Malignancy risk of thyroid nodules with minimal cystic changes: a multicenter retrospective study. followup needed? 43 0 obj A cancer diagnosis is always worrisome, but even if a nodule turns out to be thyroid cancer, you still have plenty of reasons to be hopeful. Improving your gut health with an anti-inflammatory diet and probiotics, and optimizing your iodine levels, can often reduce the size of thyroid nodules. HHS Vulnerability Disclosure, Help However, if a thyroid cyst continues to expand it may require treatment. /Subtype /Type1C /CapHeight 722 J Ultrasound Med. Multiple criteria exist from societies in different subspecialties and biopsy thresholds vary among institutions. Giles WH, Maclellan RA, Gawande AA, Ruan DT, Alexander EK, Moore FD Jr, Cho NL. Goldman L, et al., eds. /TrimBox [ 9 9 594 792 ] 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. But even though the vast majority of thyroid nodules are benign, some thyroid nodules do contain thyroid cancer. /PageLabels 37 0 R The aim of this study was to assess Treatment for hyperthyroidism usually resolves it. Gonzlez-Gonzlez A, Mate-Valdezate A, Parra-Arroyo A, Tenas-Burillo JM. The false negative rate of benign cytology was 10.4 %, and the absence of suspicious US features did not reliably exclude malignancy. At minimum, thyroid lobectomy should be strongly considered for all nodules 4 cm. This is a preview of subscription content, log in to check access. /T 343984 EQ/.Hhf1 xref Become a Gold Supporter and see no third-party ads. Some are solid, and some are fluid-filled cysts. Our Disclaimer and Privacy Policy. /FirstChar 65 Decrease in thyroid autoantibodies after eradication of Helicobacter pylori infection. Comparison of diagnostic accuracy and utility of artificial intelligence-optimized ACR TI-RADS and original ACR TI-RADS: a multi-center validation study based on 2061 thyroid nodules. In rare cases, they're cancerous. Solid hypoechoic 1.4 x 0.6 x 0.4 cm nodule in the right thyroid isthmus TR 4. Heres what you need to know about thyroid nodules and how concerned you should be if you develop one. 0000037219 00000 n 0000031286 00000 n 0000047532 00000 n Surgery. (2014). USZ*FMk(+E(5q Results: A total of 704 nodules had echogenic foci; 246 did not. 4. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. 0000046515 00000 n This usually means having a physical exam and thyroid function tests at regular intervals. Albayrak, Banu [corrected to Bayraktar, Banu]]. stream Background: Thyroid nodules are very common and a large portion are mixed echoic, with both solid and cystic areas. A positive thyroglobulin test doesnt quite rule out Hashimotos or Graves disease. I care about answering your questions and sharing my knowledge with you. WebNodules were also classified into four parenchymal patterns: hypoechoic, hyperechoic, >50% solid, and cystic. High-resolution ultrasonography (US) is commonly used to evaluate the thyroid gland, but US is frequently misperceived as unhelpful for identifying features that distinguish benign from malignant nodules. Thyroid nodules: Risks of thyroid cancer based on ultrasound findings. /Type /FontDescriptor Often, your doctor will use ultrasound to help guide the placement of the needle. /F7 62 0 R /F8 65 0 R /F9 68 0 R /F10 71 0 R /F11 74 0 R /F12 77 0 R /F13 Dec. 5, 2019. 2006;40:223-38. doi: 10.1016/j.yasu.2006.06.003. The risk of cancer increased with the size of nodule. /Metadata 39 0 R But first, well review what thyroid nodules are. Accessed Dec. 6, 2019. stream 0000048374 00000 n Decrease in TSH levels after lactose restriction in Hashimotos thyroiditis patients with lactose intolerance. /XHeight 502 Ac., CYT, What to Know If You Have Hyperthyroidism and Want to Breastfeed, Hyperthyroidism: Signs and Symptoms of an Overactive Thyroid. PMC Background: 2022 Apr 16;2022:6246150. doi: 10.1155/2022/6246150. /XHeight 505 Karunaratne D, Zhang TT, Ali ZAS, Moore A, Kirkland P, Howlett D. Ultrasound. Other factors that lead to an increased risk of thyroid nodules include: Thyroid nodules are common. 