Thyroid: Dr. Dany Zayour

Thyroid:Thyroid:Bringing Life Back into BalanceBringing Life Back into Balance

Dany Zayour, MDDany Zayour, MD

EndocrinologistEndocrinologist

Via Christi Medical AssociatesVia Christi Medical Associates

Why talk about the Thyroid?Why talk about the Thyroid?

An estimated 27 million Americans have thyroid An estimated 27 million Americans have thyroid diseasedisease

More than half are undiagnosedMore than half are undiagnosed Women are at the greatest risk, developing thyroid Women are at the greatest risk, developing thyroid

problems seven times more often than menproblems seven times more often than men A woman faces as high as a one in five chance of A woman faces as high as a one in five chance of

developing thyroid problems during her lifetimedeveloping thyroid problems during her lifetime Risk increases with age and family history of thyroid Risk increases with age and family history of thyroid

problemsproblems

Where is the Thyroid and What Does it Do?Where is the Thyroid and What Does it Do?

Your thyroid is a small bowtie or butterfly-shaped Your thyroid is a small bowtie or butterfly-shaped gland located in the neckgland located in the neck

Wrapped around the windpipeWrapped around the windpipe Below the Adam's Apple area. Below the Adam's Apple area. The thyroid produces several hormones: The thyroid produces several hormones:

triiodothyronine (T3) and thyroxine (T4)triiodothyronine (T3) and thyroxine (T4) These hormones help oxygen get into cells, and These hormones help oxygen get into cells, and

make your thyroid the master gland of metabolism.make your thyroid the master gland of metabolism.

You have a higher risk of developing thyroid disease ifYou have a higher risk of developing thyroid disease if

You're femaleYou're female You have a family member with a thyroid problemYou have a family member with a thyroid problem You or a family member have an autoimmune diseaseYou or a family member have an autoimmune disease You've been diagnosed with Chronic Fatigue You've been diagnosed with Chronic Fatigue

Syndrome Syndrome You've been diagnosed with Fibromyalgia You've been diagnosed with Fibromyalgia You've just had a babyYou've just had a baby You're a smokerYou're a smoker You've been exposed to radiationYou've been exposed to radiation You've been treated with lithiumYou've been treated with lithium

What Diseases and Conditions Affect the Thyroid?What Diseases and Conditions Affect the Thyroid?

Hypothyroidism -- An underactive thyroidHypothyroidism -- An underactive thyroid Hyperthyroidism -- An overactive thyroidHyperthyroidism -- An overactive thyroid Goiter -- An enlarged thyroidGoiter -- An enlarged thyroid Thyroid Nodules -- Lumps in the thyroid gland Thyroid Nodules -- Lumps in the thyroid gland Thyroid Cancer -- Malignant thyroid nodules or tissueThyroid Cancer -- Malignant thyroid nodules or tissue Thyroiditis -- Inflammation of the thyroidThyroiditis -- Inflammation of the thyroid

Hypothyroidism: Underactive ThyroidHypothyroidism: Underactive Thyroid

Improperly formed at birth Improperly formed at birth surgically removed all or in partsurgically removed all or in part Autoimmune disease called Hashimoto's Autoimmune disease called Hashimoto's

disease, in which antibodies gradually target disease, in which antibodies gradually target the thyroid and destroy its ability to produce the thyroid and destroy its ability to produce thyroid hormonethyroid hormone

Risk factors for hypothyroidismRisk factors for hypothyroidism

____ I have a family history of thyroid disease ____ I have a family history of thyroid disease ____ I have had my thyroid "monitored" in the past to watch for changes ____ I have had my thyroid "monitored" in the past to watch for changes ____ I had a previous diagnosis of goiters/nodules ____ I had a previous diagnosis of goiters/nodules ____ I currently have a goiter ____ I currently have a goiter ____ I was treated for hypothyroidism in the past ____ I was treated for hypothyroidism in the past ____ I had post-partum thyroiditis in the past ____ I had post-partum thyroiditis in the past ____ I had a temporary thyroiditis in the past ____ I had a temporary thyroiditis in the past ____ I have another autoimmune disease ____ I have another autoimmune disease ____ I have had a baby in the past nine months ____ I have had a baby in the past nine months

