What Is A Goiter
Goiter refers to enlargement of the thyroid gland, a butterfly shaped organ draped around the front and sides of the windpipe in the lower part of the neck.
The thyroid gland is normally about the size of two thumbs held together in the shape of a V. It can enlarge when it is inefficient in making thyroid hormones, inflamed, or occupied by tumors.
Thyroid gland enlargement can be generalized and smooth, a so called diffuse goiter or it can become larger due to growth of one or more discrete lumps within the gland, a nodular goiter.
A goitrous gland can continue producing the proper amounts of thyroid hormones, in which case it is called a euthyroid or nontoxic goiter or a goiter can develop in conditions with either overproduction of thyroid hormone, called toxic goiter, or the inability to make sufficient thyroid hormones, called goitrous hypothyroidism.
How Do I Prepare For An Upper Endoscopy
Medications for high blood pressure, heart conditions, or thyroid conditions may be taken with a small sip of water before the procedure. If you have diabetes and use insulin, you must adjust the dosage of insulin the day of the test. Your diabetes care provider will help you with this adjustment. Bring your diabetes medication with you to your appointment so you can take it after the procedure.
Make arrangements to have someone drive you home following the endoscopy. The sedation given during the procedure causes drowsiness and dizziness and impairs your judgment, making it unsafe for you to drive or operate machinery for up to 8 hours following the procedure.
How Should I Prepare
Please notify your physician if you are taking any blood thinning agents, such as aspirin, Lovenox®, Plavix® or Coumadin®.
Usually, no special preparations are required for this procedure.
For biopsies performed in children, sedation may be used. Specific instructions will be given at the time of scheduling.
What Are The Treatment Options
Most thyroid nodules require no treatment. Depending on the type of nodule and related symptoms, different treatment options may be appropriate. In some cases, thyroid surgery is needed. Your endocrinologist or ENT specialist, or otolaryngologist, may order or perform:
- Thyroid function tests, including thyroid stimulating hormone
- Blood tests, or radiology examination
- An ultrasound to see the size and appearance of the nodule
- A fine needle aspiration biopsy, which is a safe, relatively painless procedure. In this procedure, a small needle is passed into the lump, and tissue samples containing cells are taken and then sent to a pathologist for testing.
What Is A Fine Needle Aspiration Biopsy
If the nodule is large enough to warrant additional evaluation, a fine needle aspiration biopsy is often used to learn whether a thyroid nodule is benign or cancerous. With this test, a very small needle is inserted through the skin into the thyroid nodule in order to remove samples of tissue or fluid, which are then analyzed in a lab. The test is fast, safe, and usually causes little discomfort with some patients reporting a feeling of pressure to the area during the procedure.
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Causes Of Thyroid Nodules
Thyroid nodules, masses in the thyroid gland, can be the result of benign cell overgrowth or actual discrete tumors comprised of thyroid cells that can be benign or cancerous. Thyroid nodules can sometimes contain fluid, which usually collects due to bleeding from the fragile blood vessels in thyroid tumors, so called cystic degeneration. This event sometimes causes the sudden onset of pain and swelling in the front of the neck, which typically subsides over several days.
Fortunately, more than 90% of thyroid nodules are not cancers, but malignancy should be considered in every affected person. Often patients with small thyroid nodules, less than 1 cm in diameter, and no risk factors for thyroid cancer can simply be reexamined or imaged by sonography to be sure the nodule is not enlarging. For larger nodules, additional studies are usually indicated, as described below.
Conditions Commonly Diagnosed With An Upper Gi Endoscopy
Doctors use endoscopy for a close-up view of the upper digestive tractthe esophagus, stomach, and the first part of the small intestine. Doctors use upper GI endoscopyalso known as esophagogastroduodenoscopy to diagnose a range of diseases and conditions. An upper GI endoscopy can diagnose problems that affect the lining of the upper GI tract or block the passage of food. Take a look at some of the more common conditions.
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What Is An Endoscopic Ultrasound Scan Used For
An endoscopic ultrasound scan can be used for a wide range of different things, including to:
- Diagnose diseases of the internal organs, such as the pancreas. For example, to detect inflammation of the pancreas or fluid-filled sacs of the pancreas.
- Examine the structure of the heart .
- Accurately collect fluid samples from the lungs or the tummy cavity for analysis.
- Look for certain types of cancer.
Thyroid Nodule Symptom # : Uncomfortable Pressure Sensation On The Breathing Tube
- What to do about it?