0000028177 00000 n In rare cases, nodules can grow big enough to cause the following symptoms: Hyperfunctioning thyroid nodules can lead to overproduction of thyroid hormones, also known as hyperthyroidism. Thyroid cancer. [14, 15, 16, 17] One study showed probiotics decreased thyroid symptoms and the needed dose of levothyroxine. @'WUsUi: lc.e&o[lvqfj ^#y-j^ho:J[}>Et#e'l7ipK5Gi?AG1(-aXy|Qo`E5cScJ?3`f9zp?=D1-8o|iW)"# f OdOf~KuAkE'd8~ There are four main reasons why a thyroid nodule would grow:Thyroid cancerThyroid autoimmunityIodine deficiency or excessThyroid cysts Radiol Clin North Am. Abbott RD, Sadowski A, Alt AG. Patients usually return home or to work after the biopsy without any ill effects. The extra thyroxine can cause too much thyroid hormone to be produced (hyperthyroidism), leading to symptoms such as: If you have a thyroid nodule, your doctor or endocrinologist may follow up with blood tests to check your thyroid-stimulating hormone (TSH) levels for hypothyroidism or hyperthyroidism. Right side upper pole solid hypoechoic single thyroid nodule mean? official website and that any information you provide is encrypted This study examines what ultrasound features are most helpful in selecting which nodules are more likely to be cancerous and should be biopsied and which nodules are non-cancerous. By group, the malignancy rate was 2.2% (2/93) in group 1, 7.4% (16/216) in group 2, and 0% (0/26) in group 3. Thyroid cancer is one of the most treatable kinds of cancer. WebThe most important neck masses that can be mistaken with thyroid nodules include: Thyroglossal duct cyst, parathyroid cancer, parathyroid cyst, and branchial cleft cyst. 2017; doi:10.1001/jamaoto.2017.0003. Our thyroid experts in the head and neck endocrine surgery team diagnose and treat patients with a variety of thyroid and parathyroid conditions. Liu Y, Li X, Yan C, Liu L, Liao Y, Zeng H, Huang W, Li Q, Tao N, Zhou J. Eur Radiol. Your doctor will also look for signs and symptoms of hyperthyroidism, such as tremor, overly active reflexes, and a rapid or irregular heartbeat. Among 1056 thyroid nodules undergoing ultrasound with fine-needle aspiration (FNA) biopsy, 392 nodules (37.1%) were mixed echoic. /Type /FontDescriptor If youve been diagnosed with a thyroid nodule, its normal to feel anxious. For potential or actual medical emergencies, immediately call 911 or your local emergency service. /LastChar 83 0000001569 00000 n A thyroid nodule is an unusual lump (growth) of cells on your thyroid gland. Ultrasound imaging reveals that 20% to 76% of adults have thyroid nodules. Policy. NCI CPTC Antibody Characterization Program. SUMMARY OF THE STUDY 0000001713 00000 n Kellerman RD, et al. Kim J, Lee C, Kim S et al. The majority of thyroid nodules are benign, dont cause symptoms, and dont require surgery. Our website services, content, and products are for informational purposes only. Cleveland Clinics Endocrinology & Metabolism Institute is committed to providing the highest quality healthcare for patients with diabetes, endocrine and metabolic disorders, and obesity. Epub 2016 Sep 30. Some authors suggest that hypoechoic, solid nodules larger than 1 to 1.5 cm with macrocalcifications should be biopsied and spongiform nodules and cysts need no biopsy. Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. Medicine (Baltimore). Assessment of thyroid lesions (ultrasound). Acta Endocrinol (Buchar). 48 0 obj endobj What is thyroid cancer? endstream When it comes to thyroid nodules, the size matters quite a bit. Studies have shown time and time again that larger thyroid nodules tend to turn into thyroid cancer at a higher rate compared to smaller thyroid nodules. The magic number in terms of size is 1 cm or 10mm. But size isn't the only thing that matters. In: Diagnostic Ultrasound. The procedure is usually done in your doctor's office, takes about 20 minutes and has few risks. official website and that any information you provide is encrypted An official website of the United States government. Besirbellioglu BA, Ulcay A, Can M, et al. No, say experts at Johns Hopkins Department of Otolaryngology and Head and Neck Surgery. Currently, the American Thyroid Association guidelines recommends to perform a FNAB of solid nodules >1 cm and nodules >0.5 cm only when they have suspicious features detected by ultrasound. By making a few targeted diet and lifestyle changes, including focusing on your gut health and optimizing your iodine levels, you can likely reduce the size of your thyroid nodules (and your worry). 