Risk factors for hypothyroidismRisk factors for hypothyroidism

____ I have a history of miscarriage ____ I have a history of miscarriage ____ I have had part/all of my thyroid removed due to cancer ____ I have had part/all of my thyroid removed due to cancer ____ I have had part/all of my thyroid removed due to nodules ____ I have had part/all of my thyroid removed due to nodules ____ I have had part/all of my thyroid removed due to hyperthyroidism ____ I have had part/all of my thyroid removed due to hyperthyroidism ____ I have had radioactive iodine due to hyperthyroidism ____ I have had radioactive iodine due to hyperthyroidism ____ I have had anti-thyroid drugs due to hyperthyroidism____ I have had anti-thyroid drugs due to hyperthyroidism

Symptoms of hypothyroidismSymptoms of hypothyroidism

____ I am gaining weight inappropriately ____ I am gaining weight inappropriately ____ I'm unable to lose weight with diet/exercise ____ I'm unable to lose weight with diet/exercise ____ I am constipated, sometimes severely ____ I am constipated, sometimes severely ____ I have hypothermia/low body temperature____ I have hypothermia/low body temperature (I feel cold when others feel hot, I need extra sweaters, (I feel cold when others feel hot, I need extra sweaters, etc.) etc.) ____ I feel fatigued, exhausted ____ I feel fatigued, exhausted ____ Feeling run down, sluggish, lethargic ____ Feeling run down, sluggish, lethargic ____ My hair is coarse and dry, breaking, brittle, falling out ____ My hair is coarse and dry, breaking, brittle, falling out


____ My skin is coarse, dry, scaly, and thick ____ My skin is coarse, dry, scaly, and thick ____ I have a hoarse or gravely voice ____ I have a hoarse or gravely voice ____ I have puffiness and swelling around the eyes and face ____ I have puffiness and swelling around the eyes and face ____ I have pains, aches in joints, hands and feet ____ I have pains, aches in joints, hands and feet ____ I have developed carpal-tunnel syndrome, or it's getting worse____ I have developed carpal-tunnel syndrome, or it's getting worse ____ ____ I am having irregular menstrual cycles (longer, or heavier, or more frequent) I am having irregular menstrual cycles (longer, or heavier, or more frequent) ____ I am having trouble conceiving a baby ____ I am having trouble conceiving a baby


____ I feel depressed ____ I feel depressed ____ I feel restless ____ I feel restless ____ My moods change easily ____ My moods change easily ____ I have feelings of worthlessness ____ I have feelings of worthlessness ____ I have difficulty concentrating ____ I have difficulty concentrating ____ I have more feelings of sadness ____ I have more feelings of sadness ____ I seem to be losing interest in normal daily activities ____ I seem to be losing interest in normal daily activities ____ I'm more forgetful lately____ I'm more forgetful lately

HyperthyroidismHyperthyroidism

When the thyroid gland becomes overactive When the thyroid gland becomes overactive and produces too much thyroid hormone and produces too much thyroid hormone

The most common cause of hyperthyroidism is The most common cause of hyperthyroidism is the autoimmune condition known as Graves' the autoimmune condition known as Graves' disease, where antibodies target the gland and disease, where antibodies target the gland and cause it to speed up hormone production.cause it to speed up hormone production.

Risk factors for development of hyperthyroidismRisk factors for development of hyperthyroidism

GenderGender: affects women 8 times more often than men. : affects women 8 times more often than men. HistoryHistory: Having any past history of thyroid problems, : Having any past history of thyroid problems,

autoimmune disease, or endocrine disease yourself or autoimmune disease, or endocrine disease yourself or in your family in your family

AgeAge: : between 20 and 40. between 20 and 40. Pregnancy:Pregnancy: Pregnancy and the year after childbirth Pregnancy and the year after childbirth SmokingSmoking Excessive Intake of Thyroid HormoneExcessive Intake of Thyroid Hormone: : Over-the-Over-the-

counter energy, diet and glandular supplements also counter energy, diet and glandular supplements also may contain some active thyroid hormone, may contain some active thyroid hormone,

Risk factors for development of hyperthyroidismRisk factors for development of hyperthyroidism

Exposure to or Excess of Iodine/Iodine DrugsExposure to or Excess of Iodine/Iodine Drugs -- through medical tests, topical -- through medical tests, topical exposure, or ingesting of iodine or supplements containing iodine (i.e., kelp, exposure, or ingesting of iodine or supplements containing iodine (i.e., kelp, bladderwrack)bladderwrack)

