General Topics

Overview of Endocrine Neoplasia and Cancer | Endocrinology

What are endocrine neoplasia and cancer?

Endocrine neoplasia refers to growths or tumors that affect the hormone-producing endocrine system. Tumors develop in the adrenal glands, pituitary gland, parathyroid glands, or pancreas and can be cancerous or benign. The Nig Comprehensive Cancer Center‌ Endocrine Neoplasia Program is dedicated to the evaluation and treatment of the structural and hormonal symptoms of these disorders.

Our endocrine neoplasia program is the only one in Connecticut, and our dedicated team of experienced multidisciplinary specialists provides clinical services in the following areas:

  • Thyroid cancer and thyroid nodules
  • Fine injection aspiration biopsy: Thyroid and adrenal
  • Thyroid ultrasound
  • Thyroid carcinoma test: Thyrogen stimulated thyroglobulin and thyroid scan
  • Cancer and benign tumors of the adrenal glands.
  • Invasive radiology including petrous sinus sampling, adrenal vein sampling, and selective infusion of pancreatic calcium
  • Hyperparathyroidism and parathyroid tumors
  • Pituitary adenomas
  • Dynamic endocrine examination
  • Nuclear medicine scan

With specialists in a variety of diagnostic and therapeutic approaches, we work with teams of physicians from other disciplines to treat patients with endocrine neoplasia. Our medical professionals have experience in endocrine surgery, urological surgery, neurosurgery, neuro-ophthalmology, pathology, nuclear medicine, invasive radiology, hypertension, genetics, molecular biology, and endocrinology. They provide state-of-the-art patient care while conducting basic and clinical research to advance treatment options.

Types of endocrine neoplasia and cancer

Tumors can appear in any large endocrine gland, including the thyroid, parathyroid, pituitary, and adrenal glands, and the pancreas. The most common sites are:

  • Thyroid gland: Most endocrine cancers develop in the thyroid gland (a butterfly-shaped organ in the lower neck). Thyroid cancer is more common in women than in men. Statistics show that the annual rate of thyroid cancer is increasing in the United States and around the world. The good news is that most thyroid tumors (called nodules) are not cancerous.
  • Pituitary gland: A pea-sized organ connected to the brain, the pituitary gland produces hormones that affect growth and fertility. Pituitary tumors are almost always benign, but they contain more or less than one or more hormones, which can upset the balance of other glands.
  • Adrenal gland: The two adrenal glands that live above the kidneys produce hormones that regulate metabolism (cortisol), stress response (adrenaline), blood pressure (aldosterone), and certain sexual characteristics (androgens).
  • Pancreas: Although the pancreas plays an active role in the digestive system, it is also a source of important hormones, including insulin. Rare tumors produce too much insulin or other related hormones, which can affect blood sugar levels.

Although some cases are inherited, the cause of most endocrine cancers is generally unclear.

Symptoms of endocrine neoplasia and cancer

Some patients with thyroid tumors notice a lump in the neck. For others, and for other endocrine tumors, the general rules do not apply. Some tumors cause severe hormonal changes or discomfort, while other tumors do not have any symptoms.

So when does a tumor have symptoms? You basically have symptoms if it doesn’t work (makes extra hormones) but is active (doesn’t make them). For example, an adrenal tumor that produces excess testosterone can cause a patient to develop certain male characteristics, such as facial hair. Symptoms also appear as the tumor grows.

A large tumor destroys part of the gland, causing a lack of hormones. It also affects nearby structures. For example, a large pituitary tumor can focus on the nerve that runs between the eyes and the brain, causing vision changes. When endocrine tumors have no symptoms, doctors may randomly notice them and evaluate the patient for another reason.

What are the genes associated with multiple endocrine neoplasias?

Mutations in the MEN1, RET, and CDKN1B genes cause multiple endocrine neoplasms. Mutations in the MEN1 gene cause type 1 multiple endocrine neoplasias. This gene provides instructions for the production of a protein called melanin. Menin acts as a tumor suppressor, which means that it generally prevents cells from growing and dividing too quickly or uncontrollably.

Although the exact function of the meninges is unknown, it is involved in cellular functions such as DNA copying and repair and regulation of the activity of other genes. When mutations inactivate two copies of the MEN1 gene, the meninges are no longer available to control cell growth and division. Loss of functional meninges allows cells to divide more frequently, leading to tumor characterization of multiple endocrine neoplasia type 1. It is not clear why these tumors affect endocrine tissues.

Mutations in the RET gene can cause type 2 multiple endocrine neoplasias. This gene provides instructions for the production of a protein involved in cell signaling. The RET protein stimulates chemical reactions that direct cells to respond to their environment, for example by dividing or maturing. Mutations in the RET gene over-activate the protein’s signaling function, which stimulates cell growth and division in the absence of signals external to the cell. This unproven cell division can lead to the formation of tumors in the endocrine glands and other tissues.

Mutations in the CDKN1B gene cause type 4 multiple endocrine neoplasias. This gene provides instructions for the production of a protein called p27. Like the meaning protein, p27 is a tumor suppressor that helps regulate cell growth and division. Mutations in the CDKN1B gene reduce the number of functional p27 that allows cells to grow and divide without being analyzed. This irregular cell division leads to the development of tumors in the endocrine glands and other tissues.

Diagnosis of endocrine neoplasia and cancer

Doctors can perform several tests to check for a suspected endocrine tumor:

  • A medical history and physical exam to assess for physical or behavioral changes related to hormone function
  • Lab tests to check for abnormal hormone levels in the blood or urine
  • Imaging studies (CT scan, MRI, or ultrasound) to look for evidence of abnormal tissue in the gland
  • A biopsy to obtain a sample of abnormal tissue and analyze it for cancer cells

Treatment for endocrine neoplasia and cancer

For any endocrine tumor, treatment involves surgery to remove it. For people with cancer, another approach that is sometimes used is radiation therapy. Patients sometimes receive hormone therapy to balance the level of hormones in the body. Depending on the type of tumor, your doctor may prescribe other specific rules to meet your individual needs.


Procedure of Thyroid Function Tests | Endocrinology

What are thyroid function tests?

Thyroid function tests are a series of blood tests used to an extent how well your thyroid gland is operational. Available tests include T3, T3RU, T4, and TSH.

