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ARCHIVE: September is…2018





Scrapbook at Smilebox

Hello my Coffeebreak Friends…

September is a month to Remember…

Let’s not forget to Remember the many informative articles as you read below.

 You will find our up to date information on

Cholesterol, Thyroid Disease, Prostate Disease, Ovarian Cancer, Addiction

plus important updates on How to Be Prepared for various Emergencies

that strike us when we least expect.

Just scroll down the page for all of our various article. 

For more imformation contact our CBWF Team at:



My Favorite!

 I love the  Nespresso Lungo blends…

and the Frother is user friendly

and make a great Latte or Cappuccino!



order ↓ here




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Observed on the first Monday in September, Labor Day pays tribute to the contributions and achievements of American workers. It was created by the labor movement in the late 19th century and became a federal holiday in 1894. Labor Day also symbolizes the end of summer for many Americans, and is celebrated with parties, parades and athletic events.

Labor Day, an annual celebration of workers and their achievements, originated during one of American labor history’s most dismal chapters. In the late 1800s, at the height of the Industrial Revolution in the United States, the average American worked 12-hour days and seven-day weeks in order to eke out a basic living. Despite restrictions in some states, children as young as 5 or 6 toiled in mills, factories and mines across the country, earning a fraction of their adult counterparts’ wages. People of all ages, particularly the very poor and recent immigrants, often faced extremely unsafe working conditions, with insufficient access to fresh air, sanitary facilities and breaks.

As manufacturing increasingly supplanted agriculture as the wellspring of American employment, labor unions, which had first appeared in the late 18th century, grew more prominent and vocal. They began organizing strikes and rallies to protest poor conditions and compel employers to renegotiate hours and pay. Many of these events turned violent during this period, including the infamous Haymarket Riot of 1886, in which several Chicago policemen and workers were killed. Others gave rise to longstanding traditions: On September 5, 1882, 10,000 workers took unpaid time off to march from City Hall to Union Square in New York City, holding the first Labor Day parade in U.S. history.  READ MORE>>


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Why We Remember?

It has been 15 years since the day that left America

in complete devastation, despair and confusion.

The effects of that tragedy are still so real, the wounds are still so fresh,

but it is important to take time to remember and honor those that lost their lives and

take solace in the promises of God in times of tragedy.

He will never leave nor forsake us.



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We Remember!


It’s Hurricane Season…

National Preparedness Month

Would you be ready if there were an emergency?

Be prepared: assemble an emergency supply kit,

make your emergency plans, stay informed,

and get involved in helping your family, your business,

and your community be ready for emergencies.


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Create a Family Game Plan
In an emergency, every second counts- that’s why it’s crucial to have a game plan,

and why this year’s National Preparedness Month theme is “Don’t Wait Communicate.”

This September, as part of National Preparedness Month, the Red Cross encourages

all Americans to develop a family game plan. Get started using the steps below!

Check with your local chapter for trainings and events in your community.


1.  Know What to Do in Case of Emergency

It is important to make sure that the entire family is prepared and informed in the event of a disaster or emergency. You may not always be together when these events take place and should have plans for making sure you are able to contact and find one another.

The American Red Cross suggests some basic steps to make sure you remain safe:

*Meet with your family or household members.
*Discuss how to prepare and respond to emergencies that are most likely to happen where you live, learn, work and play.
*Identify responsibilities for each member of your household and plan to work together as a team.
*If a family member is in the military, plan how you would respond if they were deployed.
*Plan what to do in case you are separated during an emergency
*Choose two places to meet:
̶ Right outside your home in case of a sudden emergency, such as a fire

̶ Outside your neighborhood, in case you cannot return home or are asked to evacuate


*Choose an out-of-area emergency contact person. It may be easier to text or call long distance if local phone lines are overloaded or out of service. Everyone should have emergency contact information in writing or saved on their cell phones.
*Plan what to do if you have to evacuate
*Decide where you would go and what route you would take to get there. You may choose to go to a hotel/motel, stay with friends or relatives in a safe location or go to an evacuation shelter if necessary.
*Practice evacuating your home twice a year. Drive your planned evacuation route and plot alternate routes on your map in case roads are impassable.
*Plan ahead for your pets. Keep a phone list of pet-friendly hotels/motels and animal shelters that are along your evacuation routes.
*Let Your Family Know You’re Safe


*If your community has experienced a disaster, register on the American Red Cross Safe and Well website to let your family and friends know you are safe. You may also call 1-800-RED CROSS (1-800-733-2767) and select the prompt for “Disaster” to register yourself and your family.



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click↓ here

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You can join the effort by following four steps:

September 2010 marks the seventh annual National Preparedness Month, sponsored by the US Department of Homeland Security.

One goal of Homeland Security is to educate the public about how to prepare for emergencies, including natural disasters, mass casualties,

biological and chemical threats, radiation emergencies, and terrorist attacks.

During September, emergency preparedness will focus on:

Home and family preparedness, including pets, older Americans, and individuals with disabilities and special needs (Ready AmericaExternal Web Site Icon)
Back-to-school (Ready KidsExternal Web Site Icon)
Business preparedness (Ready BusinessExternal Web Site Icon)
Preparación en Español (Listo AmericaExternal Web Site Icon)

In collaboration with the American Red Cross, CDC’s Web site, Emergency Preparedness and You identifies and answers common questions about preparing for unexpected events, including:

Additional information and resources are available from Emergency Preparedness and Responseunder topics such as hurricane preparedness,

extreme heat, and bioterrorism. CDC continually updates information on recent outbreaks and incidents and lists emergency resources for

the general public as well as for clinicians and public health professionals.

Are you prepared? During September, focus on being ready – at home, at work, and in your community –

and prepare for a natural disaster or other emergency.