Certain Medical Treatments and DrugsCertain Medical Treatments and Drugs -- Interferon Beta-1b and Interleukin-4, -- Interferon Beta-1b and Interleukin-4, immunosuppressant therapy, antiretroviral treatment for AIDS, and lithium. A third of immunosuppressant therapy, antiretroviral treatment for AIDS, and lithium. A third of patients receiving monoclonal antibody (Campath-1H) therapy for multiple sclerosis patients receiving monoclonal antibody (Campath-1H) therapy for multiple sclerosis (MS) develop Graves' disease within six months, and receiving a donated organ or (MS) develop Graves' disease within six months, and receiving a donated organ or bone marrow transplant from someone with Graves' disease bone marrow transplant from someone with Graves' disease

Trauma to the ThyroidTrauma to the Thyroid -- vigorous manipulation or palpation of the thyroid; surgery -- vigorous manipulation or palpation of the thyroid; surgery to the thyroid, parathyroids, or the area surrounding the thyroid; injection to the to the thyroid, parathyroids, or the area surrounding the thyroid; injection to the thyroid; biopsy of the thyroid; and neck injury, i.e., whiplash, or from an automobile thyroid; biopsy of the thyroid; and neck injury, i.e., whiplash, or from an automobile seat belt after a crash. seat belt after a crash.

Major StressMajor Stress -- death of a spouse, divorce or separation, loss of a job, death of close -- death of a spouse, divorce or separation, loss of a job, death of close family member, major accident/personal injury, moving, marriage family member, major accident/personal injury, moving, marriage

Symptoms of Graves' Disease/HyperthyroidismSymptoms of Graves' Disease/Hyperthyroidism

Goiter:Goiter: Visibly larger neck, a feeling of fullness in the Visibly larger neck, a feeling of fullness in the neck or throat, discomfort with ties or scarves, a neck or throat, discomfort with ties or scarves, a feeling like the thyroid is vibrating or buzzing, a feeling like the thyroid is vibrating or buzzing, a choking sensation, pain or tenderness in the neck or choking sensation, pain or tenderness in the neck or hoarseness. hoarseness.

Weight Changes:Weight Changes: Weight loss or weight gain Weight loss or weight gain Pregnancy ProblemsPregnancy Problems Temperature Problems:Temperature Problems: warm or hot when others warm or hot when others

are cold, or feel warm all the time, low grade fever, are cold, or feel warm all the time, low grade fever, sweat more, or feel thirsty. sweat more, or feel thirsty.


Heart and Blood Pressure ChangesHeart and Blood Pressure Changes -- racing, fast heartbeat, sensation -- racing, fast heartbeat, sensation of a "loud" or pounding heartbeat, skipped beats, palpitations, or abnormal of a "loud" or pounding heartbeat, skipped beats, palpitations, or abnormal heart rhythms. heart rhythms.

Gastrointestinal ProblemsGastrointestinal Problems -- frequent bowel movements, loose bowel -- frequent bowel movements, loose bowel movements, diarrhea, more frequent urination, or nausea. movements, diarrhea, more frequent urination, or nausea.

Energy / Muscles / JointsEnergy / Muscles / Joints -- extreme fatigue, muscle and joint fatigue, -- extreme fatigue, muscle and joint fatigue, especially in leg and arm muscles, difficulty climbing stairs, exercise especially in leg and arm muscles, difficulty climbing stairs, exercise intolerance intolerance

Skin ChangesSkin Changes -- smoother, younger-looking or velvety skin, worsening -- smoother, younger-looking or velvety skin, worsening acne, bruising, spider veins on the face and neck, blister-like bumps on the acne, bruising, spider veins on the face and neck, blister-like bumps on the forehead and face, flushing in the face, hives, itching, vitiligo. forehead and face, flushing in the face, hives, itching, vitiligo.

Graves' Dermopathy/ Pretibial MyxedemaGraves' Dermopathy/ Pretibial Myxedema -- waxy, reddish-brown -- waxy, reddish-brown lesions on the shins and lower legs skin (and less often the extremities, lesions on the shins and lower legs skin (and less often the extremities, face or trunk) that are itchy and inflamed. These lesions heal into rough face or trunk) that are itchy and inflamed. These lesions heal into rough patches. patches.