11th ed. eCollection 2022. To rule out cancer and the need for a thyroidectomy, physical examination, thyroid scans, radioactive iodine uptake testing, fine-needle aspiration biopsy (FNA), or thyroid ultrasound may be used. 0 Theyre small and usually only show up during and exam. Tang JZ, Chua JME, Woon TK, Tan BS, Kiong KL. Check for errors and try again. Korean J Radiol. [Epub ahead of print]. The site is secure. For this reason, you should see your healthcare provider so they can evaluate the nodule to be sure its benign. Nodules are different from an enlarged thyroid, also called a goiter, but the two conditions do sometimes coexist in the case of a nodular goiter. Thyroid nodules are very common, and theyre usually not a cause for concern. Thyroid nodules even the occasional cancerous ones are treatable. sharing sensitive information, make sure youre on a federal Before Epub 2022 Jun 10. WebIn fact, the American thyroid association (ATA) Guidelines state that while all solid nodules larger than 1 cm should undergo FNAB, mixed cystic-solid nodules should be biopsied only when size is larger than 1.5 or 2.0 cm in the presence of suspicious US findings, or when size is above 2.0 cm if no suspicious US findings are present. Thyroid nodules are very common. Nodules detected this way are usually smaller than those found during a physical exam. WHAT ARE THE IMPLICATIONS OF THIS STUDY? MLKAu >i?=w[pSwBwT-f~).^6o@*evP Radiofrequency ablation uses a probe to access the benign nodule under ultrasound guidance, and then treats it with electrical current and heat that shrinks the nodule. 7. Complex nodules are common. 0000046654 00000 n An official website of the United States government. In some studies, a nodule is called a cyst only if it is predominantly cystic on ultrasonography, but in others, the term is applied to nodules that have any areas of cystic degeneration, which may include up to 50 percent of thyroid nodules. Cystic (fluid-filled). /Subtype /Type1C 0000036724 00000 n 0000011094 00000 n 0000017726 00000 n Bertalot G, Montresor G, Tampieri M, et al. Thyroid nodules are lumps within the thyroid gland, a butterfly-shaped organ located at the front of the neck above the collar bone. Ross DS. Bethesda, MD 20894, Web Policies For example, if you have obesity, talk to your healthcare provider about attaining a healthy weight for you. 0000045880 00000 n They may run some tests to make sure its benign. 0000002035 00000 n /Resources 42 0 R 0000008373 00000 n >DBP" Overview of thyroid nodule formation. /Encoding /WinAnsiEncoding /Descent -190 Your doctor then sends the samples to a laboratory to have them analyzed under a microscope. Because many thyroid nodules dont have symptoms, people may not even know theyre there. Eur Arch Otorhinolaryngol. However, most nodules arent a serious concern. 8600 Rockville Pike << Saccharomyces boulardii and infection due to Giardia lamblia. JAMA Intern Med. Thyroid Ultrasound: a common imaging test used to evaluate the structure of the thyroid gland. /FontDescriptor 44 0 R Risk of thyroid cancer based on thyroid ultrasound findings. This content does not have an Arabic version. If its spread to nearby tissues, such as lymph nodes. 0000030770 00000 n We do not endorse non-Cleveland Clinic products or services. Large, cystic/solid, and thyroid nodules with both characteristics had false-negative rates of 17%, 25%, and 30%, respectively, compared with 0%, 9%, and 17% for small (less than 3 cm), solid, and solid nodules 3 cm or larger, respectively. Last medically reviewed on December 15, 2017, A thyroid nodule is a lump that can develop in your thyroid gland. 0000017921 00000 n As with all cases of cancer, the earlier it can be diagnosed and treated, the better. 6. The .gov means its official. Kim D, Eun C, In H, Kim M, Jung S, Bae S. Sonographic Differentiation of Asymptomatic Diffuse Thyroid Disease from Normal Thyroid: A Prospective Study. Answer Question Read Responses (5+) Follow Darmstrong72 Any help with ultrasound report appreciated. 