule will depend upon the type of nodule.

• Benign nodules — These nodules usually develop as a result of overgrowth of normal components of the thyroid gland. Surgery is not usually recommended, and the nodule can usually be monitored over time. If the nodule grows, a repeat biopsy or surgery may be recommended.

• Suppressive (thyroid hormone) treatment — A clinician may suggest a trial of T4 in doses slightly higher than the thyroid normally produces; this is called suppressive treatment. If the nodule shrinks with treatment, it is more likely to be benign, although some malignant nodules will also respond. Thus, most experts do not recommend using this test to classify a nodule as benign or malignant.

• Malignant nodules (thyroid cancer) — Only about 5 percent of all thyroid nodules are malignant. The majority of thyroid cancers are papillary thyroid cancer. Most patients with thyroid cancer have an excellent chance for cure or long-term survival.

The treatment of thyroid cancer will depend on the type of cancer. Thyroid cancers require surgical removal of the thyroid gland and one or more treatments with radioiodine, followed by thyroid hormone (T4) suppressive therapy.

• Indeterminate or suspicious nodules — These nodules are not officially classified as malignant nodules, but they share many features with thyroid cancer. With time, they may invade surrounding tissues, at which point they are classified as cancer.

Surgical removal of these nodules is generally recommended. At the time of surgery, about 10 to 20 percent of suspicious nodules have become invasive and are classified as cancers. Occasionally, synthetic thyroid hormone (T4) treatment may be recommended to slow the growth of a microfollicular nodule. Close monitoring is also recommended.

• Autonomous nodules — Some nodules produce thyroid hormone, similar to the thyroid gland, but fail to respond to the body's hormonal controls. These nodules are called autonomous nodules. They are almost always benign, but they can lead to excess thyroid hormone production and hyperthyroidism.

Patients with an autonomous nodule and marked hyperthyroidism usually undergo surgery to remove the nodule, or undergo radioactive iodine treatment to destroy the nodule. If a person with an autonomous nodule has normal thyroid function or minimal hyperthyroidism, the appropriate treatment will depend on the person's age and other health factors.

This type of nodule may be monitored in young adults. However, high thyroid hormone levels pose a risk of an abnormal heart rhythm (atrial fibrillation) and bone loss (osteoporosis) with advancing age, and radioactive iodine treatment may be recommended for older adults.

• Cystic nodules — Cystic nodules are usually benign nodules that have filled with fluid. These nodules may simply collapse when the fluid is removed. Cystic nodules are usually monitored for changes; some symptoms, such as recurrent bleeding or cyst reformation require that the nodules are surgically removed.

Shawna Gets her Thyroid Tested on The Doctors

Shawna has a history of thyroid problems, so The Doctors send her to expert endocrinologist, Dr. Eva Cwynar to see if her thyroid is indeed the source of her symptoms. 

For more information go to http://www.TheDoctorsTV.com.