Changes to Hair / Nails / HandsChanges to Hair / Nails / Hands -- Excessive hair loss from the head and -- Excessive hair loss from the head and body, nails that easily break body, nails that easily break

Eye ProblemsEye Problems -- bulging of the eyeballs, dry eyes, achiness or pain behind -- bulging of the eyeballs, dry eyes, achiness or pain behind the eyes, redness in the eyes, puffiness, and a wide-eyed look. the eyes, redness in the eyes, puffiness, and a wide-eyed look.

Thinking/Cognition ProblemsThinking/Cognition Problems -- difficulty concentrating or making -- difficulty concentrating or making decisions, memory problems, and racing thoughts. decisions, memory problems, and racing thoughts.

Mood ProblemsMood Problems --depression, mood swings, uncontrollable anger, and --depression, mood swings, uncontrollable anger, and irrational anger. irrational anger.

Panic and AnxietyPanic and Anxiety – Anxiety, restlessness, nervousness, and even panic – Anxiety, restlessness, nervousness, and even panic attacks. In rare cases, mania, psychosis, or delirium attacks. In rare cases, mania, psychosis, or delirium

Reflex/Movement IssuesReflex/Movement Issues --fast reflexes, startle easily, and jumpy, and --fast reflexes, startle easily, and jumpy, and have tremors. They may be always moving, jiggling, tapping a foot, etc. have tremors. They may be always moving, jiggling, tapping a foot, etc.

Sleep ProblemsSleep Problems -- Insomnia, or difficulty going back to sleep after waking -- Insomnia, or difficulty going back to sleep after waking


Especially in MenEspecially in Men -- Men can experience a low sex drive, fertility -- Men can experience a low sex drive, fertility problems, and gynecomastia, an enlargement or tenderness in the problems, and gynecomastia, an enlargement or tenderness in the breasts. breasts.

Especially in WomenEspecially in Women -- In women, infertility, miscarriage, changes -- In women, infertility, miscarriage, changes to sex drive, worsening premenstrual syndrome, erratic or even to sex drive, worsening premenstrual syndrome, erratic or even nonexistent menstrual periods. nonexistent menstrual periods.

Especially in TeenagersEspecially in Teenagers -- dramatic increase in appetite, or -- dramatic increase in appetite, or unusual weight loss, sports performance problems, and delayed unusual weight loss, sports performance problems, and delayed puberty. puberty.

Especially in the Elderly / SeniorsEspecially in the Elderly / Seniors -- frequent falls, tremors, atrial -- frequent falls, tremors, atrial fibrillation, or dementia, "apathetic hyperthyroidism" --appearing fibrillation, or dementia, "apathetic hyperthyroidism" --appearing depressed, lacking in energy, confused, forgetful, and constipated -- depressed, lacking in energy, confused, forgetful, and constipated -- without weight loss. without weight loss.

Thyroid StormThyroid Storm

Life-threatening condition known as thyroid storm. Life-threatening condition known as thyroid storm. During a thyroid storm, the heart rate, blood During a thyroid storm, the heart rate, blood pressure and body temperature can become pressure and body temperature can become uncontrollably highuncontrollably high

chest pain, shortness of breath, high blood pressure, chest pain, shortness of breath, high blood pressure, confusion, delirium, psychosis, stupor, fatigueconfusion, delirium, psychosis, stupor, fatigue

fatal complications such as stroke or heart attack.fatal complications such as stroke or heart attack.

Goiter/Thyroid NodulesGoiter/Thyroid Nodules

When the thyroid become enlarged, this is When the thyroid become enlarged, this is known as a goiterknown as a goiter

Solid or liquid filled cysts, lumps, bumps and Solid or liquid filled cysts, lumps, bumps and tumors -- both benign and canceroustumors -- both benign and cancerous

Thyroid Cancer Statistics and Facts Thyroid Cancer Statistics and Facts

The American Cancer Society estimates 37,340 new cases of thyroid The American Cancer Society estimates 37,340 new cases of thyroid cancer will be diagnosed each year in the United States, most of them in cancer will be diagnosed each year in the United States, most of them in womenwomen