The thyroid is a small gland located in the lower front of the neck. It is liable for helping to control many of the body’s processes, such as metabolism, energy generation, and mood.

The thyroid produces two chief hormones: triiodothyronine (T3) and thyroxine (T4). If your thyroid gland does not produce enough of these hormones, you may experience symptoms such as weight gain, lack of energy, and depression. This condition is called hypothyroidism.

If your thyroid gland produces too many hormones, you may experience weight loss, high levels of anxiety, tremors, and a feeling of euphoria. This is called hyperthyroidism.

Generally, a doctor who is concerned about your thyroid hormone levels will order extensive screening tests, such as the T4 or the thyroid-stimulating hormone (TSH) test. If those results are abnormal, your doctor will order more tests to determine the reason for the problem.


The main thyroid hormone secreted by the thyroid gland is thyroxine, also called T4 because it contains four atoms of iodine. To exert its effects, T4 is converted to triiodothyronine (T3) by removing an iodine atom. This occurs mainly in the liver and in certain tissues where T3 acts, such as the brain. The amount of T4 produced by the thyroid gland is controlled by another hormone, which is produced in the pituitary gland located at the base of the brain, called thyroid-stimulating hormone (TSH for short).

The quantity of TSH that the pituitary sends into the bloodstream rest on the amount of T4 the pituitary sees. If the pituitary sees too little T4, then it makes more TSH signal the thyroid gland to make more T4. Once the T4 in the bloodstream exceeds a certain level, the production of TSH by the pituitary stops. In fact, the thyroid and pituitary act in many ways as a heater and a thermostat. When the heater is off and cools down, the thermostat reads the temperature and turns the heater on. When the heat rises to an appropriate level, the thermostat senses it and shuts the heater off. Therefore, the thyroid and pituitary, like a heater and a thermostat, turn on and off.

Understanding the thyroid function tests result

Blood tests to measure these hormones are obtainable and widely used, but not all are helpful in all circumstances. To assess the thyroid function tests include the following:

TSH tests

The best way to initially assess thyroid function is to measure the level of TSH in a blood sample. Changes in TSH can serve as an “early warning system,” which often occurs before the actual level of thyroid hormones in the body is too high or too low. A high TSH level indicates that the thyroid gland is not making enough thyroid hormone (primary hypothyroidism).

The opposite condition, in which the TSH level is low, usually designates that the thyroid is producing too much thyroid hormone (hyperthyroidism). Occasionally, a low TSH can be the result of an abnormality in the pituitary gland, preventing it from producing enough TSH to stimulate the thyroid (secondary hypothyroidism). In most healthy people, a normal TSH value means that the thyroid is working properly.

T4 tests

T4 is the main form of thyroid hormone that circulates in the blood. A total T4 measures hormone bound and free and can change when the binding proteins differ (see above). Free T4 measures what is not bound and can enter and affect body tissues. Tests that measure free T4, either a free T4 index (FT4) or a free T4 index (FTI), more accurately reflect how the thyroid gland is working when it is checked with a TSH.

The finding of elevated TSH and low FT4 or FTI indicates primary hypothyroidism due to thyroid gland disease. Low TSH and low FT4 or FTI designate hypothyroidism allocated to a problem affecting the pituitary gland. A low TSH with an elevated FT4 or FTI is found in people who have hyperthyroidism.

T3 tests

T3 tests are often helpful in diagnosing hyperthyroidism or determining the severity of hyperthyroidism. Hyperthyroid patients will have an elevated T3 level. In some individuals with low TSH, only T3 is elevated and FT4 or FTI is normal. The T3 test is rarely helpful in the hypothyroid patient, as it is the last test to become abnormal. Patients may present with severe hypothyroidism with high TSH and low FT4 or FTI, but with normal T3.

T3 free

Measurement of free T3 is possible, but it is often unreliable and therefore not usually useful.

Reverse T3

Reverse T3 is a biologically inactive protein that is structurally very similar to T3, but the iodine atoms are placed in different locations, rendering it inactive. Some reverse T3 is normally produced in the body, but then it breaks down rapidly. In healthy, non-hospitalized people, reverse T3 measurement does not help determine whether or not hypothyroidism exists, and it is not clinically useful.

Antibodies tests

The body’s immune system normally protects us from foreign invaders like bacteria and viruses by destroying these invaders with substances called antibodies produced by blood cells known as lymphocytes. In numerous patients with hypothyroidism or hyperthyroidism, the lymphocytes react beside the thyroid (thyroid autoimmunity) and produce antibodies beside thyroid cell proteins. Two common antibodies are the thyroid peroxidase antibody and the thyroglobulin antibody.

Measuring thyroid antibody levels can help diagnose the cause of the thyroid problem. For example, positive anti-thyroid peroxidase and / or anti-thyroglobulin antibodies in a patient with hypothyroidism result in a diagnosis of Hashimoto’s thyroiditis. Although the detection of antibodies is useful in the initial diagnosis of hypothyroidism due to autoimmune thyroiditis, following their levels overtime is not useful in detecting the development of hypothyroidism or the response to treatment. TSH and FT4 are what tell us about actual thyroid function or levels.

A different antibody that can be positive in a patient with hyperthyroidism is the TSH-stimulating receptor (TSI) antibody. This antibody makes the thyroid overactive in Graves’ disease. If you have Graves’ disease, your doctor may also order a thyrotropin receptor antibody (TSHR or TRAb) test, which detects both stimulating and blocking antibodies. Monitoring antibody levels in Graves’ patients can help assess response to hyperthyroidism treatment, determine when it is appropriate to discontinue antithyroid medication and assess the risk of transmitting antibodies to the fetus during pregnancy.


Thyroglobulin (Tg) is a protein produced by normal thyroid cells and thyroid cancer cells. It is not a measure of thyroid function and does not diagnose thyroid cancer when the thyroid gland is still present. It is most often used in patients who have had surgery for thyroid cancer to control them after treatment. Tg is included in this thyroid function test booklet to communicate that although it is frequently measured in certain settings and individuals, Tg is not a primary measure of thyroid hormone function.

Thyroid function tests without blood

Radioactive iodine consumption

Because T4 contains iodine, the thyroid gland must extract a large amount of iodine from the bloodstream to produce an adequate amount of T4. The thyroid has developed a very active mechanism to do this. Therefore, this activity can be measured by having a person ingest a small amount of iodine, which is radioactive. Radioactivity allows the doctor to track where the iodine goes. By measuring the amount of radioactivity taken up by the thyroid gland (radioactive iodine uptake, RAIU), doctors can determine if the gland is working normally.

