Bahasa/语文 :
Alternatively, FNAC can be more accurately performed under ultrasound guidance, called ultrasound-guided FNAC. It is more superior for deep-seated masses as the ultrasound allow a real-time precise targeting of the needle into the lesion in question (analogy is a soldier wearing a night-vision infra-red goggle in pitch-black darkness shooting at a target !) Other than thyroids, this technique can also be applied to other head and neck masses, as in here. The advantages of ultrasonography is that it is rapid, inexpensive, versatile, no ionizing radiation (eg. CT scan, X ray) is applied, does not require injection of contrast medium and can be easily repeated when necessary Ultrasound guided fine needle aspiration cytology (FNAC) is a safe diagnostic procedure in which any structure visualized can be reached quickly and precisely by a fine needle in any desired plane with constant visualization of the needle tip during insertion. 3.   Endoscopic   examination   of   the   vocal   cords    to   exclude   potential   involvement   of   the   nerve   (recurrent laryngeal   nerve   RLN)   supplying   the   vocal   cords   pre-   and   post-surgery.   This   can   be   done   in   the   outpatient clinic after applying some local anaesthetic nasal spray. As   a   thyroid   cancer   may   infiltrate   into   the   nerve   supplying   the   vocal   cord   muscles,   similarly   the   thyroid surgery   itself   may   potentially   affect   the   function   of   the   nerve,   it   is   vital   to   know   the   status   of   the   voice   box (vocal   cords)   before   and   after   the   surgery.   Any   vocal   cord   weakness   can   affect   the   voice   and   swallowing function. .
© Vincent Tan ENT Ultrasound-guided Fine-needle aspiration cytology (FNAC) of a thyroid gland mass (red arrow) Ultrasound-guidance showing the tip of the needle (red arrow) in the mass in question confirming accurate targeting Ultrasound-guidance showing the shaft of the needle (red arrow) in the mass in question confirming accurate targeting
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Vincent Ear, Nose, Throat, Head and Neck Surgery Specialist Clinic, Clinic Suite 210, Level 2, KPJ Klang Specialist Hospital No.102, Persiaran Rajawali/KU 1, Bandar Baru Klang, 41150 Klang, Selangor
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Copyright Dr.Vincent Tan 2018
Talks about HYPERTHYROIDISM  on 20/12/16 (for educational purposes, in Mandarin, copyright ntv7)
Talks about NECK SWELLING on 2/1/15 (for educational purposes, in BM, copyright TV9)
Talks about THYROID on 6/12/16 (for educational purposes, in BM, copyright TV3)
THYROID disorders
Thyroid    Disorders
What is a thyroid gland ?  The thyroid gland is a small organ in the midline of the neck, just below the Adam's apple (larynx). It is easy to recognize a thyroid swelling- it moves up on swallowing ! The   function   of   the   thyroid   gland   is   to   make   a   hormone   called   'thyroxine'. A   normal   amount   of   thyroxine is   required   for   normal   physical   and   mental   development.   In   adults,   thyroxine   keeps   cells   and   tissues working at just the right metabolic rate. What can go wrong with it ? However,    lumps    or    masses    can    arise    in    the    thyroid    causing    different    thyroid    diseases.   A    visible enlargement   of   the   thyroid   gland   is   called   Goitre.   The   entire   gland   may   be   involved   or   there   may   be single   or   multiple   nodules   or   lumps.   Thyroid   masses   can   also   be   associated   with   hormonal   imbalance. Patients   with   overactive   or   under-active   thyroid   glands   can   have   goitre   but   most   goitres   produce   a normal amount of thyroxine. An   overactive   thyroid   gland   would   produce   too   much   thyroxine   causing   hyperthyroidism The   symptoms of   this   condition   include   tremor,   heat   intolerance,   irritability,   increased   energy,   poor   sleep,   weight   loss and frequently, bulging eyes. Patients generally have a high metabolic rate. Too   little   thyroxine   from   an   under-active   gland   causes   an   illness   with   a   low   metabolic   rate   called hypothyroidism.   This   condition   causes   tiredness,   weight   gain,   swelling   and   slowness   of   speech   and thinking. Single Nodule A   single   swelling   or   lump   (nodule)   in   the   thyroid   gland   is   a   special   form   of   goitre.   The   majority   (90%)   of the   nodules   are   not   cancerous   but   either   simple   swellings   of   fluid   (cysts)   or   benign   growths   of   thyroid tissue with no tendency to spread or invade structures. The   remaining   10%   are   usually   a   very   low-grade   form   of   cancer,   which   is   almost   always   completely curable.   There   are   a   very   small   number   of   nodules   that   turn   out   to   be   a   more   aggressive   form   of thyroid cancer, these occur in special situations and are very rare. Multinodular Goitre (MNG) Frequently   the   lumps   are   not   single   but   multiple   and   part   of   an   innocent,   non-cancerous   condition called   MNG,   which   just   means   that   several   swellings   are   present.   Occasionally   they   can   be   later   found to harbour cancer cells ! Cyst Cysts   (fluid   collections)   in   the   thyroid   are   common.   Frequently   they   are   present   without   the   patient noticing but sometimes they can enlarge so that they can be felt.