An estimated 1,590 people will die of thyroid cancer each yearAn estimated 1,590 people will die of thyroid cancer each year Thyroid cancer is considered one of the least deadly and most survivable Thyroid cancer is considered one of the least deadly and most survivable

cancers, and 5-year survival rates for thyroid cancer is almost 97%.cancers, and 5-year survival rates for thyroid cancer is almost 97%. Thyroid cancer is more common in younger people, and nearly two-thirds of Thyroid cancer is more common in younger people, and nearly two-thirds of

those diagnosed with thyroid cancer are between the ages of 20 and 55.those diagnosed with thyroid cancer are between the ages of 20 and 55. Thyroid cancer is one of the few cancers on the rise in recent years, with a Thyroid cancer is one of the few cancers on the rise in recent years, with a

growth rate of about 6% a year since 1997. growth rate of about 6% a year since 1997. Having one or more thyroid cancer risk factors does not mean that you will Having one or more thyroid cancer risk factors does not mean that you will

definitelydefinitely develop the disease develop the disease Even if you have no risk factors, you can still develop thyroid cancerEven if you have no risk factors, you can still develop thyroid cancer

Thyroid CancerThyroid Cancer

Too Little Iodine in the DietToo Little Iodine in the Diet Exposure to RadiationExposure to Radiation Heredity/Genetics/Family History Heredity/Genetics/Family History Gender: women are two to three times more likely Gender: women are two to three times more likely

than men to develop thyroid cancer.than men to develop thyroid cancer. Age: nearly two-thirds of those diagnosed with thyroid Age: nearly two-thirds of those diagnosed with thyroid

cancer are between the ages of 20 and 55.cancer are between the ages of 20 and 55. May not cause any symptoms at all. May not cause any symptoms at all.

Symptoms of thyroid cancerSymptoms of thyroid cancer

A lump, or nodule in the neck Enlargement of the neck A lump, or nodule in the neck Enlargement of the neck Enlarged lymph nodes in the neck Enlarged lymph nodes in the neck Hoarseness, difficulty speaking normally, voice changes Hoarseness, difficulty speaking normally, voice changes Difficulty swallowing, or a choking feeling Difficulty swallowing, or a choking feeling Difficulty breathing Difficulty breathing Pain in the neck or throat, including pain from the neck to the ears Pain in the neck or throat, including pain from the neck to the ears Sensitivity in the neck -- discomfort with neckties, turtlenecks, scarves, Sensitivity in the neck -- discomfort with neckties, turtlenecks, scarves,

necklaces necklaces Persistent or chronic cough not due to allergies or illness Persistent or chronic cough not due to allergies or illness Asymmetry in the thyroid (big nodule on one side, nothing on the other)Asymmetry in the thyroid (big nodule on one side, nothing on the other)

Treatment of HypothyroidismTreatment of Hypothyroidism

When the thyroid is underactive When the thyroid is underactive (hypothyroidism) the key medical treatment is (hypothyroidism) the key medical treatment is thyroid hormone replacement with a thyroid hormone replacement with a prescription medication.prescription medication.

Levothyroxine (Synthetic Thyroxine/T4)Levothyroxine (Synthetic Thyroxine/T4)

Among conventional physicians, the most popular and Among conventional physicians, the most popular and commonly prescribed thyroid hormone replacement drug is commonly prescribed thyroid hormone replacement drug is levothyroxine, a synthetic form of thyroxine (the thyroid levothyroxine, a synthetic form of thyroxine (the thyroid hormone abbreviated as T4). Levothyroxine is also referred to hormone abbreviated as T4). Levothyroxine is also referred to as l-thyroxine.as l-thyroxine.

In the United States, levothyroxine is available as generic In the United States, levothyroxine is available as generic levothyroxine, as well as levothyroxine, as well as Synthroid and LevoxylSynthroid and Levoxyl brand name brand name tablets of levothyroxine. tablets of levothyroxine. TirosintTirosint is a brand name gel-cap liquid is a brand name gel-cap liquid form of levothyroxine.Many doctors do not recommend generic form of levothyroxine.Many doctors do not recommend generic levothyroxinelevothyroxine

Brand names are preferred, and each is generally considered Brand names are preferred, and each is generally considered equally effective.equally effective.

Liothyronine (Synthetic Triiodothyronine/T3)Liothyronine (Synthetic Triiodothyronine/T3)

The thyroid gland manufacturers both thyroxine and triiodothyronine (T3)The thyroid gland manufacturers both thyroxine and triiodothyronine (T3) Liothyronine is a synthetic form of T3, and it is available in a manufactured Liothyronine is a synthetic form of T3, and it is available in a manufactured

form as the brand Cytomel, and also as generic liothyronineform as the brand Cytomel, and also as generic liothyronine T3 can also be compounded.T3 can also be compounded. In recent years, some practitioners have been prescribing T3 in addition to In recent years, some practitioners have been prescribing T3 in addition to

T4. One 2009 study showed that the majority of patients preferred T4. One 2009 study showed that the majority of patients preferred levothyroxine plus T3 compared to levothyroxine-only treatment. levothyroxine plus T3 compared to levothyroxine-only treatment.