A very extraordinary RAIU is seen in individuals whose thyroid gland is overactive (hyperthyroidism), while a low RAIU is seen when the thyroid gland is underactive (hypothyroidism). In addition to radioactive iodine uptake, a thyroid scan may be obtained, which shows a picture of the thyroid gland and reveals which parts of the thyroid have absorbed the iodine (see thyroid nodules brochure).

Medicine Interfering with thyroid function tests

There are many medications that can affect thyroid function tests. Some common examples include:

  • Estrogens, such as those in birth control pills or during pregnancy, cause elevated levels of T4 and total T3. This is because estrogens increase the level of binding proteins. In these situations, it is best to request both TSH and free T4 for thyroid evaluation, which will normally be in the normal range.
  • Biotin, a commonly taken over-the-counter supplement, can make the measurement of various thyroid function tests appear abnormal when they are actually normal in the blood. Biotin should not be taken for 2 days before blood is drawn for thyroid function tests to avoid this effect.

Thyroid Removal Surgery (Thyroidectomy) Overview | Endocrinology

What is thyroidectomy?

A thyroidectomy is a surgical procedure to remove all or part of the thyroid gland and is used to treat diseases of the thyroid gland including:

  • Thyroid cancer
  • Hyperthyroidism (overactive thyroid gland)
  • Large goiters or thyroid nodules causing symptomatic obstruction such as difficulty swallowing or breathing.
  • Multinodular goiter

Thyroidectomy is traditionally a minimally invasive surgery that is performed through a small horizontal incision in the front of the neck. The entire thyroid gland may be removed or just a lobe, part of a lobe, and the isthmus or other structures. Depending on the extent of the operation, patients may need to take levothyroxine, an oral synthetic thyroid hormone.

Thyroidectomy without mutilation

For a select group of patients who are concerned about the possible cosmetic effects of a neck scar, we offer “scarless” thyroidectomy, a technique of removing the thyroid using small oral incisions that removes the scar from the neck. In this procedure, the surgeon accesses the thyroid gland through the patient’s mouth, known as the “transoral” approach. UCSF endocrine surgery is amongst the first programs in the world to pioneer this technique.

A new hybrid procedure using a transoral and submental technique (TOaST) offers patients an additional option, a refinement that combines the transoral approach with a small incision easily hidden just below the chin, offering the following benefits:

  • The decrease in postoperative complications and patient discomfort.
  • The ability to accommodate larger thyroid samples
  • Maintain practically all the cosmetic benefits of traditional surgery without scars.

Types of thyroid surgery

There are several different types of thyroid surgery. The most communal are lobectomy, subtotal thyroidectomy, and total thyroidectomy.

  • Lobectomy: Sometimes a nodule, inflammation, or swelling affects only half of the thyroid gland. When this occurs, a doctor will remove only one of the two lobes. The part left behind must retain part or all of its function.
  • Subtotal thyroidectomy: A subtotal thyroidectomy eliminates the thyroid gland but leaves a small amount of thyroid tissue. This preserves some of the thyroid function. Many people who have this type of surgery develop hypothyroidism, a condition that occurs when the thyroid does not produce enough hormones. This is treated with daily hormonal supplements.
  • Total thyroidectomy: A total thyroidectomy removes all of the thyroid and thyroid tissue. This surgery is suitable when nodules, swelling, or irritation affect the entire thyroid gland or when cancer is present.

Risks of thyroidectomy

Thyroidectomy is generally a safe surgical procedure. However, some people have major or minor complications. Possible complications include:

  • Hemorrhage (bleeding) under the neck wound: If this occurs, the wound protrudes and the neck swells, possibly compressing the internal structures of the neck and interfering with breathing. This is an emergency.
  • Thyroid storm: If thyroidectomy is performed to treat a very overactive gland, there may be an increase in thyroid hormones in the blood. This is a very rare complication because medicines are given before surgery to avoid this problem.
  • Recurrent laryngeal nerve injury: Because this nerve innervates the vocal cords, the injury can cause vocal cord paralysis and produce a hoarse voice, either in the short or long term.
  • Injury to a part of the superior laryngeal nerve: If this occurs, the singing patients may not be able to reach high notes and the voice may lose some projection.
  • Infection in the wound
  • Hypoparathyroidism: If the parathyroid glands cannot be protected or are damaged through surgery, the person may not be able to make enough parathyroid hormone. The parathyroid hormone helps keep blood calcium levels within the normal range. Low production of parathyroid hormone causes low levels of calcium in the blood.

Why is it for

Your doctor may indorse a thyroidectomy if you have conditions such as:

  • Thyroid cancer: Cancer is the most common cause of thyroidectomy. If you have thyroid cancer, removing most, if not all, of your thyroid is likely a treatment option.
  • Non-cancerous enlargement of the thyroid (goiter): Removal of all or part of the thyroid gland is an option if you have a large goiter that is uncomfortable or causes difficulty in breathing or swallowing, or in some belongings if the goiter is causing hyperthyroidism.
  • Overactive thyroid (hyperthyroidism): Hyperthyroidism is a disorder in which the thyroid gland produces too greatly thyroxine hormone. If you have problems with antithyroid medications and do not want radioactive iodine therapy, thyroidectomy may be an option.
  • Suspicious or indeterminate thyroid nodules: Some thyroid nodules cannot be identified as cancerous or non-cancerous after testing a sample from a needle biopsy. Doctors may recommend that people with these nodules have a thyroidectomy if the nodules are at increased risk of being cancerous.


Most people with thyroid cancer have no known risk factors, so most cases of this disease cannot be prevented.

Exposure to radiation, especially in childhood, is a known risk factor for thyroid cancer. Because of this, doctors no longer use radiation to treat less serious illnesses. Imaging tests, such as X-rays and CT scans, also expose children to radiation, but in much lower doses, so it is not clear how much they might increase the risk of thyroid cancer (or other cancers). If there is an increased risk, it is probably small, but to be safe, children should not have these tests unless absolutely necessary. When needed, they should be performed using the lowest dose of radiation that still provides a clear image.

