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 necessaryUltrasound 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.Endoscopicexaminationofthevocalcordstoexcludepotentialinvolvementofthenerve(recurrent laryngealnerveRLN)supplyingthevocalcordspre-andpost-surgery.Thiscanbedoneintheoutpatient clinic after applying some local anaesthetic nasal spray.Asathyroidcancermayinfiltrateintothenervesupplyingthevocalcordmuscles,similarlythethyroid surgeryitselfmaypotentiallyaffectthefunctionofthenerve,itisvitaltoknowthestatusofthevoicebox (vocalcords)beforeandafterthesurgery.Anyvocalcordweaknesscanaffectthevoiceandswallowing function..
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Vincent Ear, Nose, Throat, Head and Neck Surgery Specialist Clinic, Clinic Suite 210, Level 2,KPJ Klang Specialist HospitalNo.102, Persiaran Rajawali/KU 1,Bandar Baru Klang,41150 Klang,Selangor
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 !Thefunctionofthethyroidglandistomakeahormonecalled'thyroxine'. Anormalamountofthyroxine isrequiredfornormalphysicalandmentaldevelopment.Inadults,thyroxinekeepscellsandtissues working at just the right metabolic rate.What can go wrong with it ?However,lumpsormassescanariseinthethyroidcausingdifferentthyroiddiseases.Avisible enlargementofthethyroidglandiscalledGoitre.Theentireglandmaybeinvolvedortheremaybe singleormultiplenodulesorlumps.Thyroidmassescanalsobeassociatedwithhormonalimbalance. Patientswithoveractiveorunder-activethyroidglandscanhavegoitrebutmostgoitresproducea normal amount of thyroxine.Anoveractivethyroidglandwouldproducetoomuchthyroxinecausinghyperthyroidism Thesymptoms ofthisconditionincludetremor,heatintolerance,irritability,increasedenergy,poorsleep,weightloss and frequently, bulging eyes. Patients generally have a high metabolic rate.Toolittlethyroxinefromanunder-activeglandcausesanillnesswithalowmetabolicratecalled hypothyroidism.Thisconditioncausestiredness,weightgain,swellingandslownessofspeechand thinking.Single NoduleAsingleswellingorlump(nodule)inthethyroidglandisaspecialformofgoitre.Themajority(90%)of thenodulesarenotcancerousbuteithersimpleswellingsoffluid(cysts)orbenigngrowthsofthyroid tissue with no tendency to spread or invade structures.Theremaining10%areusuallyaverylow-gradeformofcancer,whichisalmostalwayscompletely curable.Thereareaverysmallnumberofnodulesthatturnouttobeamoreaggressiveformof thyroid cancer, these occur in special situations and are very rare.Multinodular Goitre (MNG)Frequentlythelumpsarenotsinglebutmultipleandpartofaninnocent,non-cancerouscondition calledMNG,whichjustmeansthatseveralswellingsarepresent.Occasionallytheycanbelaterfound to harbour cancer cells !CystCysts(fluidcollections)inthethyroidarecommon.Frequentlytheyarepresentwithoutthepatient noticing but sometimes they can enlarge so that they can be felt.
Colloid NodulesThese 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 TumoursThesetumours(generally'adenoma')arecausedbyanabnormalgrowthofthyroidfolliclecells. Theyhavenocapacity tospreadorcausedestructionoftissuebuttheycannotbedifferentiatedfromoneofthetypesofthyroidcanceron FNAC (please see next column). Surgery is usually recommended for diagnosis. Thyroid CancersThemostcommonthyroidcancersaredifferentiatedthyroidcancersnamedeitherpapillaryorfollicularcancer.These makeupmorethan90%ofthyroidcancerandtheyveryrarelycausedeath.Theydohavethepotentialtospreadto lymphnodesintheneckandtootherpartsofthebodysuchasthelungsbuteveniftheydo,thesetumoursarestill treatable. Surgery is necessary in most cases.So what are the complications?Goitres,especiallyMNG,canbecomeverylargeandcausepressureonthewindpipe(trachea)andswallowingtube (oesophagus).Thiscanresultinshortnessofbreath,voicechange,cough,increasedpressuresensationintheneck and sometimes difficulty swallowing.Surgerytoremovethethyroidglandisusuallynecessarytotreatlargegoitresthatarecausingsymptoms.Surgeryis alsonecessarywherethereisasuspicionofthyroidcancerinanenlargedthyroidglandandwheretheswellingis causing cosmetic deformity.So, how is a thyroid problem diagnosed?1. Anultrasoundscanmayberequestedtomeasuretheshapeofthethyroidandtolookfornodulesorcystswithin the gland. 2.Fineneedleaspirationcytology(FNAC).Thisisanextremelyvaluabletestfordiagnosingthyroidlumps.Asmall sampleofcellsorfluidisremovedfromthethyroidglandbypassinganeedlethroughthenoduleorcystinthegland. Theaspirateisthenexaminedunderthemicroscopeandthetypeofcellsmakinguptheswellingcanbeseen.The testisusually80-90percentaccurate.Histology(Studyofthecellsmakingupthesweling)ofthemassinquestionis importanttodifferentiateacancerousandnon-canceroustype,andfurthertothat,whichparticularsubtypeofcells. 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
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 necessaryUltrasound 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.Endoscopicexaminationofthevocalcordstoexclude potentialinvolvementofthenerve(recurrentlaryngealnerve RLN)supplyingthevocalcordspre-andpost-surgery.Thiscan bedoneintheoutpatientclinicafterapplyingsomelocal anaesthetic nasal spray.Asathyroidcancermayinfiltrateintothenervesupplyingthe vocalcordmuscles,similarlythethyroidsurgeryitselfmay potentiallyaffectthefunctionofthenerve,itisvitaltoknowthe statusofthevoicebox(vocalcords)beforeandafterthesurgery. Anyvocalcordweaknesscanaffectthevoiceandswallowing function..
