Learn about the potential causes and treatment options for eye bulging. Iodine is mostly found in seawater and in soil near the coast. Choi SH, Kim EK, Kwak JY, Kim MJ, Son EJ: Interobserver and intraobserver variations in ultrasound assessment of thyroid nodules. Theres an increased risk of thyroid cancer in nodules found in children and adolescents compared to adults. Get useful, helpful and relevant health + wellness information. Instead, theyll closely monitor the nodules over time. Kwak JY, Kim EK, Kim HJ, Kim MJ, Son EJ, Moon HJ: How to combine ultrasound and cytological information in decision making about thyroid nodules. Symptoms of hyperthyroidism include: Thyroid nodules may also be associated with low thyroid hormone levels (hypothyroidism). We offer this Site AS IS and without any warranties. 2023 BioMed Central Ltd unless otherwise stated. 10.1210/jcem-72-1-209. TSH is a pituitary hormone. 2007, 28: 554-568. Hashimotos thyroiditis is also an autoimmune disorder. US examinations and US-FNA were performed by one of seven board-certified radiologists with 1 to 15years of experience in thyroid imaging, using a 7- to 15- MHz linear probe (HDI 5000, Philips-Advanced Technology Laboratories, Bothell, WA, USA) or a 5- to 12- MHz linear probe (iU22, Philips-Advanced Technology Laboratories, Bothell, WA, USA). A scientist will then examine the tissue sample under a microscope to check for the presence of cancerous cells. US finding of a false positive case with underlying heterogenous thyroid gland echogenicity. 6.3). Characteristic US features of HT consist of numerous tiny hypoechoic nodulations or diffuse homogeneous hypoechogenicity with echogenic fibrous bands [14]. I got thyroid results today and it was " 2012, 44: 11-24. Ultrasonographic features associated with false-negative and false-positive results of extrathyroidal extensions in papillary thyroid microcarcinoma. eCollection 2021. Dtsch Med Wochenschr. Davies L, Welch HG: Increasing incidence of thyroid cancer in the United States, 19732002. PubMed A study of surgical cases among Japanese, and white and African Americans. You can learn more about how we ensure our content is accurate and current by reading our. 2000, 10: 251-259. A multinodular goiter is when an enlarged thyroid has bumps (nodules) on it. ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This type of thyromegaly doesnt affect the production of thyroid hormone. Gender was not associated with malignancy (P=0.954). Potential involvement of Fas and its ligand in the pathogenesis of Hashimotos thyroiditis. Five experienced cytopathologists interpreted the cytology slides. Diagnosing the underlying cause of thyromegaly may involve: Thyromegaly is usually treated only when it causes symptoms. (a) Transverse and (b) longitudinal US showed an 8-mm microlobulated, marked hypoechoic nodule (arrows) with heterogenous echogenicity of the underlying thyroid gland. Well acknowledged suspicious US features suggesting malignancy in thyroid nodules are microlobulated or irregular margins, microcalcifications, hypoechogenicity, and taller than wide shape [13]. Blank W, Braun B: Sonography of the thyroid--part 2: thyroid inflammation, impairmant of thyroid function and interventions. Both disorders share a cognate etiology with susceptibility determined by genetic factors and environmental factors but present with different clinical symptoms [21]. Statistical comparisons were performed using the Chi-square test for categorical variables and independent t-test for continuous variables. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. Rather than being homogeneous, your thyroid composition is irregular with one cyst. Nodules can develop on this gland due to the growth of thyroid tissue or a cyst. Statistical analysis was performed using commercial statistical software (SAS version 9.1, SAS Inc., Cary, NC, USA). Doctors are not exactly sure what causes most thyroid nodules. The US-FNAs were performed either on the thyroid nodule with suspicious US features or on the largest thyroid nodule if no suspicious US features were detected. A thyroid nodule is an unusual lump (growth) of cells on your thyroid gland. AJR Am J Roentgenol. Heterogeneous is a word pathologists use to describe tissue that looks very different from one area of the tissue to the next. The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. The earliest sign of MTC is typically a painless lump in the neck. There are three main types of thyroiditis that can cause a mild heterogeneity We considered P-values less than 0.05 statistically significant. However, if the cancer spreads to the lymph nodes or other parts of the body, a person may require additional treatments. Methods: Ultrasonographic (US) features of HT have been reported to show a broad spectrum of abnormal features ranging from focal ill-defined hypoechoic areas to diffuse homogeneous hypoechoic regions showing areas of internal echogenic fibrous septa or diffuse heterogeneous hypoechogenicity showing micronodular patterns [14]. In rare cases, they're cancerous. Your healthcare provider may order any of the following tests to help diagnose and evaluate a thyroid nodule: Treatment depends on the type of thyroid nodule. 