Genetic testing can be done to look for gene mutations found in familial medullary thyroid cancer (MTC). Because of this, most familial cases of TCM can be prevented or treated early by removing the thyroid gland. Once the disease is exposed in a family, the rest of the family associates can be tested for the mutated gene.

If you have a family history of TCM, it is important that you see a doctor who is familiar with the latest advances in genetic counselling and genetic testing for this disease. Removing the thyroid gland in children who carry the abnormal gene will likely prevent cancer that could otherwise be fatal.

Thyroidectomy complications

  • Hypocalcemia (3-5%): Most communal cause of airway obstruction after 24 hours
  • Hematoma (1-2%): Most communal cause of airway obstruction within 24 hours
  • Recurrent injury of the laryngeal nerve (0.77%): Usually causes unilateral damage, stridor, hoarseness
  • Wound infection (0.2-0.5%)

Treatment Options of Thyroid Nodules | Endocrinology

What are thyroid nodules?

Thyroid nodules are solid or fluid-filled lumps that form inside your thyroid, a small gland located at the base of your neck above your breastbone. Most thyroid nodules are not serious and cause no symptoms. Only a small percentage of thyroid nodules are cancerous.

The thyroid gland, which is made up of the right and left lobes connected to the isthmus (or “bridge”), makes and releases thyroid hormones. Thyroid hormones regulate functions such as body temperature, digestion, and heart function.

Oftentimes, you don’t know you have a thyroid nodule until your doctor finds it during a routine medical exam. Or your doctor may retrieve it during a scan done for another health reason. However, some thyroid nodules may become enlarged or difficult to swallow or inhale. Treatment options depend on the type of thyroid nodule you have.

Are thyroid nodules serious?

Very often the answer is no. You may not normally feel thyroid nodules. Although they are caused by cell growth, most thyroid nodules are not cancerous.

1 in 10 thyroid nodules become cancerous. Benign (non-cancerous) thyroid nodules are common. Most people get them as they age. If the thyroid nodule is not cancerous, it does not require treatment. Doctors can be seen to make sure it is not growing or starting to cause other problems.

Types of thyroid nodules

There are different types of non-cancerous thyroid nodules:

  • Toxic nodules make up a large amount of thyroid hormone. This leads to hyperthyroidism, which speeds up metabolism.
  • Multinodular goiters have many nodules. They can also make too much thyroid hormone and put pressure on other structures.
  • Thyroid cysts are filled with fluid, sometimes with other wastes. They can occur after an injury.

How do I know if I have thyroid nodules?

Most thyroid nodules do not cause any symptoms. However, if you have multiple nodules or large nodules, you will be able to see them. Although rare, the nodules can press against other structures in the neck and cause symptoms:

  • Difficulty swallowing or breathing
  • Blur or change of voice
  • Neck Pain
  • Goiter (enlarged thyroid gland)

Overfunctioning thyroid nodules lead to the overproduction of thyroid hormones, also known as hyperthyroidism. Hyperthyroidism symptoms:

  • Irritability / Fear
  • Muscle weakness/tremors
  • Mild or missed fighting periods
  • Weight Loss
  • Trouble sleeping
  • Enlarged thyroid gland
  • Vision problems or eye irritation.
  • Heat sensitivity (difficulty coping with heat)
  • Increase or decrease appetite
  • Difficulty breathing
  • Itchy skin / clammy skin
  • Hair is thinning
  • Skin flushing (sudden reddening of the face, neck, or upper chest)
  • Heart palpitations (fast or irregular heartbeats)

Thyroid nodules can be associated with low thyroid hormone levels or hypothyroidism. Symptoms of hypothyroidism:

  • Fatigue (feeling tired)
  • Often periods of high effort
  • I forget
  • Weight gain
  • Dry, rough skin and hair and hair loss
  • Rough throat
  • Difficulty dealing with low temperatures.
  • Weakness/irritability
  • Constipation
  • Depression
  • Generalized edema (swelling) 

Symptoms of a thyroid nodule

You may have a thyroid nodule and no noticeable symptoms. If the nodule is large enough, you will develop:

  • An enlarged thyroid gland called a goiter.
  • Pain at the base of your neck
  • Difficulty to swallow
  • Difficulty breathing
  • Big throat

If your thyroid nodule produces excess thyroid hormones, you may develop symptoms of hyperthyroidism,

  • Fast and irregular heartbeat
  • Unexplained weight loss
  • Muscular weakness
  • Trouble sleeping
  • Fear

In some cases, thyroid nodules develop in people with Hashimoto’s thyroiditis. It is an autoimmune thyroid condition that increases the risk of developing an ineffective thyroid (hypothyroidism). Symptoms of hypothyroidism:

  • Persistent fatigue
  • Unexplained weight gain
  • Constipation
  • Cold sensitivity
  • Dry skin and hair
  • Brittle nails

Causes of thyroid nodules

Many conditions can cause nodules to develop in the thyroid gland:

  • Normal thyroid tissue growth: An enlargement of normal thyroid tissue is sometimes called a thyroid adenoma. It is not clear why this occurs, but it is not cancerous and cannot be considered serious unless it causes embarrassing symptoms due to its size.
  • Some thyroid adenomas can cause hyperthyroidism.
  • Thyroid cyst Fluid-filled cavities in the thyroid gland are usually caused by degenerative thyroid adenomas. Solid components often mix with fluid in thyroid cysts. Cysts are generally not cancerous but occasionally contain cancerous solid components.
  • Chronic inflammation of the thyroid: Hashimoto’s disease, a thyroid disorder, causes inflammation of the thyroid and results in the formation of large nodules. It is often associated with hypothyroidism.
  • Multinodular goiter: The term goiter is used to describe any enlargement of the thyroid gland, which can be caused by iodine deficiency or by a thyroid disorder. Multinodular goiter consists of multiple different nodules within the goiter, but their cause is less clear.
  • Thyroid cancer: The chances of developing nodule cancer are small. However, a nodule that is large and stiff or that causes pain or discomfort may be of greater concern. You may want to check this with your doctor.
  • Some factors, such as a family history of thyroid or other endocrine cancers and a history of radiation exposure from medical treatment or radioactive fallout, can increase the risk of thyroid cancer.
  • Iodine deficiency: Lack of iodine in your diet can sometimes lead to the development of thyroid nodules in the thyroid gland. Iodine deficiency is rare in the United States, where iodine is generally added to table salt and other foods.