A normal thyroid gland in the neck (source: Netter Interactive Atlas) Effects of too much thyroxine (hyperthyroidism) on the eyes: “staring” look, bulging eyes to the extent of difficulty closing the eyes (last pic)  © Vincent Tan ENT Thyroid swelling in different shapes and sizes (L-R): Small colloid cyst, large colloid cyst and a multinodular thyroid mass (goitre)  © Vincent Tan ENT An ultrasound of the neck in progress, with the red arrow showing the probe An ultrasound image of a thyroid mass (the blue line showing the approximate size) © Vincent Tan ENT An ultrasound of the thyroid in progress using color Doppler scan
Colloid Nodules These are benign nodules made up of thyroid tissue that have become enlarged. They can be single or multiple and can sometimes become very large. Surgery becomes necessary if the nodule becomes large and causes compressive symptoms or if they cause cosmetic deformity. Non-Cancerous Tumours These   tumours   (generally   'adenoma')   are   caused   by   an   abnormal   growth   of   thyroid   follicle   cells. They   have   no   capacity to   spread   or   cause   destruction   of   tissue   but   they   cannot   be   differentiated   from   one   of   the   types   of   thyroid   cancer   on FNAC (please see next column). Surgery is usually recommended for diagnosis. Thyroid Cancers The   most   common   thyroid   cancers   are   differentiated   thyroid   cancers   named   either   papillary   or   follicular   cancer.   These make   up   more   than   90%   of   thyroid   cancer   and   they   very   rarely   cause   death.   They   do   have   the   potential   to   spread   to lymph   nodes   in   the   neck   and   to   other   parts   of   the   body   such   as   the   lungs   but   even   if   they   do,   these   tumours   are   still treatable. Surgery is necessary in most cases. So what are the complications? Goitres,   especially   MNG,   can   become   very   large   and   cause   pressure   on   the   windpipe   (trachea)   and   swallowing   tube (oesophagus).   This   can   result   in   shortness   of   breath,   voice   change,   cough,   increased   pressure   sensation   in   the   neck and sometimes difficulty swallowing. Surgery   to   remove   the   thyroid   gland   is   usually   necessary   to   treat   large   goitres   that   are   causing   symptoms.   Surgery   is also   necessary   where   there   is   a   suspicion   of   thyroid   cancer   in   an   enlarged   thyroid   gland   and   where   the   swelling   is causing cosmetic deformity. So, how is a thyroid problem diagnosed? 1. An   ultrasound   scan   may   be   requested   to   measure   the   shape   of   the   thyroid   and   to   look   for   nodules   or   cysts   within the gland. 2.   Fine   needle   aspiration   cytology   (FNAC) .   This   is   an   extremely   valuable   test   for   diagnosing   thyroid   lumps.   A   small sample   of   cells   or   fluid   is   removed   from   the   thyroid   gland   by   passing   a   needle   through   the   nodule   or   cyst   in   the   gland. The   aspirate   is   then   examined   under   the   microscope   and   the   type   of   cells   making   up   the   swelling   can   be   seen.   The test   is   usually   80-90   percent   accurate.   Histology   (Study   of   the   cells   making   up   the   sweling)   of   the   mass   in   question   is important   to   differentiate   a   cancerous   and   non-cancerous   type,   and   further   to   that,   which      particular   subtype   of   cells. This in turns makes a big difference in the subsequent treatment of the mass.