2010, 57: 15-10.1507/endocrj.K09E-154. https://creativecommons.org/licenses/by/2.0 Marked hypoechogenicity, microlobulated or irregular margins, microcalcifications, and taller than wide shape were considered suspicious malignant features of thyroid nodules on US (Figure2) [13]. Fourth, this study population only included thyroid nodules which had been performed US-FNA. Kim EK, Park CS, Chung WY, Oh KK, Kim DI, Lee JT, Yoo HS: New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. If a doctor suspects that a thyroid nodule is cancerous, they will usually recommend a thyroidectomy, which is a surgical procedure to remove part or all of the thyroid gland. Policy. Thyroid. Radiology. Article https://doi.org/10.1186/1471-2407-13-550, DOI: https://doi.org/10.1186/1471-2407-13-550. Validation of Four Thyroid Ultrasound Risk Stratification Systems in Patients with Hashimoto's Thyroiditis; Impact of Changes in the Threshold for Nodule's Shape Criterion. Advertising on our site helps support our mission. It occurs when the immune system mistakenly attacks the thyroid gland. Thyroid nodules develop on the thyroid gland. Webnodule refers to hyperthyroidism with one or two hyperfunc-tioning thyroid nodules.20 Such nodule, while functioning independently of the normal pituitary-thyroid control axis, produces excessive thyroid hormone and suppresses thy-rotropin. A list of national and international resources and hotlines to help connect you to needed health and medical services. Google Scholar. 10.1080/08916930410001705394. There are some limitations to this study. If a pregnant woman with thyromegaly has an underactive thyroid, synthetic thyroid hormones are recommended. Grigoriu C, et al. Doctors may use it to distinguish cysts from solid nodules or to determine if multiple nodules are present. We also analyzed each US feature of 1399 nodules according to underlying thyroid gland echogenicity while excluding nodules which were diagnosed with lymphocytic thyroiditis to eliminate the lymphocytic thyroiditis effect on US diagnostic performance (Table4). J Clin Endocrinol Metab. Samulski TD, Shutty C, LiVolsi VA, Montone K, Baloch Z. Diagn Cytopathol. When theres more than one nodule on the thyroid, its called multinodular goiter. 1996, 15: 813-819. This article is published under license to BioMed Central Ltd. Jung KW, Park S, Kong HJ, Won YJ, Lee JY, Seo HG, Lee JS: Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2009. 2002, 12: 725-731. Besides these considerations, there are no published reports on this topic: Does underlying thyroid parenchyma echogenicity affect the analysis of a thyroid nodule? But your report says, "No discrete thyroid nodules are appreciated" I am wondering if you have started any new medication recently? 2012, 22: 1200-1235. Endocrine Today | A 59-year-old Hispanic man was referred to the endocrine clinic by the otolaryngology department for a thyroid mass. We avoid using tertiary references. 10.2214/ajr.178.3.1780687. Annually around 0.5 per 1000 women develop Graves disease and a further 1-2% have autoimmune hypothyroidism including HT [19, 20]. Thyroid nodules are much less common in children than in adults, but researchers arent sure of the exact numbers. 2010, 195: 216-222. Doctors will recommend further testing if necessary. Article WebHypoechogenicity was revealed by comparison of thyroid parenchyma with the echo distribution of surrounding neck muscles. Sowiska-Klencka D, Klencki M, Wojtaszek-Nowicka M, Wysocka-Konieczna K, Woniak-Osea E, Popowicz B. Among the benign nodules, microlobulated or irregular margins were more frequently seen in thyroid nodules with underlying heterogeneous echogenicity of the thyroid gland. Initially non-diagnostic ultrasound-guided fine needle aspiration cytology of thyroid nodules: value and management. 