Diagnosis of thyroid nodules

You can see one by looking at yourself in the mirror. Your chin is a slightly inflated mirror face. Swallow and look at both sides of the windpipe near Adam’s apple. Gently place your fingers on the neck there and look for a lump. If you find one, ask your doctor. 90% of thyroid nodules are benign (not cancerous).

If you notice one, check with your doctor. For your thyroid problems, you may want to see a specialist called an endocrinologist. Endocrinologists specialize in health problems related to the hormone-producing glands, including the thyroid. They will do a physical exam and order one of the following tests to find out if it is cancer:

  • Blood tests for thyroid hormones
  • Ultrasound
  • Fine needle biopsy
  • Thyroid scan

With a biopsy, your doctor inserts a fine needle into your thyroid nodule to collect some cells. They are sent to the laboratory for further study. Cancer-free thyroid nodules are so large that they can still be a problem if you find it difficult to breathe or swallow.

When evaluating a lump or nodule in the neck, one of your doctor’s main goals is to rule out the possibility of cancer. Your doctor will also want to know if your thyroid is working properly. The tests include:

Physical exam: Your doctor will ask you to swallow when examining your thyroid because the nodule in your thyroid gland generally moves up and down when you swallow.

Your doctor will also look for signs and symptoms of hyperthyroidism, such as tremors, hyperactive reactions, and fast or irregular heartbeats. He will also look for signs and symptoms of hypothyroidism, such as slow heart rate, dry skin, and facial swelling.

Thyroid function tests: Tests that measure your blood levels of thyroid-stimulating hormone (TSH) and hormones made by the thyroid gland can indicate whether you have hyperthyroidism or hypothyroidism.

Ultrasound: This imaging technique uses high-frequency sound waves to create images of your thyroid gland. Thyroid ultrasound provides the best information about the shape and structure of the nodules. Doctors can use it to separate cysts from solid nodules or to find out if there are multiple nodules. Doctors can also use it as a guide to performing a fine needle aspiration biopsy.

Fine needle aspiration biopsy: The nodules are usually biopsied to confirm that there is no cancer. During the procedure, your doctor will insert a very thin needle into the nodule and remove the sample of cells.

This procedure is usually performed in your doctor’s office, takes about 20 minutes, and involves a few accidents. Often your doctor will use an ultrasound to guide you in placing the needle. Your doctor will send these samples to the laboratory for analysis under a microscope.

Thyroid scan: Your doctor may recommend a thyroid scan to help diagnose thyroid nodules. During this test, a radioactive iodine isotope is injected into a vein in your hand. You lie on the table while the special camera produces an image of your thyroid on the computer screen.

Nodules that produce high levels of thyroid hormone, called hot nodules, show up on the scan because they absorb more isotopes than normal thyroid tissue. Hot nodules are almost always cancer-free.

In some cases, nodules that take up less of the isotope, called cold nodules, are cancerous. However, a thyroid scan does not distinguish between cancer and cold nodules.

Treatment of thyroid nodules

Treatment depends on the type of thyroid nodule you have. Treatment of benign nodules

If the thyroid nodule is not cancer, treatment options include:

  • Waiting carefully: If a biopsy shows that you have a cancer-free thyroid nodule, your doctor may suggest that you look at your condition.
  • This means getting regular physical exams and thyroid function tests: It can also include an ultrasound. If the nodule is large, you may have another biopsy. If the benign thyroid nodule does not change, it will never need treatment.
  • Thyroid hormone therapy: If your thyroid function test finds that your gland is not producing enough thyroid hormone, your doctor may recommend thyroid hormone therapy.
  • Surgery: If the cancer-free nodule needs surgery, it may be difficult for you to breathe or swallow. Doctors may consider surgery for those with large multinodular goiters, especially when the goiters block the airways, esophagus, or blood vessels. Nodules that are identified indefinitely or suspiciously by biopsy may also require surgical removal so that they can be examined for signs of cancer.

Treatment of nodules that cause hyperthyroidism.

If a thyroid nodule produces thyroid hormones and your thyroid gland overloads normal levels of hormone production, your doctor may recommend that you treat your hyperthyroidism. These may include:

  • Radioactive iodine: Doctors use radioactive iodine to treat hyperthyroidism. When taken in capsules or liquid form, radioactive iodine is absorbed by the thyroid gland. It causes the nodules to shrink and the signs and symptoms of hyperthyroidism disappear, usually within two to three months.
  • Antithyroid drugs: In some cases, your doctor may prescribe antithyroid medications such as methimazole (Tapazol) to reduce the symptoms of hyperthyroidism. Treatment is often chronic and can cause serious side effects on the liver, so it is important to discuss the risks and benefits of treatment with your doctor.
  • Surgery: If treatment with radioactive iodine or antithyroid drugs is not an option, you may be a candidate for surgery to remove the overactive thyroid nodule. You will discuss the surgical risks with your doctor.

Treatment of cancerous nodules

Treatment with nodules for cancer usually involves surgery.

  • Observation: The risk of developing very small cancers is low, so it is advisable to consult your doctor closely before treating cancerous nodules. This decision is often made with the help of a thyroid specialist. The exam includes ultrasound monitoring and blood tests.
  • Surgery: A common treatment for cancerous nodules is surgical removal. Previously, removal of most of the thyroid tissue was standard; This procedure is called a total thyroidectomy. Currently, however, more limited surgery to remove only half of the thyroid is appropriate for some cancerous nodules. Total thyroidectomy can be used depending on the extent of the disease.

Thyroid Surgery Risks Damage to the nerves that control the vocal cords and damage to the parathyroid glands: The four small glands at the back of the thyroid can help regulate body-level minerals like calcium.

After thyroid surgery, you need lifelong treatment with levothyroxine to supply your body with thyroid hormone. Your thyroid specialist can help you determine the correct amount to take because it may require more than hormone replacement to control your cancer risk.


7 Types and Diagnosis of Thyroiditis | Endocrinology

What is thyroiditis?

The thyroid gland is butterfly-shaped (weighing 15-20 grams) located in front of the lower neck between Adam’s apple and the breastbone. It produces hormones that regulate the metabolism of the thyroid. Metabolism is the rate at which your body processes things (how fast it burns food for energy and heat). Thyroiditis is an inflammation or inflammation of the thyroid gland and leads to either high or low thyroid hormone production.