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)
What is a thyroid gland ?Thethyroidglandisasmallorganinthemidlineoftheneck, just below the Adam's apple (larynx).Itiseasytorecognizeathyroidswelling-itmovesupon swallowing !Thefunctionofthethyroidglandistomakeahormonecalled 'thyroxine'.Anormalamountofthyroxineisrequiredfor normalphysicalandmentaldevelopment.Inadults,thyroxine keepscellsandtissuesworkingatjusttherightmetabolic rate.What can go wrong with it ?However,lumpsormassescanariseinthethyroidcausing differentthyroiddiseases.Avisibleenlargementofthethyroid glandiscalledGoitre.Theentireglandmaybeinvolvedor theremaybesingleormultiplenodulesorlumps.Thyroid massescanalsobeassociatedwithhormonalimbalance. Patientswithoveractiveorunder-activethyroidglandscan havegoitrebutmostgoitresproduceanormalamountof thyroxine.Anoveractivethyroidglandwouldproducetoomuchthyroxine causinghyperthyroidismThesymptomsofthiscondition includetremor,heatintolerance,irritability,increasedenergy, poorsleep,weightlossandfrequently,bulgingeyes.Patients generally have a high metabolic rate.Toolittlethyroxinefromanunder-activeglandcausesan illnesswithalowmetabolicratecalledhypothyroidism.This conditioncausestiredness,weightgain,swellingand slowness of speech and thinking.Single NoduleAsingleswellingorlump(nodule)inthethyroidglandisa specialformofgoitre.Themajority(90%)ofthenodulesare notcancerousbuteithersimpleswellingsoffluid(cysts)or benigngrowthsofthyroidtissuewithnotendencytospreador invade structures.Theremaining10%areusuallyaverylow-gradeformof cancer,whichisalmostalwayscompletelycurable.Thereare averysmallnumberofnodulesthatturnouttobeamore aggressiveformofthyroidcancer,theseoccurinspecial situations and are very rare.Multinodular Goitre (MNG)Frequentlythelumpsarenotsinglebutmultipleandpartofan innocent,non-cancerousconditioncalledMNG,whichjust meansthatseveralswellingsarepresent.Occasionallythey can be later found to harbour cancer cells !CystCysts(fluidcollections)inthethyroidarecommon.Frequently theyarepresentwithoutthepatientnoticingbutsometimes they can enlarge so that they can be felt.
Colloid NodulesThese 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 TumoursThesetumours(generally'adenoma')arecausedbyan abnormalgrowthofthyroidfolliclecells.Theyhavenocapacity tospreadorcausedestructionoftissuebuttheycannotbe differentiatedfromoneofthetypesofthyroidcanceronFNAC (pleaseseenextcolumn).Surgeryisusuallyrecommendedfor diagnosis. Thyroid CancersThemostcommonthyroidcancersaredifferentiatedthyroid cancersnamedeitherpapillaryorfollicularcancer. Thesemake upmorethan90%ofthyroidcancerandtheyveryrarelycause death.Theydohavethepotentialtospreadtolymphnodesin theneckandtootherpartsofthebodysuchasthelungsbut eveniftheydo,thesetumoursarestilltreatable.Surgeryis necessary in most cases.So what are the complications?Goitres,especiallyMNG,canbecomeverylargeandcause pressureonthewindpipe(trachea)andswallowingtube (oesophagus).Thiscanresultinshortnessofbreath,voice change,cough,increasedpressuresensationintheneckand sometimes difficulty swallowing.Surgerytoremovethethyroidglandisusuallynecessaryto treatlargegoitresthatarecausingsymptoms.Surgeryisalso necessarywherethereisasuspicionofthyroidcancerinan enlargedthyroidglandandwheretheswellingiscausing cosmetic deformity.So, how is a thyroid problem diagnosed?1.Anultrasoundscanmayberequestedtomeasurethe shapeofthethyroidandtolookfornodulesorcystswithinthe gland. 2.Fineneedleaspirationcytology(FNAC).Thisisan extremelyvaluabletestfordiagnosingthyroidlumps.Asmall sampleofcellsorfluidisremovedfromthethyroidglandby passinganeedlethroughthenoduleorcystinthegland.The aspirateisthenexaminedunderthemicroscopeandthetype ofcellsmakinguptheswellingcanbeseen.Thetestisusually 80-90percentaccurate.Histology(Studyofthecellsmaking upthesweling)ofthemassinquestionisimportantto differentiateacancerousandnon-canceroustype,andfurther tothat,whichparticularsubtypeofcells.Thisinturnsmakesa big difference in the subsequent treatment of the mass.
RELATED LINKS
Head & Neck Swellings
Vocal Cord Weakness & Paralysis
Ultrasound-guided biopsy
Ear, Nose and Throat (ENT), Thyroid, Head and Neck Surgery