A thyroid nodule that causes problems with breathing should almost always be removed with surgery. This is a routine operation because this symptom is pretty common. There is an uncommon thyroid cancer that can present with these pressure on the trachea symptoms, but the vast majority of people with this symptom have a large, benign goiter that needs removed. An ultrasound scan should be done in all patients who have problems breathing related to the thyroid gland.
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Thyroid Goiter: When Is A Ct Scan Ordered
When physical examination and or ultrasound cannot completely determine how far the goiter actually goes, then a CT scan should be ordered. The CT scan will show areas that the thyroid goiter extends and prepare the expert thyroid surgeon their safe and effective approach to remove all of the goiter gland and spare all other structures. Even though a thyroid goiter may extend extensively below the sternum and go well into the chest, these goiters can almost routinely be removed through a relatively straight forward low collar incision in the lower neck. If your surgeon is telling you that they need to “split your chest” or “open your sternum”, make sure that you have identified a highly experience thyroid surgeon. Again, such approaches are almost never actually required.
What Questions Should I Ask My Doctor
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Options For Reducing Your Wait Time
Talk to your family doctor about how you may be able to reduce your wait time. You can:
- tell your family doctor youre willing to travel to a specialist with a shorter wait time
- ask about getting treatment at a different hospital
- tell your specialist youre willing to go for diagnostic imaging appointments on evenings, nights or weekends those appointments may be available sooner
- see if there is a cancellation list you could be added to, if you can be available on short notice when last-minute openings become available
- make sure you follow any instructions about what to do before your appointment so you dont risk having to reschedule
How Is The Procedure Performed
Image-guided, minimally invasive procedures such as fine needle aspiration of the thyroid are most often performed by a specially trained radiologist with experience in needle aspiration and ultrasound.
Needle biopsies are usually done on an outpatient basis.
The neck will be cleansed with antiseptic. Medicine to numb the area may or may not be used. An ultrasound transducer with a small amount of sterile water soluble gel will be placed on your neck over the thyroid nodule. The radiologist will insert the needle through the skin under direct imaging guidance, advance it to the site of the thyroid nodule and aspirate samples of tissue. After the sampling, the needle will be removed. New needles will be reinserted if additional samples are required. Several specimens may be needed for a complete analysis.
Once the biopsy is complete, pressure will be applied to the area to decrease the risk of bleeding. A bandage may be placed if necessary. No sutures are needed.
This procedure is usually completed in less than 30 minutes.
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When To Seek A Second Opinion
Some situations warrant a referral to an endocrinologist, a hormone specialist. You should ask for a referral from your primary care doctor if you find yourself in one of these situations after you or someone you’re close to is diagnosed with thyroid disease:
- You’re pregnant or trying to get pregnant.
- The thyroid disease is in a newborn or child.
- You’re diagnosed with thyroid nodules or an enlarged thyroid gland .
- You have any type of hyperthyroidism, including Graves’ disease.
- Your hypothyroidism is caused by a problem with the pituitary gland.
- You’re not feeling better despite treatment.
What Is Upper Gastrointestinal Endoscopy
Upper GI endoscopy is a procedure in which a doctor uses an endoscopea flexible tube with a camerato see the lining of your upper GI tract. A gastroenterologist, surgeon, or other trained health care professional performs the procedure, most often while you receive light sedation to help you relax.
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Types Of Thyroid Cancer
There are 4 main types of thyroid cancer. They are:
- papillary carcinoma this is the most common type, accounting for about 6 out of 10 cases it usually affects people under the age of 40, particularly women
- follicular carcinoma accounts for around 3 out of 20 cases of thyroid cancer and tends to affect older adults
- medullary thyroid carcinoma accounts for between 5 and 8 out of every 100 diagnosed cases unlike the other types of thyroid cancer, medullary thyroid carcinoma can run in families
- anaplastic thyroid carcinoma this is the rarest and most aggressive type of thyroid cancer, accounting for less than 1 in 20 thyroid cancers it usually affects older people over the age of 60
Papillary and follicular carcinomas are sometimes known as differentiated thyroid cancers, and they’re often treated in the same way.
What Is An Upper Endoscopy
An upper endoscopy is a procedure a doctor uses to look at the inner lining of the upper digestive tract .
This test is also sometimes called an esophagogastroduodenoscopy, or EGD.
This procedure is done with an endoscope, a thin, flexible tube with a light and a small video camera on the end. The tube is put in through your mouth, down your throat, and into your esophagus, stomach, and small intestine.
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How Is Thyroid Cancer Diagnosed
In the past thyroid cancer was often discovered by patients themselves. You may see or feel a lump or nodule on the front of your neck, or your doctor may notice a nodule during a routine physical examination. But today, it is more common for a thyroid cancer to be incidentally identified on a CT/MRI or neck ultrasound done for some reason unrelated to the thyroid.