0000002565 00000 n %PDF-1.4 Our team of licensed nutritionists and dietitians strive to be objective, unbiased, honest and to present both sides of the argument. /ProcSet [ /PDF /Text ] % If small nodules are less than 1 cm or filled with fluid, Konrad P, Chojnacki J, Kaczka A, Pawowicz M, Rudnicki C, Chojnacki C. Ocena czynnoci tarczycy u osb z zespoem przerostu bakteryjnego jelita cienkiego [Thyroid dysfunction in patients with small intestinal bacterial overgrowth]. Join endocrinologist Paul Ladenson, M.D., as he outlines the signs and symptoms of the various thyroid disorders and discusses the interplay among other diseases and the thyroid. 0000020220 00000 n 2017 May;27(5):641-650. doi: 10.1089/thy.2016.0336. 0000052569 00000 n Epub 2012 Oct 18. Would you like email updates of new search results? /Type /Font In most cases, thyroid nodules arent a cause for concern. >> Risks of thyroid surgery include damage to the nerve that controls your vocal cords and damage to your parathyroid glands four tiny glands located on the back of your thyroid that help control your body's levels of minerals, such as calcium. << World J Surg. A thyroid nodule may be worth a closer look if its larger than 1 cm or painful, or if youre also experiencing symptoms related to hypo- or hyperthyroidism. Results: This may include: Treatment for a nodule that's cancerous usually involves surgery. Choosing an experienced specialist can mean more options to help personalize your treatment and achieve better results. << Disclaimer: (1) The information provided on this website is for educational purposes only and is not intended to diagnose or treat any disease. Cytopathology. /FontFile3 45 0 R 26th ed. Some medications are safe, but you may have to pump and dump during other tests and treatments. /StemV 141 94 0 obj Written by Dr. Michael Ruscio, DC on Anyone can have a thyroid nodule, including children and adults. /Widths [ 833 722 778 833 667 611 833 778 333 611 778 611 1000 833 833 722 Partially cystic thyroid nodules: ultrasound findings of malignancy. Thyroid cancer management: From a suspicious nodule to targeted therapy. 0000008824 00000 n /FontBBox [ -153 -250 992 986 ] 0000013675 00000 n If you use iodized table salt, youre likely consuming enough. Accessed Oct. 31, 2019. 0000000017 00000 n However, over 75% of nodules found in children and adolescents are noncancerous (benign). E5X`>E#}Q)MgJ5/?f[O>LYz$/ 9ovKdrr"xl)%. Results were compared with the cytologic or surgical findings. Ultrasonography. 0000014110 00000 n Then, suppose she tells you theres a nodule on your thyroid. Would you like email updates of new search results? 5th ed. Learn the symptoms and your treatment, Its crucial that you get treatment if you have hyperthyroidism. The .gov means its official. /StemH 140 All rights reserved. 2011 Dec;16(6):482. The numbers in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers. Coquia S, Chu L, Hamper U. Curious about high TSH levels and fertility? We are vaccinating all eligible patients. /Type /Page 40 55 0000051727 00000 n Every product is science-based, validated by real-world use, and personally vetted by Dr. Ruscio, DC. @ qTzlyA{jT=$uRAp?B!I$kL1?~U9_Kj3' 4&`m3j2lqcSp~*j1wa: SRBAZ5C D6zQ S endstream PKakpG! Anti-Cancer Drugs. eCollection 2022. Clipboard, Search History, and several other advanced features are temporarily unavailable. According to the American Thyroid Association, roughly half of the population will have a thyroid nodule by age 60. Multiple (more than one nodule). WebLikely benign: Thyroid lesions are classified as solid or cystic or a combination of both. The relationship between autoimmune thyroid disease and iodine intake: a review. << /Flags 262176 Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. All rights reserved. However, you may wonder if theres a hyperthyroidism diet that can support treatment, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. See below for individual systems. [7, 8, 9]. Unable to load your collection due to an error, Unable to load your delegates due to an error. 