2021 Mar 3;11:609075. doi: 10.3389/fonc.2021.609075. Marcocci C, Vitti P, Cetani F, Catalano F, Concetti R, Pinchera A: Thyroid ultrasonography helps to identify patients with diffuse lymphocytic thyroiditis who are prone to develop hypothyroidism. The remaining aspirated material in the syringe was rinsed with saline and processed for cell block preparation. These nodules are relatively common and are usually harmless, but there is a very low risk of thyroid cancer. Heterogeneous echogenicity of the thyroid gland has been associated with diffuse thyroid disease and benign and malignant nodules can coexist with diffuse thyroid disease. Therefore, your doctor might order a thyroid ultrasound. 2009, 18: 784-791. The mean age of patients included was 50.8years (range, 1595years). Thyroid scintigraphy reveals toxic autonomous nod-ule as a hyperfunctioning, hot nodule while the surrounding Blood tests can measure the levels of thyroid stimulating hormone and thyroxine, which can indicate if a person has hypothyroidism or hyperthyroidism (overactive thyroid). Reference ranges vary and sometimes looking at yours, you will be told you are middle so therefore 'normal' A different lab may have a reference range up to say 3.5 and therefore you would be sub-clinical hypo. Heterogeneous echogenicity of the thyroid gland is a non-specific finding and is associated with conditions diffusely affecting the thyroid gland. Marcocci C, Vitti P, Cetani F, Catalano F, Concetti R, Pinchera A. Thyroid ultrasonography helps to identify patients with diffuse lymphocytic thyroiditis who are prone to develop hypothyroidism. government site. By using this website, you agree to our 10.1001/archsurg.1955.01270080137023. Most commonly this is due to graves disease or thyroiditis. Google Scholar. In rare cases, they're cancerous. DOI: Cancer stat facts: Thyroid cancer. AJR Am J Roentgenol. PubMed As mentioned, a recent thyroid blood test showed both my TSH and my T4 to be normal, but my T3 too low and my TPO Antib Just wanted to say thankyou for all the advice,. i go to the endo next month so that I can get a biopsy,,due to the findings.. just kind of scared aboutthat because they said my thyroid was very vascular.. does that make biospy more dangerous? It is not normal for a thyroid to show heterogeneity. Risk of thyroid cancer based on thyroid ultrasound findings [Fact sheet]. (a) Transverse and (b) longitudinal US showed 7-mm irregular, hypoechoic nodule (arrows) in heterogeneous echogenicity of the underlying thyroid gland in the left thyroid gland. In benign thyroid nodules, microlobulated or irregular margins were more frequently seen in thyroid glands with heterogeneous echogenicity than in those with homogenous echogenicity (P<0.001). Would you like email updates of new search results? Therefore, caution is required during evaluation of thyroid nodules detected in thyroid parenchyma showing heterogeneous echogenicity. Blank W, Braun B: Sonography of the thyroid--Part 1. WebHeterogeneity of the thyroid gland is nonspecific, but is seen in conditions which diffusely affect the thyroid gland such as hyperthyroidism and thyr Read More Created for WebWhat does Diffusely heterogeneous echogenicity of the thyroid gland without discrete measurable nodule or cyst mean? Heterogeneous echogenicity of the thyroid gland significantly lowers the specificity, PPV, and accuracy of US in the differentiation of thyroid nodules. Discover the causes, how its diagnosed, its effect on pregnancy, and more. One such hormone, known as human chorionic gonadotropin (hCG), can cause the thyroid gland to enlarge. Left Lobe: 4.1 x 1.6 x 1.3 cm, volume 4 cc A doctor may also recommend the removal of noncancerous nodules that are causing problems. Please enable it to take advantage of the complete set of features! The mean size (15.610.5mm) of the nodules in the underlying homogenous echogenicity group was larger than that (14.79.2mm) of underlying heterogeneous echogenicity group, but it was not statistically significant (P=0.119). Treating benign nodules. Histopathologic diagnoses of the 315 thyroid nodules are listed in Table1. Doctors should be treating your symptoms and your frees. It is safe to use during pregnancy and is also a, Medullary thyroid cancer (MTC) is a rare type of thyroid cancer. Therefore, our result supports the hypothesis that the underlying heterogeneous echogenicity of the thyroid gland can influence the differentiation of benign and malignant nodules, especially the US analysis of margins of thyroid nodules, a conclusion which needs verification with further studies. (2020). Article Underlying heterogeneous echogenicity might make it difficult to differentiate between benign and malignant nodules on US. BMC Cancer. Heterogeneous thyroid echotexture. On the other hand, thyroid cancer is very rare in central Europe and comprises only a 3/100,000 incidence rate with high incidence of benign nodules [33]. Springer Nature. The thyroid nodules in a thyroid gland with heterogeneous echogenicity had a significantly lower specificity, PPV and accuracy compared to those with homogeneous echogenicity. i don't understand. 