RELATED LINKS
Head & Neck Swellings
Vocal Cord Weakness & Paralysis
Ultrasound-guided biopsy
VINCENT
Ear, Nose and Throat (ENT), Thyroid, Head and Neck Surgery
Specialist Clinic
Committed to YOUR Well-being
Bahasa/语文 :
Alternatively, FNAC can be more accurately performed under ultrasound guidance, called ultrasound-guided FNAC. It is more superior for deep-seated masses as the ultrasound allow a real-time precise targeting of the needle into the lesion in question (analogy is a soldier wearing a night-vision infra-red goggle in pitch-black darkness shooting at a target !) Other than thyroids, this technique can also be applied to other head and neck masses, as in here. The advantages of ultrasonography is that it is rapid, inexpensive, versatile, no ionizing radiation (eg. CT scan, X ray) is applied, does not require injection of contrast medium and can be easily repeated when necessary Ultrasound guided fine needle aspiration cytology (FNAC) is a safe diagnostic procedure in which any structure visualized can be reached quickly and precisely by a fine needle in any desired plane with constant visualization of the needle tip during insertion. 3.    Endoscopic    examination    of    the    vocal    cords     to    exclude potential    involvement    of    the    nerve    (recurrent    laryngeal    nerve RLN)   supplying   the   vocal   cords   pre-   and   post-surgery.   This   can be    done    in    the    outpatient    clinic    after    applying    some    local anaesthetic nasal spray. As   a   thyroid   cancer   may   infiltrate   into   the   nerve   supplying   the vocal    cord    muscles,    similarly    the    thyroid    surgery    itself    may potentially   affect   the   function   of   the   nerve,   it   is   vital   to   know   the status   of   the   voice   box   (vocal   cords)   before   and   after   the   surgery. Any   vocal   cord   weakness   can   affect   the   voice   and   swallowing function. .
© Vincent Tan ENT Ultrasound-guided Fine-needle aspiration cytology (FNAC) of a thyroid gland mass (red arrow) Ultrasound-guidance showing the tip of the needle (red arrow) in the mass in question confirming accurate targeting Ultrasound-guidance showing the shaft of the needle (red arrow) in the mass in question confirming accurate targeting
Talks about HYPERTHYROIDISM  on 20/12/16 (for educational purposes, in Mandarin, copyright ntv7)
Talks about NECK SWELLING on 2/1/15 (for educational purposes, in BM, copyright TV9)
Talks about THYROID on 6/12/16 (for educational purposes, in BM, copyright TV3)
Thyroid    Disorders
What is a thyroid gland ?  The   thyroid   gland   is   a   small   organ   in   the   midline   of   the   neck, just below the Adam's apple (larynx). It   is   easy   to   recognize   a   thyroid   swelling-   it   moves   up   on swallowing ! The   function   of   the   thyroid   gland   is   to   make   a   hormone   called 'thyroxine'.    A    normal    amount    of    thyroxine    is    required    for normal   physical   and   mental   development.   In   adults,   thyroxine keeps   cells   and   tissues   working   at   just   the   right   metabolic rate. What can go wrong with it ? However,   lumps   or   masses   can   arise   in   the   thyroid   causing different   thyroid   diseases.   A   visible   enlargement   of   the   thyroid gland   is   called   Goitre.   The   entire   gland   may   be   involved   or there   may   be   single   or   multiple   nodules   or   lumps.   Thyroid masses    can    also    be    associated    with    hormonal    imbalance. Patients   with   overactive   or   under-active   thyroid   glands   can have    goitre    but    most    goitres    produce    a    normal    amount    of thyroxine. An   overactive   thyroid   gland   would   produce   too   much   thyroxine causing    hyperthyroidism    The    symptoms    of    this    condition include   tremor,   heat   intolerance,   irritability,   increased   energy, poor   sleep,   weight   loss   and   frequently,   bulging   eyes.   Patients generally have a high metabolic rate. Too    little    thyroxine    from    an    under-active    gland    causes    an illness   with   a   low   metabolic   rate   called   hypothyroidism.   This condition     causes     tiredness,     weight     gain,     swelling     and slowness of speech and thinking. Single Nodule A   single   swelling   or   lump   (nodule)   in   the   thyroid   gland   is   a special   form   of   goitre.   The   majority   (90%)   of   the   nodules   are not   cancerous   but   either   simple   swellings   of   fluid   (cysts)   or benign   growths   of   thyroid   tissue   with   no   tendency   to   spread   or invade structures. The    remaining    10%    are    usually    a    very    low-grade    form    of cancer,   which   is   almost   always   completely   curable.   There   are a   very   small   number   of   nodules   that   turn   out   to   be   a   more aggressive    form    of    thyroid    cancer,    these    occur    in    special situations and are very rare. Multinodular Goitre (MNG) Frequently   the   lumps   are   not   single   but   multiple   and   part   of   an innocent,    non-cancerous    condition    called    MNG,    which    just means   that   several   swellings   are   present.   Occasionally   they can be later found to harbour cancer cells ! Cyst Cysts   (fluid   collections)   in   the   thyroid   are   common.   Frequently they   are   present   without   the   patient   noticing   but   sometimes they can enlarge so that they can be felt.