2008 Jul;32(7):1253-63. doi: 10.1007/s00268-008-9494-z. Accessed Nov. 4, 2019. Between January 2000 and March 30, 2005, records of 11,618 thyroid ultrasound exams performed for any reason in 8806 patients (some had multiple nodules) were reviewed. /FontDescriptor 47 0 R While the diagnosis of a thyroid nodule is established, thyroid nodule should be differentiated based on benign or malignant features and the type of nodule. A thyroid nodule is a lump in or on the thyroid gland. Conclusions: American Thyroid Association. /Flags 262176 /Length 232 If you have a solid complex should have biopsy , fna a simple as Aspirin with syringe done in office. Results: 0000002322 00000 n The incidental thyroid nodule. A total of 96 patients diagnosed with cancer were matched for age, sex and year of ultrasonography with 369 controls with benign thyroid nodules. Foley TP Jr. /FirstChar 44 << 2015;34(4):304-11. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (http://www.thyroid.org/wp-content/uploads/patients/brochures/Nodules_brochure.pdf). 42 0 obj endobj The object of this study was to evaluate the frequency of malignancy in mixed echoic thyroid nodules and ascertain the ultrasound findings that help distinguish benign from malignant nodules. Elsevier; 2020. https://www.clinicalkey.com. Some thyroid nodules with true microcalcifications are thyroid cancers. Thyroid nodule. If your thyroid nodule is benign, there are two main natural treatment options to improve your thyroid nodules: One of the most common reasons for thyroid nodules is thyroid autoimmunity, especially Hashimotos thyroiditis. In addition to this, PEF increased the malignancy risk by35.3%, in solid nodules and an approximate risk of 10%, in mixed nodules. /Length 3091 Complex Sometimes, your doctor detects a thyroid nodule when you have an imaging test, such as an ultrasound, CT or MRI scan, to evaluate another condition in your head or neck. Family history of thyroid nodules or thyroid cancer. Swollen lymph nodes in the neck are very common and happen in many conditions. 0000042078 00000 n >> Hypothyroidism. FOIA why would a cystic thyroid nodule turn solid into a solid thyroid nodule? You have signs or symptoms of hyperthyroidism or hypothyroidism. 2014;203(6):1310-6. SUBCENTIMETER SOLID THYROID ISTHMIC NODULE. Bookshelf doi: 10.1001/jamainternmed.2013.9245. Unauthorized use of these marks is strictly prohibited. Accessed Nov. 7, 2019. There is a need to do needle. Aliyev A, Aliyeva I, Giammarile F, Talibova N, Aliyeva G, Novruzov F. Endocrinol Diabetes Metab. (2017). Thyroid nodules are less common in children. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. stream /N 4 American Thyroid Association. https://www.uptodate.com/contents/search. 2005-2023 Healthline Media a Red Ventures Company. 0000036123 00000 n Healthline Media does not provide medical advice, diagnosis, or treatment. Ultrasound of thyroid cancer. Diagnostic performance of six ultrasound-based risk stratification systems in thyroid follicular neoplasm: A retrospective multi-center study. 0000005181 00000 n With the increased use of thyroid ultrasound, some studies suggest that thyroid nodules occur in >50% of the population. You're also likely to have another biopsy if the nodule grows larger. /Ascent 722 Assuming the cystic nodule turns into a solid nodule, the indication for biopsy will depend on the characteristics of this solid nodule. This study suggests that ultrasound features of microcalcifications, solid nodule and size larger than 2 cm can be used to identify patients at high risk for thyroid cancer. If small nodules are less than 1 cm or filled with fluid, they are almost always benign. Steinmetz-Wood SN, Kennedy AG, Tompkins BJ, Gilbert MP. >> National Library of Medicine Thyroid nodules that had the highest probability of malignancy were those that were large (3 cm or larger), cystic/solid, or large and cystic/solid. Masks are required inside all of our care facilities. 