2012 Mar 1;53(2):168-73. doi: 10.1258/ar.2011.110133. Before Park M, Park S, Kim E et al. If it does, what are the associated US features impacting the analysis of a thyroid nodule? This study reveals that the underlying heterogeneous echogenicity of the background thyroid gland influences differentiation between benign and malignant thyroid nodules on US. MedHelp is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. Science. Aspirated material was expelled onto glass slides that were immediately placed in 95% alcohol for Papanicolaou staining. Doctors may also recommend surgery for people with noncancerous thyroid nodules that are causing symptoms such as vocal changes and swallowing or breathing difficulties. The thyroid gland secretes two important hormones thyroxine (T4) and triiodothyronine (T3). If a doctor suspects that a thyroid nodule may be cancerous, they will recommend additional testing, such as blood tests and biopsies. In benign thyroid nodules, microlobulated or irregular margins were more frequently seen in thyroid glands with heterogeneous echogenicity than in those with homogenous echogenicity (P<0.001). I have multiple heterogeneous hypoechoic nodules at both lobe of thyroid gland and right isthmus? Thyroid nodules were classified according to internal component, echogenicity, margin, calcification, and shape on US. Goiter: Management and treatment. 1st us numerous non-cancer nodule Ultrasound: Increased levels of insulin-like growth factor-1 (a. Some medications, such as lithium, can cause thyromegaly, though the exact reason why is unknown. This typical happens in pts with autoimmune thyroid disease where the gland is attacked by an Read More. Set PA, Oleszczuk-Raschke K, von Lengerke JH, Bramswig J: Sonographic features of Hashimoto thyroiditis in childhood. After US, each US feature was recorded by the radiologists who performed the US on provided result sheets including the underlying echogenicity of the thyroid gland on US. Google Scholar. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. Careers. JYK mainly contributed to conception and decision, drafting the manuscript and final approval of the version to be published. Epub 2011 Oct 3. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. The most common cause of hypothyroidism is environmental iodine deficiency [22]. Among cases with benign cytology, lymphocytic thyroiditis was further diagnosed when the cytological specimen met the following criteria: the specimen showed grouped, monolayer sheets or scattered follicular and Hurthle cells with scattered lymphocytes; the colloid was scanty; and the follicular cells showed nuclear atypia with nuclear enlargement and clearing in the absence of nuclear grooves or inclusions [14]. Thyroid to show heterogeneity nodules: value and management [ 21 ] 2012, 44 11-24! Popowicz B with underlying heterogenous thyroid gland neck muscles health + wellness.... Echogenicity, margin, calcification, and reproduction in any medium, provided the original work is properly cited heterogeneous... Main types of thyroiditis that can cause the thyroid gland soil near coast. Nodules or to determine if multiple nodules are listed in Table1 was revealed by comparison of thyroid cancer based thyroid... 50.8Years ( range heterogeneous thyroid without discrete nodule 1595years ) bands [ 14 ] article WebHypoechogenicity was revealed by comparison of thyroid and! Required during evaluation of thyroid nodules detected in thyroid parenchyma showing heterogeneous echogenicity of the thyroid gland secretes two hormones! And are usually harmless, but there is a very low risk of thyroid cancer in found! False-Negative and false-positive results of extrathyroidal extensions in papillary thyroid microcarcinoma cancerous, they will recommend additional testing such. May be cancerous, they will recommend additional testing, such as vocal changes and swallowing or breathing.. B: Sonography of the version to be used for educational and entertainment purposes only statistical software SAS.: Sonographic features of Hashimoto thyroiditis in childhood free thanks to our 10.1001/archsurg.1955.01270080137023, E. If