The most common initial finding is the appearance of a painless lump in the lower anterior neck in the region of the thyroid gland. In most cases the thyroid function is normal when measured by blood tests.
Usually the diagnosis of thyroid cancer is suspected because a nodule or mass is detected in the front of the neck. In most cases, a needle biopsy of the nodule is needed to obtain cells for careful evaluation under a microscope. In most cases, microscopic analysis of the cells obtained from a needle biopsy can readily determine if a nodule is benign or malignant . While thyroid blood tests are usually done to evaluate the function of the thyroid, and a thyroid ultrasound is often done to evaluate the structure of the thyroid gland, neither of these types of tests are sufficient to confidently determine if a thyroid nodule is benign or malignant.
Why Do Doctors Use Upper Gi Endoscopy
Upper GI endoscopy can help find the cause of unexplained symptoms, such as
- persistent heartburn
- strictures or narrowing of the esophagus
Upper GI endoscopy can check for damage after a person eats or drinks harmful chemicals.
During upper GI endoscopy, a doctor obtains biopsies by passing an instrument through the endoscope to obtain a small piece of tissue for testing. Biopsies are needed to diagnose conditions such as
Doctors also use upper GI endoscopy to
- treat conditions such as bleeding from ulcers, esophageal varices, or other conditions
- dilate or open up strictures with a small balloon passed through the endoscope
- remove objects, including food, that may be stuck in the upper GI tract
- remove polyps or other growths
- place feeding tubes or drainage tubes
Doctors are also starting to use upper GI endoscopy to perform weight loss procedures for some people with obesity.
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Whats It Like To Have An Upper Endoscopy
This is a general outline of what typically happens before, during, and after an upper endoscopy. But your experience might be a little different, depending on why youâre having the test, where youâre having the test done, and your overall health. Be sure to talk to your health care provider before having this test so you understand what to expect, and ask questions if thereâs anything youâre not sure about.
Possible Complications Of Upper Endoscopy
Upper endoscopy is usually safe, but there is a small risk of:
- Bleeding from a place where the doctor removed tissue samples
- Perforation of the lining of the digestive tract
- Reactions to anesthesia
Bleeding is often minor and goes away on its own, but if not, it might need to be treated. Surgery might be needed to fix a perforation.
Before you go home, your doctor or nurse should give you specific instructions on when you might need to call the doctorâs office for problems. Be sure you understand when you should call.
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What Is Ultrasound
During a fine needle aspiration biopsy of the thyroid, a small sample of tissue is removed from the thyroid gland. The thyroid gland is located in front of the neck just above the neckline and is shaped like a butterfly, with two lobes on either side of the neck connected by a narrow band of tissue.
A needle biopsy, also called a needle aspiration, involves removing some cellsin a less invasive procedure involving a hollow needlefrom a suspicious area within the body and examining them under a microscope to determine a diagnosis.
How Does It Work
Endoscopy is an excellent way to look at and take samples from parts of the gut. By attaching an ultrasound probe, the endoscope can also help to create detailed pictures of parts of the body that are difficult to show in other scans.
Ultrasound is a high-frequency sound that you cannot hear but which can be emitted and detected by special machines.
Ultrasound travels freely through fluid and soft tissues. However, ultrasound is reflected back when it hits a more solid surface. For example, the ultrasound will travel freely through blood in a heart chamber. However, when it hits a solid valve, a lot of the ultrasound echoes back. Another example is that when ultrasound travels though bile in a gallbladder it will echo back strongly if it hits a solid gallstone.
So, as ultrasound ‘hits’ different structures of different density in the body, it sends back echoes of varying strength. This helps to build a picture of the structures surrounding the probe.
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You Have A Digestive System Problem That Needs To Be Treated
Upper endoscopy can be used to treat a blocked part of the digestive tract or some other types of problems. For example, a small laser put on the end of an endoscope can be used to burn away part of a tumor that is blocking the passage of food. Or an endoscope can be used to place a rigid tube called a stent into a part of the digestive tract to help keep it open.
How Head And Neck Cancer Is Diagnosed
There are many tests used for diagnosing head and neck cancer. Not all tests described here will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:
The type of cancer suspected
Your signs and symptoms
Your age and general health
The results of earlier medical tests
If a person has symptoms and signs of head and neck cancer, the doctor will take a complete medical history, noting all symptoms and risk factors. In addition, the following tests may be used to diagnose head and neck cancer:
After diagnostic tests are done, your doctor will review the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer. This is called staging.
The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.
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