Thyroiditis has three stages:

  • Thyrotoxic phase: Thyrotoxicosis means that the thyroid is inflamed and releasing too many hormones.
  • Hypothyroid phase: After a few weeks or months of overactive thyroid hormones, there may not be enough thyroid hormones to release the thyroid. This can lead to a lack of thyroid hormones or hypothyroidism.
  • Euthyroid stage: In the third euthyroid stage, thyroid hormone levels are normal. This stage can come temporarily after the thyrotoxic phase before moving to the hypothyroid stage or it can come finally after the thyroid gland can recover from inflammation and maintain normal hormone levels.

Types of thyroiditis

  1. Hashimoto’s thyroiditis: An autoimmune disease caused by antithyroid antibodies. It is the most common form of thyroiditis and is five times more common in women than in men. Hashimoto’s thyroiditis usually leads to hypothyroidism and requires replacement therapy with thyroid hormone replacement therapy.
  2. Silent thyroiditis or painless thyroiditis: Another autoimmune disease caused by antithyroid antibodies. It is also common in women and is the most common cause of Hashimoto’s thyroiditis.
  3. Postpartum thyroiditis: An autoimmune condition caused by antithyroid antibodies sometimes occurs immediately after a woman gives birth.
  4. Radiation-Induced Thyroiditis: A condition caused by external radiation or radioactive iodine that is used to treat hyperthyroidism as a medical treatment for some cancers.
  5. Subacute thyroiditis or Quervain thyroiditis: A common traumatic condition caused by a virus
  6. Acute thyroiditis or separating thyroiditis: A rare condition caused by infection or bacterial
  7. Drug-induced thyroiditis: A condition caused by the use of drugs such as amiodarone, interferon, lithium, and cytokines. It occurs only in a small number of patients using objectionable medications, so it is not common in the general population.

Thyroiditis causes

  • Thyrotoxic phase: The thyroid is inflamed and releases a lot of hormones.
  • Hypothyroid phase: After a few weeks or months, thyroid hormone is released excessively and can lead to hypothyroidism when you don’t have enough left.
  • Euthyroid stage: At this stage, thyroid levels are normal. It occurs between or at the end of the first two stages after the inflammation has subsided.

Symptoms of thyroiditis

Common symptoms are fatigue, swelling at the base of the neck, and sometimes some pain in the front of the throat. However, other symptoms vary depending on whether your thyroid is inactive (hypothyroidism) or hyperthyroidism (hyperthyroidism).

Symptoms of hypothyroidism can include:

  • Fatigue
  • Depression
  • Weight gain
  • Dry Skin
  • Constipation
  • Muscle pains
  • Cold impatience

Symptoms of hyperthyroidism can include:

  • Anxiety and irritability
  • Weight Loss
  • Insomnia
  • Heart palpitations
  • Muscular weakness
  • Impatient to heat

The thyroid can be attacked by various agents. These attacks cause inflammation and damage to thyroid cells, which can lead to thyroiditis. Some of the agents that cause thyroiditis are antibodies (the most common cause), medications, radiation, and organisms (viruses and bacteria). The conditions that attack the body are autoimmune diseases. Thyroiditis is an autoimmune (antibody-mediated) disease.

Some people are not sure why they make thyroid antibodies. Thyroid disease is known to run in families. Thyroiditis can be caused by an infection or a side effect of some medications.

Risk factors for thyroiditis

These factors contribute to the risk of Hashimoto’s disease:

  • Gender: Women are more likely to get Hashimoto’s disease.
  • Years: Hashimoto’s disease can occur at any age, but usually in middle age.
  • Family History: If other members of your family have thyroid or other autoimmune diseases, you are at a higher risk for Hashimoto’s disease.
  • Other autoimmune diseases: Having another autoimmune disease, such as rheumatoid arthritis, type 1 diabetes, or lupus, increases your risk of getting Hashimoto’s disease.
  • Radiation exposure: People exposed to high levels of environmental radiation are at increased risk for Hashimoto’s disease.

Thyroiditis diagnosis

Your doctor may do one or more of these tests.

  • Blood test: Thyroid hormones circulate in your blood, and their levels can help your doctor diagnose a specific type of thyroiditis.
  • Radioactive iodine intake test (RAIU): Since iodine builds up in the thyroid gland, a doctor or nurse will give you radioactive iodine as a pill or liquid. During the next 24 hours, your doctor will check at various points how much iodine your thyroid has absorbed.
  • Thyroid scan: Receive an injection of radioactive iodine. You lie face down on the table with your head tilted back and your neck exposed. Your doctor will use a device to take pictures of your thyroid.
  • Erythrocyte sedimentation rate (ESR or sedimentation rate): This test measures inflammation to see how fast red blood cells fall. A high ESR means you have subacute thyroiditis.
  • Ultrasound: An ultrasound of your thyroid shows a nodule or growth, a change in blood flow, and the shape or density of the gland.

Treatment of thyroiditis

The observation and use of action medications may be involved in the treatment of Hashimoto’s disease. If there is no evidence of a hormone deficiency, and your thyroid is working normally, your doctor may prescribe a wait-and-watch procedure. If you need medication, you will need it for the rest of your life.

Synthetic hormones

If Hashimoto’s disease causes thyroid hormone deficiency, you may need thyroid hormone replacement therapy. It usually involves daily use of the synthetic thyroid hormone levothyroxine (Levoxyl, Synthroid, others). Synthetic levothyroxine is similar to thyroxine, which is a natural version of this hormone produced by the thyroid gland. Oral medications restore proper hormone levels and reverse all symptoms of hypothyroidism.

Monitor the dose

To determine the optimal dose of levothyroxine initially, your doctor will usually monitor your TSH level six to eight weeks after treatment and after any dose changes. Once you have determined the dose that normalizes your thyroid tests, your doctor may check your TSH level every 12 months so that the dose you need can vary. High amounts of thyroid hormone can accelerate bone loss, which can make osteoporosis worse or increase your risk for the disease. Excessive treatment with levothyroxine can also cause heart rhythm disorders (arrhythmia).

If you have coronary artery disease or severe hypothyroidism, your doctor may start treatment with smaller doses and gradually increase the dose. The establishment of the progressive hormone allows you to adapt to the increase in your cardiac metabolism.