Get an Emergency Kit

An emergency kit includes the basics for survival: fresh water, food, clean air, and warmth. You should have enough supplies

to survive for at least three days. Review the items recommended for a disaster supplies kit or

print the Homeland Security Emergency Supply checklist Adobe PDF file [PDF – 324 KB]External Web Site Icon.

Make an Emergency Plan

Make plans with your family and friends in case you’re not together during an emergency. Discuss how you’ll contact each other,

where you’ll meet, and what you’ll do in different situations. Read how to develop afamily disaster plan or fill out

the Homeland Security Family Emergency Plan {PDF – 521 KB] Adobe PDF fileExternal Web Site Icon.

Emergency Supply Kit

You may need to survive on your own after an emergency. This means having your own food, water, and other supplies in sufficient quantity

to last for at least three days. Local officials and relief workers will be on the scene after a disaster, but they cannot reach everyone immediately.

You could get help in hours, or it might take days. In addition, basic services such as electricity, gas, water, sewage treatment, and telephones may

be cut off for days, or even a week or longer.

Recommended Items To Include In A Basic Emergency Supply Kit:

  • Water, one gallon of water per person per day for at least three days, for drinking and sanitation
  • Food, at least a three-day supply of non-perishable food
  • Battery-powered or hand crank radio and a NOAA Weather Radio with tone alert and extra batteries for both
  • Flashlight and extra batteries
  • First aid kit
  • Whistle to signal for help
  • Dust mask, to help filter contaminated air and plastic sheeting and duct tape to shelter-in-place
  • Moist towelettes, garbage bags and plastic ties for personal sanitation
  • Wrench or pliers to turn off utilities
  • Can opener for food (if kit contains canned food)
  • Local maps
  • Cell phone with chargers, inverter or solar charger

Additional Items To Consider Adding To An Emergency Supply Kit:

  • Prescription medications and glasses
  • Infant formula and diapers
  • Pet food and extra water for your pet
  • Cash or traveler’s checks and change
  • Important family documents such as copies of insurance policies, identification and bank account records in a waterproof, portable container.
  • You can use the Emergency Financial First Aid Kit (EFFAK) – PDF, 277Kb) developed by Operation Hope,
  •  FEMA and Citizen Corps to help you organize your information.
  • Emergency reference material such as a first aid book or information from
  • Sleeping bag or warm blanket for each person. Consider additional bedding if you live in a cold-weather climate.
  • Complete change of clothing including a long sleeved shirt, long pants and sturdy shoes. Consider additional clothing if you live in a cold-weather climate.
  • Household chlorine bleach and medicine dropper – When diluted nine parts water to one part bleach, bleach can be used as a disinfectant.
  •  Or in an emergency, you can use it to treat water by using 16 drops of regular household liquid bleach per gallon of water.
  •  Do not use scented, color safe or bleaches with added cleaners.
  • Fire Extinguisher
  • Matches in a waterproof container
  • Feminine supplies and personal hygiene items
  • Mess kits, paper cups, plates and plastic utensils, paper towels
  • Paper and pencil
  • Books, games, puzzles or other activities for children

Find out how to keep food safe during and after an emergency by visiting

Ask about planning at your workplace and your child’s school or daycare center. The US Department of EducationExternal Web Site Icon

gives guidelines for school preparedness. Workers at small, medium, and large businesses

should practice for emergencies of all kinds. See Ready BusinessExternal Web Site Icon for more information.

Be Informed

Being prepared means staying informed. Check all types of media – Web sites, newspapers, radio, TV, mobile and land phones –

for global, national and local information. During an emergency, your local Emergency Management or Emergency Services office

will give you information on such things as open shelters and evacuation orders. Check Ready AmericaExternal Web Site Iconcommunity and state information to learn

about resources in your community.

Tornadoes are nature’s most violent storms. They can appear suddenly without warning and can be invisible until dust and debris

are picked up or a funnel cloud appears. Planning and practicing specifically how and where you take shelter is a matter of survival.

Be prepared to act quickly. Keep in mind that while tornadoes are more common in the Midwest, Southeast and Southwest, they can

occur in any state and at any time of the year, making advance preparation is vitally important.Familiarize yourself with the terms

that are used to identify a tornado hazard.

  • tornado watch means a tornado is possible in your area.
  • tornado warning is when a tornado is actually occurring, take shelter immediately.

Listen to Local Officials

Learn about the emergency plans that have been established in your area by your state and local government.

In any emergency, always listen to the instructions given by local emergency management officials.


For further information on how to plan and prepare for tornadoes as well as what to do during and after a tornado, visit:

Federal Emergency Management Agency,NOAA Watch or American Red Cross.

for more information on Tornadoes click here>>

Emergency Preparedness for Pets



Emergency Preparedness for the Senior Citizens



Get InvolvedExternal Web Site Icon

Look into taking first aid and emergency response training, participating in community exercises, and volunteering to support local first responders.

Contact Citizens CorpsExternal Web Site Icon, which coordinates activities to make communities safer, stronger and better prepared to respond to an emergency situation.

Homeland Security promotes emergency preparedness throughout the year via the Ready America campaign.

Checklists, brochures, and videos are available in

EnglishExternal Web Site Icon and in SpanishExternal Web Site Icon online and by phone (1-800-BE-READY and 1-888-SE-LISTO).



Always contact your doctor for more information!

National Cholesterol Education Month


September is National Cholesterol Education Month,

a good time to get your blood cholesterol checked and take steps to lower it if it is high.

National Cholesterol Education Month is also a good time

to learn about lipid profiles and about food and lifestyle choices that help you reach personal cholesterol goals.

High blood cholesterol affects over 65 million Americans.

It is a serious condition that increases your risk for heart disease. The higher your cholesterol level,

the greater the risk. You can have high cholesterol and not know it.