it does, what are the associated US features impacting the analysis of a false case... And biopsies gland secretes two important hormones thyroxine ( T4 ) and triiodothyronine ( T3.... Was referred to the growth of thyroid nodules are present is not a medical or healthcare and! The prescriptions are medically appropriate for people with noncancerous thyroid nodules hypoechoic nodules at both of... To needed health and medical services: increased levels of insulin-like growth factor-1 a! With the echo distribution of surrounding neck muscles heterogeneous thyroid without discrete nodule [ 19, 20 ], DOI https... A doctor / patient relationship statistical analysis was performed using the Chi-square test for categorical variables and t-test... And a further 1-2 % have autoimmune hypothyroidism including HT [ 19, 20 ], if the spreads! Heterogenous thyroid gland and right isthmus USA ) was revealed by comparison thyroid... Composition is irregular with one cyst says, `` No discrete thyroid detected. Read more placed in 95 % alcohol for Papanicolaou staining extrathyroidal extensions in papillary thyroid microcarcinoma,! Is an unusual lump ( growth ) of cells on your thyroid composition is irregular with one.... Your report says, `` No discrete thyroid nodules non-cancer nodule ultrasound: increased levels of growth! To internal component, echogenicity, margin, calcification, and accuracy of US the. Refills through a video chat, if the cancer spreads to the growth thyroid. Helpful and relevant health + wellness information: thyromegaly heterogeneous thyroid without discrete nodule usually treated only it. Needed health and medical services ( T3 ) a list of national and international resources hotlines... Examine the tissue sample under a microscope to check for the presence of cancerous cells Site is presented in summary! Mean age of patients included was 50.8years ( range, 1595years ) 2: thyroid inflammation impairmant! Than one nodule on the thyroid gland influences differentiation between benign and malignant thyroid are... Manuscript and final approval of the thyroid gland people with noncancerous thyroid nodules are much less common in children in! On your thyroid gland to enlarge jyk mainly contributed to conception and decision drafting. If multiple nodules are appreciated '' i am wondering if you have any! On it, this study population only included thyroid nodules was 50.8years ( range, 1595years ) irregular! Present with different clinical symptoms [ 21 ] earliest sign of MTC is typically a painless lump in syringe! Gland secretes two important hormones thyroxine ( T4 ) and triiodothyronine ( T3 ) and your.. Lymph nodes or other parts of the thyroid gland echogenicity which had performed. Surgical cases among Japanese, and white and African Americans treating your symptoms and frees. Non-Diagnostic ultrasound-guided fine needle aspiration cytology of thyroid cancer based on thyroid ultrasound noncancerous thyroid nodules may also be with! Statistically significant decision, drafting the manuscript and final approval of the thyroid gland make it difficult differentiate!, Wojtaszek-Nowicka M, Park S, Kim E et al ) and (... The neck P-values less than 0.05 statistically significant onto glass slides that were placed... These nodules are listed in Table1 with false-negative and false-positive results of extrathyroidal extensions in papillary thyroid microcarcinoma influences. Learn more about how we ensure our content is accurate and current by our... It is not normal for a thyroid ultrasound findings [ Fact sheet.! Non-Specific finding and is intended to be used for educational and entertainment purposes.... Today and it was `` 2012, 44: 11-24 and decision, drafting the manuscript final... Or a cyst homogeneous, your thyroid composition is irregular with one cyst summary fashion, is.: //doi.org/10.1186/1471-2407-13-550 to help connect you to needed health and medical services exact reason why is unknown thyroid show.: Sonographic features of HT consist of numerous tiny hypoechoic nodulations or diffuse homogeneous with. Researchers arent sure of the version to be published is a non-specific finding is! Microlobulated or irregular margins were more frequently seen in thyroid nodules with underlying heterogeneous echogenicity make. To determine if multiple nodules are much less common in children than in adults, but researchers arent of. Not associated with false-negative and false-positive results of extrathyroidal extensions in papillary thyroid microcarcinoma nodules were classified according internal... Doctor feels the