Levothyroxine has virtually no side effects and is relatively inexpensive when used in proper doses. If you change brands, tell your doctor to make sure you are still getting the correct dose. Also, do not skip doses or stop taking the medicine. If you do, the signs and symptoms will gradually return.

Effects of other substances

Certain medicines, drugs, and certain foods can affect your ability to absorb levothyroxine. However, taking levothyroxine four hours before or after other actions can solve the problem. Talk to your doctor if you take large amounts of soy products or a high fibre diet or any of the following:

  • Iron supplements, including multivitamins that contain iron
  • Cholestyramine (private), a medicine used to lower cholesterol levels in the blood.
  • Aluminum hydroxide, which is found in some antacids.
  • Sucralfate, an ulcer drug
  • Calcium supplements

Do you need a combination of hormones?

Levothyroxine is a synthetic form of natural T-4. T-4 becomes T-3 in the body. While most people are only successfully treated with levothyroxine, some people do not feel completely normal on levothyroxine.

The researchers looked at whether it might be beneficial to adjust standard treatment for hypothyroidism to replace some T-4 with small amounts of T-3. However, most studies have concluded that the inclusion of T-3 has no more benefit than treatment with T-4 alone.

There is some evidence that T-3 may be beneficial for certain subtypes, such as people who have had their thyroid surgically removed (thyroidectomy). Investigations are ongoing.

T-3 can be given alone as liothyronine (cytomegaly) or in combination with T-4. Taking a combination of T-4 and T-3 produces higher than normal T-3 levels, especially immediately after taking the medication. It causes a rapid heart rate, anxiety, and trouble sleeping.

But, for those who haven’t had enough relief from T-4 alone, it’s a long time to see if the combination of adding liothyronine to standard levothyroxine treatment can help you over a three to six-month trial.

The standard treatment for Hashimoto’s disease is levothyroxine, a synthetic form of thyroxine (T-4). However, an extract containing thyroid hormone is obtained from the thyroid gland of pigs. These products, for example, thyroid arm or, containing levothyroxine and triiodothyronine (T-3).

  • Doctors have many concerns about thyroid hormone extract, such as Armor Thyroid,
  • The balance of T-4 and T-3 in animals is not the same as in humans.
  • The exact amount of T-4 and T-3 in each batch of natural extract product can vary, leading to unpredictable levels of these hormones in the blood.

Complications of thyroiditis

If left untreated, an active thyroid gland (hypothyroidism) caused by Hashimoto’s disease can lead to several health problems:

  • Preserve: The gland expands as the thyroid is constantly stimulated to release more hormones, a condition called a goiter. Hypothyroidism is one of the most common causes of a goiter. It is usually not uncomfortable, but a large goiter can affect your appearance and interfere with swallowing or breathing.
  • Heart problems: Hashimoto’s disease may be associated with an increased risk of heart disease because it occurs in people with high concentrations of lipoprotein cholesterol (LDL), the “bad” cholesterol, and the thyroid gland (hypothyroidism). If left untreated, hypothyroidism can lead to an enlarged heart and heart failure.
  • Mental health problems: Depression can occur early in Hashimoto’s disease and get worse over time. Hashimoto’s disease causes a decrease in sexual desire (libido) in both men and women and leads to a decrease in mental functioning.
  • Myxedema: This rare malignant condition develops due to chronic severe hypothyroidism as a result of untreated Hashimoto’s disease. Its signs and symptoms include drowsiness followed by profound lethargy and unconsciousness.

Myxedema can trigger a coma by exposing your body to colds, narcotics, infections, or other stress. Myxedema requires immediate emergency medical treatment.

  • Birth defects: Babies born to women with untreated hypothyroidism due to Hashimoto’s disease are more likely to have birth defects than babies born to healthy mothers. Doctors have known for a long time that these children are more likely to have intellectual and developmental problems. There may be a link between hypothyroidism and birth defects, such as a cleft palate.

Hypothyroidism is also linked to heart, brain, and kidney problems during pregnancy and childhood. If you are thinking of getting pregnant or are in the early stages of pregnancy, monitor your thyroid level.


What Causes a Goiter? | Signs and Symptoms | Endocrinology

Overview of goiter

A goiter is an important element of the traditional thyroid. Her thyroid maybe a butterfly wormhole located at my base on my neck, slightly below Adam’s apple. Although the goiters are generally painless, and outsized goiter can cause coughing and difficulty swallowing or breathing.

The most common explanation for goiter worldwide may be a lack of iodine within the diet. within us, where the utilization of iodized salt is common, a goiter is most frequently thanks to the overproduction of thyroid by-hormone or nodules within the glandular itself.

Treatment depends on the dimensions of the goiter, your symptoms, and therefore the cause. These are just a couple of the shared goal-setting programs you’ll use. Goiter is a condition in which the thyroid gland grows. The thyroid gland is a small butterfly-shaped gland located in the neck, just below Adam’s apple.

The thyroid gland produces the hormones thyroxine (also known as T4) and triiodothyronine (also known as T3). (Most people convert T4 to T3 outside of the thyroid.) These hormones play a role in certain bodily functions, including body temperature, mood and arousal, pulse rate, digestion, and others.

Types of goiter

Goiters have many causes. As a result, there are different types. In addition to:

  • Colloid goiter (local): A colloid goiter develops due to a lack of iodine, a mineral necessary for the production of thyroid hormones. People with this type of goiter often live in iodine-deficient areas.
  • Nontoxic goiter: The cause of non-toxic goiter is generally unknown, although it may be due to medications such as lithium. Lithium is used to treat mental disorders such as bipolar disorder. Non-toxic goiters do not affect thyroid hormone production and maintain healthy thyroid function. They are also harmless.
  • Toxic nodular or multinodular goiter: One or more small nodules form when this type of goiter spreads. The nodules produce their own thyroid hormone, which causes hyperthyroidism. It usually presents as an extension of the normal goiter.

Causes of goiter

These hormones circulate in your bloodstream and help regulate your metabolism. They maintain the rate at which your body consumes fat and carbohydrates, helps control your body temperature, affects your heart rate, and helps regulate protein production.

Your thyroid gland also makes calcitonin, which helps regulate the amount of calcium in your blood. Your pituitary gland and hypothalamus regulate the production and rate of release of T-4 and T-3.