Lowering cholesterol levels that are too high lessens your risk for developing heart disease

and reduces the chance of having a heart attack or dying of heart disease.


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The National Heart, Lung, and Blood Institute

offers helpful resources

to use during National Cholesterol Education Month.

For Individuals

Get these public education booklets for yourself and

share them with family and friends.

For Persons with High Blood Cholesterol Who Need to Lower It

Heart Healthy Recipes



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Cholesterol: Top foods to improve your numbers
Diet can play an important role in lowering your cholesterol.

Here are the top foods to lower your cholesterol and protect your heart.

By Mayo Clinic Staff

Can a bowl of oatmeal help lower your cholesterol? How about a handful of walnuts or an avocado? A few simple tweaks to your diet — like these, along with exercise and other heart-healthy habits — might help you lower your cholesterol.

Oatmeal, oat bran and high-fiber foods

Oatmeal contains soluble fiber, which reduces your low-density lipoprotein (LDL), the “bad” cholesterol. Soluble fiber is also found in such foods as kidney beans, apples, pears, barley and prunes.

When women in a University of Toronto study added oat bran to an already heart-healthy diet, HDL-cholesterol levels—the beneficial kind—climbed more than 11 percent.

• Consider a daily bowl of oat bran hot cereal or old-fashioned oatmeal for breakfast. Oat bran muffins can also pack a tasty dose into your day.

Soluble fiber can reduce the absorption of cholesterol into your bloodstream. Five to 10 grams or more of soluble fiber a day decreases your total and LDL cholesterol. Eating 1 1/2 cups of cooked oatmeal provides 6 grams of fiber. If you add fruit, such as bananas, you’ll add about 4 more grams of fiber. To mix it up a little, try steel-cut oatmeal or cold cereal made with oatmeal or oat bran.

Fish and omega-3 fatty acids

Eating fatty fish can be heart healthy because of its high levels of omega-3 fatty acids, which can reduce your blood pressure and risk of developing blood clots. In people who have already had heart attacks, fish oil — or omega-3 fatty acids — may reduce the risk of sudden death.

Although omega-3 fatty acids don’t affect LDL levels, because of their other heart benefits, the American Heart Association recommends eating at least two servings of fish a week. The highest levels of omega-3 fatty acids are in:

Lake trout
Albacore tuna
You should bake or grill the fish to avoid adding unhealthy fats. If you don’t like fish, you can also get small amounts of omega-3 fatty acids from foods such as ground flaxseed or canola oil.

You can take an omega-3 or fish oil supplement to get some of the benefits, but you won’t get other nutrients in fish, such as selenium. If you decide to take a supplement, talk to your doctor about how much you should take.

Walnuts, almonds and other nuts

Walnuts, almonds and other tree nuts can improve blood cholesterol. Rich in mono- and polyunsaturated fatty acids, walnuts also help keep blood vessels healthy.
Substances in almond skins help prevent LDL “bad” cholesterol from being oxidized, a process that can otherwise damage the lining of blood vessels and increase cardiovascular risk.

• Sprinkle almonds on cereals and salads, nibble on a handful for an afternoon snack.

Eating about a handful (1.5 ounces, or 42.5 grams) a day of most nuts, such as almonds, hazelnuts, peanuts, pecans, some pine nuts, pistachio nuts and walnuts, may reduce your risk of heart disease. Make sure the nuts you eat aren’t salted or coated with sugar.

All nuts are high in calories, so a handful will do. To avoid eating too many nuts and gaining weight, replace foods high in saturated fat with nuts. For example, instead of using cheese, meat or croutons in your salad, add a handful of walnuts or almonds.


Avocados are a potent source of nutrients as well as monounsaturated fatty acids (MUFAs). According to a recent study, adding an avocado a day to a heart-healthy diet can help improve LDL levels in people who are overweight or obese.

People tend to be most familiar with avocados in guacamole, which usually is eaten with high-fat corn chips. Try adding avocado slices to salads and sandwiches or eating them as a side dish. Also try guacamole with raw cut vegetables, such as cucumber slices.

The monounsaturated fats in avocados have been found to lower “bad” LDLs and raise “good” HDLs, especially in people with mildly elevated cholesterol.

• Slice avocados into sandwiches and salads or mash with garlic, lemon juice and salsa for a terrific guacamole.

Replacing saturated fats, such as those found in meats, with MUFAs are part of what makes the Mediterranean diet heart healthy.

Olive oil

Another good source of MUFAs is olive oil.

Try using about 2 tablespoons (23 grams) of olive oil a day in place of other fats in your diet to get its heart-healthy benefits. To add olive oil to your diet, you can saute vegetables in it, add it to a marinade or mix it with vinegar as a salad dressing. You can also use olive oil as a substitute for butter when basting meat or as a dip for bread.

Both avocados and olive oil are high in calories, so don’t eat more than the recommended amount.

Foods with added plant sterols or stanols

Foods are available that have been fortified with sterols or stanols — substances found in plants that help block the absorption of cholesterol.

Some margarines, orange juice and yogurt drinks come with added plant sterols and can help reduce LDL cholesterol by 5 to 15 percent. The amount of daily plant sterols needed for results is at least 2 grams — which equals about two 8-ounce (237-milliliter) servings of plant sterol-fortified orange juice a day.

It’s not clear whether food with plant sterols or stanols reduce your risk of heart attack or stroke, although experts assume that foods that reduce cholesterol do reduce the risk. Plant sterols or stanols don’t appear to affect levels of triglycerides or of high-density lipoprotein (HDL), the “good” cholesterol.

Blueberries contain a powerful antioxidant called pterostilbene that may help lower LDL cholesterol.

• Toss a cup of frozen blueberries together with a half-cup of orange juice and vanilla-flavored yogurt into the blender for a healthy breakfast drink. Sprinkle fresh blueberries on cereals and eat them by the handfuls for snacks.