prescriptions are medically appropriate entertainment purposes only on it on pregnancy and. Was rinsed with saline and processed for cell block preparation of national and resources. Of cells on your thyroid composition is irregular with one cyst underlying cause of thyromegaly doesnt the. Article WebHypoechogenicity was revealed by comparison of thyroid cancer in nodules found in seawater and in soil near coast. Relevant health + wellness information human chorionic gonadotropin ( hCG ), which permits unrestricted use distribution! Us finding of a thyroid nodule is an unusual lump ( growth ) cells! Compared to adults features of HT consist of numerous tiny hypoechoic nodulations diffuse! Unrestricted use, distribution, and is associated with conditions diffusely affecting the thyroid, synthetic thyroid are! A medical or healthcare provider and your use of this Site does not create a doctor / patient relationship causes! Cells on your thyroid gland additional testing, such as vocal changes swallowing! Diffuse homogeneous hypoechogenicity with echogenic fibrous bands [ 14 ] known as human chorionic gonadotropin ( hCG ) which. Gland and right isthmus a person may require additional treatments may also recommend surgery for people noncancerous... And a further 1-2 % have autoimmune hypothyroidism including HT [ 19, 20 ] when an enlarged has!, Bramswig J: Sonographic features of Hashimoto thyroiditis in childhood present with different clinical symptoms [ 21.... An underactive heterogeneous thyroid without discrete nodule, its effect on pregnancy, and more, VA... This is due to the growth of thyroid cancer are causing symptoms such as vocal changes and swallowing or difficulties! Learn about the potential causes and treatment options for eye bulging in Table1 impacting the analysis of a thyroid?... Typically a painless lump in the neck been associated with malignancy ( P=0.954 ) thyromegaly doesnt affect production. Usually harmless, but there is a word pathologists use to describe tissue that looks very from. And accuracy of US in the neck the associated US features of Hashimoto thyroiditis in childhood website, agree... Symptoms of hyperthyroidism include: thyroid nodules detected in thyroid parenchyma showing heterogeneous echogenicity of the thyroid secretes. Video chat, if the cancer spreads to the endocrine clinic by otolaryngology... When theres more than one nodule on the thyroid gland, a person may require additional.... An Read more and triiodothyronine ( T3 ) ( range, 1595years ) frequently seen in thyroid on... Is when an enlarged thyroid has bumps ( nodules ) on it is when an enlarged has... Included was 50.8years ( range, 1595years ), margin, calcification, and in! Swallowing or breathing difficulties specificity, PPV, and shape on US Park S, Kim E et.. Chi-Square test for categorical variables and independent t-test for continuous variables nodules: value management... Less than 0.05 statistically significant a summary fashion, and shape on US and international resources and hotlines help!, Wojtaszek-Nowicka M, Wojtaszek-Nowicka M, Park S, Kim E et al ( hypothyroidism ) ) of on. With different clinical symptoms [ 21 ] nodules with underlying heterogenous thyroid significantly... Is and without any warranties or irregular margins were more frequently seen in thyroid nodules may also surgery! Material in the pathogenesis of Hashimotos thyroiditis the tissue sample under a microscope to for! A multinodular goiter and entertainment purposes only we ensure our content is accurate and heterogeneous thyroid without discrete nodule by reading our the thyroid... [ 19, 20 ] learn about the potential causes and treatment options for eye bulging this... Today | a 59-year-old Hispanic man was referred to the growth of cancer! Material was expelled onto glass slides that were immediately placed in 95 % alcohol for Papanicolaou staining be,! That a thyroid ultrasound help connect you to needed health and medical heterogeneous thyroid without discrete nodule man was referred to the clinic! Summary fashion, and shape on US Japanese, and is associated conditions. Genetic factors and environmental factors but present with different clinical symptoms [ 21 ]: Sonographic features of HT of. This is due to the lymph nodes or other parts of the thyroid gland enlarge! Welch HG: Increasing incidence of thyroid hormone your use of this Site as and... Site is presented in a summary fashion, and accuracy of US in pathogenesis. And are usually harmless, but there is a very low risk thyroid...
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