2. HlUyPgdHGF1hQT$!8;\b DVo`hV\A$XqjkZL|{^ZE4=:6.::DHoQ:{25?z2Sr3MH 41}"y1%*kw&G);Hn3Rl5)L3v'aRm.d_9R\{no5|YHQcUT If youve been diagnosed with a thyroid nodule and are taking the watch and wait approach, youll need to see your provider regularly so that they can monitor the nodule for any changes. Its simply a sign that your doctor may need to do additional testing, such as a biopsy. A diagnosis of cancer was made in 10.5% of nodules measuring 1 1.9 cm. A good rule of thumb for knowing when to take a closer look is if they are larger than 1 cm or painful. Graves disease is an autoimmune disease that causes the thyroid gland to create too much thyroid hormone. >> /BleedBox [ 9 9 594 792 ] THYROID ISTHMUS: Measures 0.52 cm. There is no relationship here. Accessed Oct. 31, 2019. This site needs JavaScript to work properly. /CharSet Immune response and intestinal permeability in children with acute gastroenteritis treated with Lactobacillus rhamnosus GG: a randomized, double-blind, placebo-controlled trial. << KMz?4\;bU&Lw0@Id~{Tca /Z{*L%46 MC&Z1 =8 ]:FQXFFwQ!#Bj, PH2YrLV /StemH 87 A publication of the American Thyroid Association, Risk of thyroid cancer based on thyroid ultrasound findings. However, its still important to see your healthcare provider if you notice a lump on your thyroid (in the front of your neck). However, a thyroid scan can't distinguish between cold nodules that are cancerous and those that aren't cancerous. 0000004788 00000 n Autonomously functioning thyroid nodules (AFTN) account for 5%-10% of thyroid nodules, For nodules with mixed composition, the cystic fluid would be Solid nodules in your thyroid are more likely to be malignant than fluid-filled nodules, but theyre still rarely cancerous. Accessed Nov. 4, 2019. 93 0 obj Dincer N, Balci S, Yazgan A, Guney G, Ersoy R, Cakir B, Guler G. Cytopathology. RESULTS. what should i do? If a thyroid nodule is causing voice or swallowing problems, your doctor may recommend treating it with surgery to remove all or part of the thyroid gland. Find more COVID-19 testing locations on Maryland.gov. The vast majority more than 95% of thyroid nodules are benign (noncancerous). 4 Some investigators have This article contains scientific references. 0000004280 00000 n National Library of Medicine endobj 0000003108 00000 n The prognosis for cancerous (malignant) thyroid nodules varies greatly depending on several factors, including: If you have thyroid cancer, your healthcare provider will be able to give you a more accurate prognosis. In 2017, the Thyroid Imaging Reporting and Data System (TI-RADS) Committee of the American College of Radiology (ACR) published a white paper that presented a new /FontName /NOLLBE+Univers-CondensedBold Elselvier; 2018. https://www.clinicalkey.com. The webinar recording is presented as part of A Womans Journey Conversations That Matter webinar series. Fine needle aspiration biopsy (FNAB) is the best way to find out whether a thyroid nodule is cancerous or benign. Ultrasound Q. Bugdaci MS, Zuhur SS, Sokmen M, Toksoy B, Bayraktar B, Altuntas Y. endobj 2022 Oct;41(4):670-677. doi: 10.14366/usg.22059. Its simple: Most people treated with RFA are back to their normal activities the next day with no problems. We reviewed 90 consecutive patients who underwent preoperative FNA of thyroid nodules followed by thyroid surgery during a period of 27 months, including their clinical data, type and size of thyroid nodule, FNA cytology results, and final pathology report of the surgical specimen. /ItalicAngle 0 However, today more limited surgery to remove only half of the thyroid may be appropriate for some cancerous nodules. *Inquiries relevant to the practice only. << Accessed Oct. 31, 2019. 0000031624 00000 n However, if you have several nodules or large nodules, you may be able to see them. /Filter /FlateDecode WebIn a study of 3483, nodules measuring >10 mm in the largest dimension (found during physical exams or after discovering an incidental nodule on imaging), the prevalence of The logic here is that since the thyroid hormone is partly made of iodine, supplementing will help increase thyroid hormone levels. Mixed solid and cystic nodules are the most common finding in thyroid US and are often hyperplastic benign nodules with degeneration and internal debris as 500 500 500 444 795 611 611 556 611 500 444 611 611 278 500 556 444 833 667 /Type /Catalog This article is based on scientific evidence, written by experts and fact checked by experts. Have your thyroid. [18, 19, 20]. 0000020734 00000 n
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