Beans & Lentils
From a recent study in the Annals of Internal Medicine, LDL “bad” cholesterol levels fell almost twice as far in those volunteers on a low-fat diet who added beans and lentils (along with more whole grains and vegetables) to the menu.

• Experiment with beans in soups, salads, and dips. Tuck them into burritos, lasagnas and casseroles.

When volunteers in a USDA study added barley to the standard American Heart Association diet, LDL “bad” cholesterol levels fell more than twice as far.

• Barley makes a great substitute for rice, adds depth to soups and is terrific combined with dried fruits, nuts and a little oil and vinegar for a hearty salad.

Whey protein

Whey protein, which is one of two proteins in dairy products — the other is casein — may account for many of the health benefits attributed to dairy. Studies have shown that whey protein given as a supplement lowers both LDL and total cholesterol.

You can find whey protein powders in health food stores and some grocery stores. Follow the package directions for how to use them.

Other changes to your diet

For any of these foods to provide their benefit, you need to make other changes to your diet and lifestyle.

Although some fats are healthy, you need to limit the saturated and trans fats you eat. Saturated fats, like those in meat, butter, cheese and other full-fat dairy products, and some oils, raise your total cholesterol. Trans fats, often used in margarines and store-bought cookies, crackers and cakes, are particularly bad for your cholesterol levels. Trans fats raise LDL cholesterol, and lower high-density lipoprotein (HDL), the “good” cholesterol.

Food labels report the content of trans fats, but, unfortunately, only in foods that contain at least one gram per serving. That means you could be getting some trans fats in a number of foods, which could add up to enough trans fats in a day to be unhealthy and increase cholesterol. If a food label lists “partially hydrogenated oil,” it has trans fat, and it’s best to avoid it.

In addition to changing your diet, making other heart-healthy lifestyle changes is key to improving your cholesterol. Exercising, quitting smoking and maintaining a healthy weight will help keep your cholesterol at a healthy level.

September Is 

Ovarian Cancer Awareness Month

September is TEAL

Thousands Wear TEAL Across the USA
September marks the nationwide observance of National Ovarian Cancer Awareness Month.

The first Friday in September is National Wear TEAL Day, and the Ovarian Cancer National Alliance

will lead the efforts of thousands of Americans wearing TEAL to increase awareness about the deadly disease.

TEAL is the ovarian cancer community’s color and

serves as a reminder that ovarian cancer is the deadliest of all the cancers

of the reproductive system and a leading cause of cancer death among women.

To find out what you can do this September to get involved, visit our September guide.

The United States of Teal campaign
United States of Teal is the Ovarian Cancer National Alliance’s campaign to raise awareness about ovarian cancer by gaining the support of state legislative leadership.

With our United States of Teal campaign we’re targeting all 50 state houses and asking legislators to pledge their allegiance to the fight against ovarian cancer. By signing a pledge card, they are letting their constituents know that they are committed to promoting ovarian cancer research, improving the lives of women suffering from ovarian cancer, and helping us raise awareness about ovarian cancer symptoms. Once a legislator pledges, we’ll turn his/her state teal on the United States of Teal web site ( See the map below to see if your state has turned TEALyet!

To learn more about the campaign, visit

What’s New?
Our Shop+Give Program
Some of our favortite retailers have teamed up with the Ovarian Cancer National Alliance this September.

A portion of the proceeds of selected TEAL items from the following retailers will benefit the work of OCNA:

Macy’s, Chico’s, Ann Taylor Loft, PaperSource, RedEnvelope, DHC, Sketchers and Tom Shoes.

Click here to shop TEAL items from your favorite retailer! And Don’t forget to download the App for future online purchases.

Ovarian cancer is a growth of abnormal malignant cells that begins in the ovaries (women’s reproductive glands that produce ova).

Cancer that spreads to the ovaries but originates at another site is not considered ovarian cancer. 

Ovarian tumors can be benign (noncancerous)

or malignant (cancerous). Although abnormal, cells of benign tumors do not metastasize (spread to other parts of the body).

Malignant cancer cells in the ovaries can metastasize in two ways:  directly to other organs in the pelvis and abdomen (the more common way),

through the bloodstream or lymph nodes to other parts of the body.

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By Mayo Clinic staff

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Living with cancer newsletter

Subscribe to our Living with cancernewsletter to stay up to date on cancer topics.

Symptoms of ovarian cancer are not specific to the disease, and they often

mimic those of many other more-common conditions,

including digestive and bladder problems.

When ovarian cancer symptoms are present, they tend to be persistent and worsen with time.

Signs and symptoms of ovarian cancer may include:

  • Abdominal pressure, fullness, swelling or bloating
  • Pelvic discomfort or pain
  • Persistent indigestion, gas or nausea
  • Changes in bowel habits, such as constipation
  • Changes in bladder habits, including a frequent need to urinate
  • Loss of appetite or quickly feeling full
  • Increased abdominal girth or clothes fitting tighter around your waist
  • A persistent lack of energy
  • Low back pain

While the causes of ovarian cancer are unknown, some theories exist:

Genetic errors may occur because of damage from the normal monthly release of an egg.

Increased hormone levels before and during ovulation may stimulate the growth of abnormal cells.


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Types of Ovarian Cancer

Different types of ovarian cancer are classified according to the type of cell from which they start.

Epithelial tumors – About 90 percent of ovarian cancers develop in the epithelium, the thin layer of tissue that covers the ovaries.

This form of ovarian cancer generally occurs in postmenopausal women.

Germ cell carcinoma tumors –Making up about five percent of ovarian cancer cases, this type begins in the cells that form eggs.