A normal thyroid gland in the neck (source: Netter Interactive Atlas) Effects of too much thyroxine (hyperthyroidism) on the eyes: “staring” look, bulging eyes to the extent of difficulty closing the eyes (last pic)  © Vincent Tan ENT Thyroid swelling in different shapes and sizes (L-R): Small colloid cyst, large colloid cyst and a multinodular thyroid mass (goitre) © Vincent Tan ENT
Colloid Nodules These are benign nodules made up of thyroid tissue that have become enlarged. They can be single or multiple and can sometimes become very large. Surgery becomes necessary if the nodule becomes large and causes compressive symptoms or if they cause cosmetic deformity. Non-Cancerous Tumours These    tumours    (generally    'adenoma')    are    caused    by    an abnormal   growth   of   thyroid   follicle   cells.   They   have   no   capacity to   spread   or   cause   destruction   of   tissue   but   they   cannot   be differentiated   from   one   of   the   types   of   thyroid   cancer   on   FNAC (please   see   next   column).   Surgery   is   usually   recommended   for diagnosis. Thyroid Cancers The   most   common   thyroid   cancers   are   differentiated   thyroid cancers   named   either   papillary   or   follicular   cancer. These   make up   more   than   90%   of   thyroid   cancer   and   they   very   rarely   cause death.   They   do   have   the   potential   to   spread   to   lymph   nodes   in the   neck   and   to   other   parts   of   the   body   such   as   the   lungs   but even   if   they   do,   these   tumours   are   still   treatable.   Surgery   is necessary in most cases. So what are the complications? Goitres,   especially   MNG,   can   become   very   large   and   cause pressure    on    the    windpipe    (trachea)    and    swallowing    tube (oesophagus).   This   can   result   in   shortness   of   breath,   voice change,   cough,   increased   pressure   sensation   in   the   neck   and sometimes difficulty swallowing. Surgery   to   remove   the   thyroid   gland   is   usually   necessary   to treat   large   goitres   that   are   causing   symptoms.   Surgery   is   also necessary   where   there   is   a   suspicion   of   thyroid   cancer   in   an enlarged    thyroid    gland    and    where    the    swelling    is    causing cosmetic deformity. So, how is a thyroid problem diagnosed? 1.   An    ultrasound    scan    may    be    requested    to    measure    the shape   of   the   thyroid   and   to   look   for   nodules   or   cysts   within   the gland. 2.    Fine    needle    aspiration    cytology    (FNAC) .    This    is    an extremely   valuable   test   for   diagnosing   thyroid   lumps.   A   small sample   of   cells   or   fluid   is   removed   from   the   thyroid   gland   by passing   a   needle   through   the   nodule   or   cyst   in   the   gland.   The aspirate   is   then   examined   under   the   microscope   and   the   type of   cells   making   up   the   swelling   can   be   seen.   The   test   is   usually 80-90   percent   accurate.   Histology   (Study   of   the   cells   making up    the    sweling)    of    the    mass    in    question    is    important    to differentiate   a   cancerous   and   non-cancerous   type,   and   further to   that,   which      particular   subtype   of   cells.   This   in   turns   makes   a big difference in the subsequent treatment of the mass.
RELATED LINKS
Head & Neck Swellings
Vocal Cord Weakness & Paralysis
Ultrasound-guided biopsy
APPOINTMENT:  +603-3377 7864 +6012-3760 728 VINCENT EAR, NOSE & THROAT, THYROID , HEAD AND NECK SURGERY SPECIALIST CLINIC  VINCENT
Ear, Nose and Throat (ENT), Thyroid, Head and Neck Surgery
Specialist Clinic
Committed to YOUR Well-being
Copyright Dr.Vincent Tan 2018
THYROID disorders
An ultrasound of the neck in progress, with the red arrow showing the probe An ultrasound image of a thyroid mass (the blue line showing the approximate size) © Vincent Tan ENT An ultrasound of the thyroid in progress using color Doppler scan