A prominent study published in the A prominent study published in the New England Journal of MedicineNew England Journal of Medicine found found that patients benefited from T4/T3 combination treatmentthat patients benefited from T4/T3 combination treatment

Some other studies have failed to demonstrate a benefit and the use of Some other studies have failed to demonstrate a benefit and the use of T4/T3 combination treatments remains controversialT4/T3 combination treatments remains controversial

Liotrix (Synthetic Thyroxine/Triiodothyronine T4/T3 Combination)Liotrix (Synthetic Thyroxine/Triiodothyronine T4/T3 Combination)

Liotrix is a synthetic combination of thyroxine Liotrix is a synthetic combination of thyroxine and triiodothyronine (T4 and T3)and triiodothyronine (T4 and T3)

Liotrix is available in a manufactured form, Liotrix is available in a manufactured form, known by the brand name Thyrolarknown by the brand name Thyrolar

Thyrolar has been in back-order and short Thyrolar has been in back-order and short supply for a number of years, and is rarely used supply for a number of years, and is rarely used in the United Statesin the United States. .

Desiccated Natural ThyroidDesiccated Natural Thyroid

Desiccated thyroid is a drug prepared from dried porcine (pig) Desiccated thyroid is a drug prepared from dried porcine (pig) thyroidthyroid

Desiccated thyroid was the only thyroid drug available in the Desiccated thyroid was the only thyroid drug available in the early 1900s, until levothyroxine was introduced in the 1950searly 1900s, until levothyroxine was introduced in the 1950s

Natural thyroid fell out of favor as the synthetic product was Natural thyroid fell out of favor as the synthetic product was touted as more modern and stabletouted as more modern and stable

Since the 1990s, desiccated thyroid has enjoyed a resurgence, Since the 1990s, desiccated thyroid has enjoyed a resurgence, primarily with older doctors and holistically-oriented physicians primarily with older doctors and holistically-oriented physicians who claim that it resolves symptoms better than synthetics in who claim that it resolves symptoms better than synthetics in some patientssome patients

Several brands of desiccated thyroid are available by Several brands of desiccated thyroid are available by prescription, including Nature-Throid and Armour Thyroidprescription, including Nature-Throid and Armour Thyroid

The T4/T3 Thyroid Drug ControversyThe T4/T3 Thyroid Drug Controversy

The use of T4 and T3 together as a treatment for The use of T4 and T3 together as a treatment for hypothyroidism is controversialhypothyroidism is controversial

The standard treatment is levothyroxine (T4) aloneThe standard treatment is levothyroxine (T4) alone The addition of T3 to the levothyroxine/T4-only The addition of T3 to the levothyroxine/T4-only

treatment is, however, a topic of ongoing research and treatment is, however, a topic of ongoing research and discussiondiscussion

The Armour Thyroid / Desiccated Thyroid ControversyThe Armour Thyroid / Desiccated Thyroid Controversy

Desiccated thyroid drugs, including Armour Thyroid, Desiccated thyroid drugs, including Armour Thyroid, have been in use for more than 100 yearshave been in use for more than 100 years

Remain popular with holistic, alternative and Remain popular with holistic, alternative and integrative physicians as a thyroid treatment and for integrative physicians as a thyroid treatment and for thyroid hormone replacement in hypothyroid patientsthyroid hormone replacement in hypothyroid patients

These drugs are controversial, however; it can be a These drugs are controversial, however; it can be a challenge to find doctors who will prescribe them. challenge to find doctors who will prescribe them.

Treatment of hyperthyroidismTreatment of hyperthyroidism

Antithyroid medications: Methimazole, PTUAntithyroid medications: Methimazole, PTU Radioactive iodine ablationRadioactive iodine ablation SurgerySurgery

Treatment of Thyroid CancerTreatment of Thyroid Cancer

SurgerySurgery

THANK YOUTHANK YOU

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Thyroid: Dr. Dany Zayour