While germ cell carcinoma can occur in women of any age, it tends to be found most often in women in their early 20s. Six main kinds of germ cell carcinoma exist,

but the three most common types are: teratomas, dysgerminomas, and endodermal sinus tumors. Many tumors that arise in the germ cells are benign.

Stromal carcinoma tumors – Ovarian stromal carcinoma accounts for about five percent of ovarian cancer cases. It develops in the connective

tissue cells that hold the ovary together and those that produce the female hormones estrogen and progesterone. The two most common types are

granulosa cell tumors and sertoli-leydig cell tumors. Unlike with epithelial ovarian carcinoma,

70 percent of stromal carcinoma cases are diagnosed in Stage I. READ MORE>>

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Treatments and drugs

By Mayo Clinic staff

Living with cancer newsletter

Treatment of ovarian cancer usually involves a combination of surgery and chemotherapy.

Treatment for ovarian cancer usually involves an extensive operation that includes removing both ovaries, fallopian tubes, and the uterus as

well as nearby lymph nodes and a fold of fatty abdominal tissue known as the omentum, where ovarian cancer often spreads. Your surgeon also removes

as much cancer as possible from your abdomen (surgical debulking).

Less extensive surgery may be possible if your ovarian cancer was diagnosed at a very early stage. For women with stage I ovarian cancer, surgery may involve

removing one ovary and its fallopian tube. This procedure may preserve the ability to have children in the future.

After surgery, you’ll most likely be treated with chemotherapy — drugs designed to kill any remaining cancer cells. Chemotherapy may also be

used as the initial treatment in some women with advanced ovarian cancer. Chemotherapy drugs can be administered in a vein (intravenously) or injected

directly into the abdominal cavity, or both methods of administering the drugs can be used. Chemotherapy drugs can be given alone or in combination..FOR MORE INFORMATION>>


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How to Contribute

If you or someone you know has been touched by ovarian cancer, you know the challenges that have to be faced. Our job, as an organization,

is to keep this cause front and center for women, the medical community, the scientific community and the legislators who appropriate funds to

support awareness, research and new diagnostics and treatments.

Your contribution will help support all of the Ovarian Cancer National Alliance’s advocacy, education, and awareness programs. Nearly half of our

funding comes from individual donors who share our goals in an effort to conquer ovarian cancer.

The Ovarian Cancer National Alliance is a 501(c)(3) nonprofit organization, as defined by the Internal Revenue Code. Donations are tax deductible to

the fullest extent allowed by law. The Ovarian Cancer National Alliance’s Tax Identification Number is 31-1581756.

See“About Us” for more

information on our financial stewardship.

Please choose from the following topics:






September Is Prostate Cancer Awareness Month

Cancer is a disease in which abnormal cells in the body grow out of control. When cancer starts in the prostate, it is called prostate cancer.

The prostate is a walnut-sized organ located just below the bladder and in front of the rectum in men. It produces fluid that makes up a part of semen.

Prostate cancer is the most commonly diagnosed cancer in men, and second only to lung cancer in the number of cancer deaths.

In 2007 (the most recent year for which statistics are available), 223,307 men were diagnosed with prostate cancer, and 29,093 men died from it.

* CDC provides men, doctors, and policymakers with the latest information about prostate cancer.

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Different people have different symptoms for prostate cancer. Some men do not have symptoms at all.

Some symptoms of prostate cancer are—

  • Difficulty in starting urination.
  • Weak or interrupted flow of urine.
  • Frequent urination, especially at night.
  • Difficulty in emptying the bladder completely.
  • Pain or burning during urination.
  • Blood in the urine or semen.
  • Pain in the back, hips, or pelvis that doesn’t go away.
  • Painful ejaculation.

If you have any symptoms that worry you, be sure to see your doctor right away.

These symptoms may be caused by conditions other than prostate cancer.

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Risk Factors

There is no way to know for sure if you will get prostate cancer. Men have a greater chance of getting prostate cancer if they are

50 years old or older, are African-American, or have a father, brother, or son who has had prostate cancer.

Screening for Prostate Cancer

Not all medical experts agree that screening for prostate cancer will save lives. Currently, there is not enough credible evidence to decide

if the potential benefit of prostate cancer screening outweighs the potential risks. The potential benefit of prostate cancer screening is early detection of cancer,

which may make treatment more effective. Potential risks include false positive test results (the test says you have cancer when you do not),

treatment of prostate cancers that may never affect your health, and mild to serious side effects from treatment of prostate cancer.


Most organizations recommend that men discuss with their doctors the benefits and risks of prostate cancer screening.

CDC supports informed decision making, which encourages men to talk with their doctors to learn the nature and risk of prostate cancer,

understand the benefits and risks of the screening tests, and make decisions consistent with their preferences and values.

Tests that are commonly used to screen for prostate cancer are—

  • Digital rectal exam (DRE): A doctor, nurse, or other health care professional places a gloved finger into the rectum to
  • feel the size, shape, and hardness of the prostate gland.
  • Prostate specific antigen test (PSA): PSA is a substance made by the prostate. The PSA test measures the level of PSA in the blood,
  •  which may be higher in men who have prostate cancer. However, other conditions such as an enlarged prostate, prostate infections,
  • and certain medical procedures also may increase PSA levels.

Is prostate cancer screening right for you? The decision is yours. To help men aged 50 years or older understand both sides of the issue,

CDC has developed several helpful guides to assist you with making an informed decision:

* Data source: U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2007 Incidence and Mortality Web-based Report.

Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention,

and National Cancer Institute; 2010. Available at:


More Information


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About Recovery Month

Get general information about National Recovery Month, held every September to increase awareness and celebrate successes of those in recovery.
National Recovery Month (Recovery Month) is a national observance held every September to educate Americans that substance use treatment and mental health services can enable those with a mental and/or substance use disorder to live a healthy and rewarding life.
Recovery Month celebrates the gains made by those in recovery, just as we celebrate health improvements made by those who are managing other health conditions such as hypertension, diabetes, asthma, and heart disease. The observance reinforces the positive message that behavioral health is essential to overall health, prevention works, treatment is effective, and people can and do recover.
There are millions of Americans whose lives have been transformed through recovery. Since these successes often go unnoticed by the broader population, Recovery Month provides a vehicle for everyone to celebrate these accomplishments. Each September, tens of thousands of prevention, treatment, and recovery programs and facilities around the country celebrate National Recovery Month. They speak about the gains made by those in recovery and share their success stories with their neighbors, friends, and colleagues. In doing so, everyone helps to increase awareness and furthers a greater understanding about the diseases of mental and substance use disorders.
Now in its 26th year, Recovery Month highlights the achievements of individuals who have reclaimed their lives in long-term recovery and honors the treatment and recovery service providers who make recovery possible. Recovery Month also promotes the message that recovery in all of its forms is possible and encourages citizens to take action to help expand and improve the availability of effective prevention, treatment, and recovery services for those in need.
The Recovery Month theme is carefully developed each year to invite individuals in recovery and their support systems to spread the message and share the successes of recovery. Learn more about this year’s theme.
Materials produced for the Recovery Month observance include print, Web, television, radio, and social media tools. These resources help local communities reach out and encourage individuals in need of services, and their friends and families, to seek treatment and recovery services and information. Materials provide multiple resources including SAMHSA’s National Helpline 1-800-662 HELP (4357) for information and treatment referral as well as other SAMHSA resources for locating services.



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Over the years, National Recovery Month (Recovery Month) has inspired millions of people to raise awareness about mental and/or substance use disorders, share their stories of recovery, and encourage others who are still in need of services and support.
Recovery Month began in 1989 as Treatment Works! Month, which honored the work of substance use treatment professionals in the field. The observance evolved into National Alcohol and Drug Addiction Recovery Month in 1998, when it expanded to include celebrating the accomplishment of individuals in recovery from substance use disorders. The observance evolved once again in 2011 to National Recovery Month (Recovery Month) to include all aspects of behavioral health.
Review the Recovery Month: 20 Years of Excellence and Achievement Timeline – 2009 (PDF | 357 KB), which showcases the many strides the treatment and recovery field has made and details the campaign’s success and evolution of Treatment Works! into National Recovery Month.
Support Organizations
Currently, more than 200 federal, state, and local government entities, as well as nonprofit organizations and associations affiliated with prevention, treatment, and recovery of mental and/or substance use disorders, comprise the Recovery Month Planning Partners’ group. The Planning Partners assist in the development, dissemination, and collaboration of materials; promotion; and event sponsorship for the Recovery Month initiative.
Last Updated: 07/18/2015

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Why Teens Are Impulsive, Addiction-Prone And Should Protect Their Brains
JANUARY 28, 2015 2:03 PM ET

Teens can’t control impulses and make rapid, smart decisions like adults can — but why?

Research into how the human brain develops helps explain. In a teenager, the frontal lobe of the brain, which controls decision-making, is built but not fully insulated — so signals move slowly.

“Teenagers are not as readily able to access their frontal lobe to say, ‘Oh, I better not do this,’ ” Dr. Frances Jensen tells Fresh Air’s Terry Gross.

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Jensen, who’s a neuroscientist and was a single mother of two boys who are now in their 20s, wrote The Teenage Brain to explore the science of how the brain grows — and why teenagers can be especially impulsive, moody and not very good at responsible decision-making.

“We have a natural insulation … called myelin,” she says. “It’s a fat, and it takes time. Cells have to build myelin, and they grow it around the outside of these tracks, and that takes years.”

This insulation process starts in the back of the brain and heads toward the front. Brains aren’t fully mature until people are in their early 20s, possibly late 20s and maybe even beyond, Jensen says.

“The last place to be connected — to be fully myelinated — is the front of your brain,” Jensen says. “And what’s in the front? Your prefrontal cortex and your frontal cortex. These are areas where we have insight, empathy, these executive functions such as impulse control, risk-taking behavior.”

This research also explains why teenagers can be especially susceptible to addictions — including drugs, alcohol, smoking and digital devices.

On why teenagers are more prone to addiction

Addiction is actually a form of learning. … What happens in addiction is there’s also repeated exposure, except it’s to a substance and it’s not in the part of the brain we use for learning — it’s in the reward-seeking area of your brain. … It’s happening in the same way that learning stimulates and enhances a synapse. Substances do the same thing. They build a reward circuit around that substance to a much stronger, harder, longer addiction.

“The effects of substances are more permanent on the teen brain. They have more deleterious effects and can be more toxic to the teen than the adult.”
Just like learning a fact is more efficient, sadly, addiction is more efficient in the adolescent brain. That is an important fact for an adolescent to know about themselves — that they can get addicted faster.

It also is a way to debunk the myth, by the way, that, “Oh, teens are resilient, they’ll be fine. He can just go off and drink or do this or that. They’ll bounce back.” Actually, it’s quite the contrary. The effects of substances are more permanent on the teen brain. They have more deleterious effects and can be more toxic to the teen than the adult.

On the effects of binge drinking and marijuana on the teenage brain

Binge drinking can actually kill brain cells in the adolescent brain where it does not to the same extent in the adult brain. So for the same amount of alcohol, you can actually have brain damage — permanent brain damage — in an adolescent for the same blood alcohol level that may cause bad sedation in the adult, but not actual brain damage. …
Because they have more plasticity, more substrate, a lot of these drugs of abuse are going to lock onto more targets in [adolescents’] brains than in an adult, for instance. We have natural cannabinoids, they’re called, in the brain. We have kind of a natural substance that actually locks onto receptors on brain cells. It has, for the most part, a more dampening sedative effect. So when you actually ingest or smoke or get cannabis into your bloodstream, it does get into the brain and it goes to these same targets.