The hypothalamus at the base of your brain, which acts as a thermostat for your entire system, refers to your pituitary gland to produce a hormone called thyroid-stimulating hormone (TSH). Your pituitary gland, also at the base of your brain, releases a certain amount of TSH, depending on the amount of thyroxine and T-3 you have in your blood. Your thyroid gland regulates the production of its hormones based on the amount of TSH it receives from the pituitary gland.

Having a goiter does not mean that your thyroid gland is not working normally. Even when it expands, your thyroid produces normal amounts of hormones. However, it produces too much or too little thyroxine and T-3

Many things can cause your thyroid gland to expand. The most common are:

  • Iodine deficiency: Iodine is essential for the production of thyroid hormones and is mainly found in seawater and coastal soils. In developing countries, people living inland or at high altitudes are often deficient in iodine and can develop a goiter when the thyroid expands in an attempt to obtain more iodine. A diet rich in hormone-resistant foods such as cabbage, broccoli, and cauliflower can exacerbate iodine deficiency.

In countries where iodine is commonly added to table salt and other foods, a lack of iodine in the diet is not usually the cause of goiter.

  • Cemetery disease: Goiter sometimes occurs when the thyroid gland produces too much thyroid hormone (hyperthyroidism). In people with Graves disease, antibodies produced by the immune system mistakenly attack the thyroid gland, causing excess production of thyroxine. This overstimulation causes the thyroid to swell.
  • Hashimoto’s disease: Goiter is also caused by an underactive thyroid (hypothyroidism). Like Graves’ disease, Hashimoto’s disease is an autoimmune disorder. Instead of your thyroid making more hormones, Hashimoto damages your thyroid so it makes much less.

By absorbing low levels of hormones, your pituitary gland produces more TSH to stimulate the thyroid, thereby enlarging the gland.

  • Multinodular goiter: In this condition, several solid or fluid-filled lumps called nodules develop on both sides of the thyroid, resulting in an enlargement of the entire gland.
  • Solitary thyroid nodules: In this case, a single nodule develops in one part of the thyroid gland. Most nodules are cancer-free (they are benign) and do not cause cancer.
  • Thyroid cancer: Thyroid cancer is much less common than benign thyroid nodules. The thyroid nodule biopsy is very accurate in determining if it is cancer.
  • The pregnancy: Human chorionic gonadotropin (HCG), a hormone produced during pregnancy, can cause the thyroid gland to expand slightly.
  • Inflammation: Thyroiditis is an inflammatory condition that causes pain and inflammation in the thyroid. It can also cause the body to make more or less thyroxine.

Symptoms & signs of goiter

Not all goiters cause signs and symptoms.

  • The swelling at the base of your neck is especially noticeable when you shave or apply makeup
  • It feels tight in the throat
  • Cough
  • Blunt
  • Difficulty swallowing
  • Difficulty breathing

Risk factors for goiter

Common risk factors

Common risk factors for the development of this disease can be occupational, dietary, environmental, genetic, age, and gender.

Common risk factors for developing goiter:

  • Table salt deficiency in dietary iodine.
  • People over the age of 40 are more likely to develop goiter.
  • Women are more likely to have goiter and thyroid disorders.
  • For unknown reasons, thyroid disorders are more likely to occur during pregnancy and menopause.
  • Medicines used in the treatment of heart diseases such as amiodarone and in psychotherapy such as lithium. Some other medications include phenylbutazone or aminoglutetamide and propylthiorecil.
  • Radiation treatments target the neck and chest areas.
  • Positive family history

Less common risk factors

Less common risk factors for developing goiter:

  • Family history of autoimmune disorders,
  • Exposure to radiation and hazardous radiation as a result of nuclear reactor accidents,
  • Smoking cigarettes,
  • Emotional stress,
  • Infections (rare),
  • Goitrogenic foods:

High risk (high amounts of goiter):

  • Cabbage, cauliflower, bok choy, broccoli, Brussels sprouts, kale, kohlrabi, mustard and mustard greens, radish, kohlrabi, soybeans, and turnip.
  • Low risk (small amounts of goitrogens):
  • Fruits (peaches, pears, strawberries), nuts (peanuts, pine nuts), bamboo shoots, sweet potatoes, and spinach.

Diagnosis of goiter

Your doctor may find an enlarged thyroid gland by feeling your neck and swallowing it during a routine physical exam. In some cases, your doctor may even experience the presence of nodules.

The diagnosis of this disease can also include:

  • Hormone tests: Blood tests can determine the number of hormones produced by the thyroid and pituitary glands. If your thyroid is inactive, your thyroid hormone levels will be low. At the same time, the level of thyroid-stimulating hormone (TSH) rises as your pituitary gland tries to stimulate your thyroid gland.

The disease associated with an overactive thyroid generally has high levels of thyroid hormone in the blood and is lower than normal TSH levels.

  • Antibody test: Some causes of this disease produce abnormal antibodies. A blood test can confirm the presence of these antibodies.
  • Ultrasound: A wand-shaped device (transducer) is placed around your neck. Sound waves bounce off your neck and back, forming images on a computer screen. Imaging Your doctor may not feel the size of your thyroid gland and whether there are nodules in the gland.
  • Thyroid scan: During a thyroid scan, a radioactive isotope is injected into a vein inside your elbow. You lie on a table with your head stretched out while a special camera produces an image of your thyroid on a computer screen.

Depending on the time it takes for the isotope to reach the thyroid gland, the time required for the procedure can vary. Thyroid scans provide information about the nature and size of your thyroid, but they are more aggressive, time-consuming, and more expensive than ultrasound exams.

  • Biopsy: During a fine needle aspiration biopsy, an ultrasound is used to guide the needle into the thyroid and obtain a sample of tissue or fluid for analysis.

Goiter treatment

It does not require treatment, especially if it is small and thyroid hormone levels are normal. However, if your thyroid hormone levels are affected, too high or too low, you need treatment.

Return thyroid hormone levels to normal during treatment, usually with medication. When the medicine works, the thyroid begins to return to its normal size. However, the large nodular goiter with most of the internal scar tissue does not shrink with treatment. If the it is uncomfortable and causes an overproduction of thyroid hormone that does not respond to medications, large enough to cause symptoms due to its size or cancer, the entire thyroid gland may need to be surgically removed.

Your doctor may want to re-examine this disease with an ultrasound periodically to make sure it is not growing too large or developing suspicious nodules that require a fine needle biopsy.