It turns out that these targets actually block the process of learning and memory so that you have an impairment of being able to lay down new memories. What’s interesting is not only does the teen brain have more space for the cannabis to actually land, if you will, it actually stays there longer. It locks on longer than in the adult brain. … For instance, if they were to get high over a weekend, the effects may be still there on Thursday and Friday later that week. An adult wouldn’t have that same long-term effect.

On marijuana’s effect on IQ

People who are chronic marijuana users between 13 and 17, people who [use daily or frequently] for a period of time, like a year plus, have shown to have decreased verbal IQ, and their functional MRIs look different when they’re imaged during a task. There’s been a permanent change in their brains as a result of this that they may not ever be able to recover.

It is a fascinating fact that I uncovered going through the literature around adolescence is our IQs are still malleable into the teen years. I know that I remember thinking and being brought up with, “Well, you have that IQ test that was done in grade school with some standardized process, and that’s your number, you’ve got it for life — whatever that number is, that’s who you are.”

It turns out that’s not true at all. During the teen years, approximately a third of the people stayed the same, a third actually increased their IQ, and a third decreased their IQ. We don’t know a lot about exactly what makes your IQ go up and down — the study is still ongoing — but we do know some things that make your IQ go down, and that is chronic pot-smoking.

On teenagers’ access to constant stimuli

We, as humans, are very novelty-seeking. We are built to seek novelty and want to acquire new stimuli. So, when you think about it, our social media is just a wealth of new stimuli that you can access at all times. The problem with the adolescent is that they may not have the insider judgment, because their frontal lobes aren’t completely online yet, to know when to stop. To know when to say, “This is not a safe piece of information for me to look at. If I go and look at this atrocious violent video, it may stick with me for the rest of my life — this image — and this may not be a good thing to be carrying with me.” They are unaware of when to gate themselves.

On not allowing teenagers to have their cellphones at night

It may or may not be enforceable. I think the point is that when they’re trying to go to sleep — to have this incredibly alluring opportunity to network socially or be stimulated by a computer or a cellphone really disrupts sleep patterns. Again, it’s also not great to have multiple channels of stimulation while you’re trying to memorize for a test the next day, for instance.

So I think I would restate that and say, especially when they’re trying to go to sleep, to really try to suggest that they don’t go under the sheets and have their cellphone on and be tweeting people.

First of all, the artificial light can affect your brain; it decreases some chemicals in your brain that help promote sleep, such as melatonin, so we know that artificial light is not good for the brain. That’s why I think there have been studies that show that reading books with a regular warm light doesn’t disrupt sleep to the extent that using a Kindle does.



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Drugs of Choice on College Campuses

Trends change over time and no drug is immune to college experimentation.

However, there are a few substances that are consistently abused among college students.

These include:

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Alcohol makes up the vast majority of substance-related problems on college campuses.

Because drinking is often socially acceptable, recognizing a problem in college students who drink can be difficult.

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Dubbed the “study drug,” Adderall and other stimulants are increasing in popularity

among college students who are facing pressure to meet all of their academic requirements.

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As legislation tips in favor of marijuana legalization, more college students

are turning to pot as their drug of choice. On some campuses, marijuana use outweighs even that of alcohol.

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Popularized in the 90s, ecstasy has made a resurgence in recent years in its pure form,

known as MDMA or molly. College students fall well within the target age range

for the “party drug,” which is most often abused by teens and 20-somethings.

MDMA is most common at raves and concerts.




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Cholesterol is a waxy substance that’s found in the fats (lipids) in your blood. While your body needs cholesterol to continue building healthy cells, having high cholesterol can increase your risk of heart disease.

When you have high cholesterol, you may develop fatty deposits in your blood vessels. Eventually, these deposits make it difficult for enough blood to flow through your arteries. Your heart may not get as much oxygen-rich blood as it needs, which increases the risk of a heart attack. Decreased blood flow to your brain can cause a stroke.

High cholesterol (hypercholesterolemia) can be inherited, but it’s often the result of unhealthy lifestyle choices, and thus preventable and treatable. A healthy diet, regular exercise and sometimes medication can go a long way toward reducing high cholesterol.

High cholesterol has no symptoms. A blood test is the only way to detect high cholesterol.

When to see a doctor:

Ask your doctor for a baseline cholesterol test at age 20 and then have your cholesterol retested at least every five years. If your test results aren’t within desirable ranges, your doctor may recommend more frequent measurements. Your doctor may also suggest you have more frequent tests if you have a family history of high cholesterol, heart disease or other risk factors, such as smoking, diabetes or high blood pressure.

Cholesterol is carried through your blood, attached to proteins. This combination of proteins and cholesterol is called a lipoprotein. You may have heard of different types of cholesterol, based on what type of cholesterol the lipoprotein carries. They are:

Low-density lipoprotein (LDL). LDL, or “bad,” cholesterol transports cholesterol particles throughout your body. LDL cholesterol builds up in the walls of your arteries, making them hard and narrow.
Very-low-density lipoprotein (VLDL). This type of lipoprotein contains the most triglycerides, a type of fat, attached to the proteins in your blood. VLDL cholesterol makes LDL cholesterol larger in size, causing your blood vessels to narrow. If you’re taking cholesterol-lowering medication but have a high VLDL level, you may need additional medication to lower your triglycerides.
High-density lipoprotein (HDL). HDL, or “good,” cholesterol picks up excess cholesterol and takes it back to your liver.
Factors within your control — such as inactivity, obesity and an unhealthy diet — contribute to high LDL cholesterol and low HDL cholesterol. Factors beyond your control may play a role, too. For example, your genetic makeup may keep cells from removing LDL cholesterol from your blood efficiently or cause your liver to produce too much cholesterol.

You’re more likely to have high cholesterol that can lead to heart disease if you have any of these risk factors:

Smoking. Cigarette smoking damages the walls of your blood vessels, making them likely to accumulate fatty deposits. Smoking may also lower your level of HDL, or “good,” cholesterol.
Obesity. Having a body mass index (BMI) of 30 or greater puts you at risk of high cholesterol.
Large waist circumference. Your risk increases if you are a man with a waist circumference of at least 40 inches (102 centimeters) or a woman with a waist circumference of at least 35 inches (89 centimeters).
Poor diet. Foods that are high in cholesterol, such as red meat and full-fat dairy products, will increase your total cholesterol. Eating saturated fat, found in animal products, and trans fats, found in some commercially baked cookies and crackers, also can raise your cholesterol level.
Lack of exercise. Exercise helps boost your body’s HDL “good” cholesterol while lowering your LDL “bad” cholesterol. Not getting enough exercise puts you at risk of high cholesterol.
Diabetes. High blood sugar contributes to higher LDL cholesterol and lower HDL cholesterol. High blood sugar also damages the lining of your arteries.

High cholesterol can cause atherosclerosis, a dangerous accumulation of cholesterol and other deposits on the walls of your arteries. These deposits (plaques) can reduce blood flow through your arteries, which can cause complications, such as:

Chest pain. If the arteries that supply your heart with blood (coronary arteries) are affected, you may have chest pain (angina) and other symptoms of coronary artery disease.
Heart attack. If plaques tear or rupture, a blood clot may form at the plaque-rupture site — blocking the flow of blood or breaking free and plugging an artery downstream. If blood flow to part of your heart stops, you’ll have a heart attack.
Stroke. Similar to a heart attack, if blood flow to part of your brain is blocked by a blood clot, a stroke occurs.

If you think you may have high cholesterol, or are worried about having high cholesterol because of a strong family history, make an appointment with your family doctor to have your cholesterol level checked.

Because appointments can be brief, and because there’s often a lot of ground to cover, it’s a good idea to be prepared for your appointment. Here’s some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there’s anything you need to do in advance, such as restrict your diet. For a cholesterol test, you will likely have to avoid eating or drinking anything (other than water) for nine to 12 hours before the blood sample is taken.
Write down any symptoms you’re experiencing. High cholesterol itself has no symptoms, but high cholesterol is a risk factor for heart disease. Letting your doctor know if you have symptoms such as chest pains or shortness of breath can help your doctor decide how aggressively your high cholesterol needs to be treated.
Write down key personal information, including a family history of high cholesterol, heart disease, stroke, high blood pressure or diabetes, and any major stresses or recent life changes, as well as exposure to other cardiac risks, such as a personal history of smoking or exposure to family members who smoke (secondary exposure).
Make a list of all medications, as well as any vitamins or supplements, that you’re taking.
Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
Be prepared to discuss your diet and exercise habits. If you don’t already exercise or eat a healthy diet, be ready to talk to your doctor about any challenges you might face in getting started.
Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For high cholesterol, some basic questions to ask your doctor include:

What kinds of tests will I need?
What’s the best treatment?
What foods should I eat or avoid?
What’s an appropriate level of physical activity?
How often do I need a cholesterol test?
What are the alternatives to the primary approach that you’re suggesting?
I have other health conditions. How can I best manage them together?
Are there any restrictions that I need to follow?
Should I see a specialist?
If I need medication, is there a generic alternative to the medicine you’re prescribing me?
Are there any brochures or other printed material that I can take home with me?
What websites do you recommend visiting?
In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask questions during your appointment at any time that you don’t understand something.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

Do you have a family history of high cholesterol, high blood pressure, or heart disease or strokes?
What are your diet and exercise habits like?
Do you smoke? Are you or were you around other smokers?
Have you had a cholesterol test before? If so, when was your last test? What were your cholesterol levels?
What you can do in the meantime

It’s never too early to make healthy lifestyle changes, such as quitting smoking, eating healthy foods and becoming more physically active. These are primary lines of defense against high cholesterol and its complications, including heart attack and stroke.

A blood test to check cholesterol levels — called a lipid panel or lipid profile — typically reports:

Total cholesterol
LDL cholesterol
HDL cholesterol
Triglycerides — a type of fat in the blood
For the most accurate measurements, don’t eat or drink anything (other than water) for nine to 12 hours before the blood sample is taken.

For more on your blood test numbers

click ↓ here

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Lifestyle and home remedies
By Mayo Clinic Staff
Lifestyle changes are essential to improve your cholesterol level. To bring your numbers down, lose excess weight, eat healthy foods and increase your physical activity. If you smoke, quit.

Lose extra pounds

Excess weight contributes to high cholesterol. Losing even 5 to 10 pounds can help lower total cholesterol levels. Start by taking an honest look at your eating habits and daily routine. Consider your challenges to weight loss — and ways to overcome them. Set long-term, sustainable goals.

Eat heart-healthy foods

What you eat has a direct impact on your cholesterol level. In fact, a diet rich in fiber and other cholesterol-lowering foods may help lower cholesterol as much as statin medication for some people.

Choose healthier fats.

Saturated fat and trans fat raise your total cholesterol and LDL cholesterol. Get no more than 10 percent of your daily calories from saturated fat. Monounsaturated fat — found in olive, peanut and canola oils — is a healthier option. Almonds and walnuts are other sources of healthy fat.
Eliminate trans fats. Trans fats, which are often found in margarines and commercially baked cookies, crackers and snack cakes, are particularly bad for your cholesterol levels. Not only do trans fats increase your total LDL (“bad”) cholesterol, but they also lower your HDL (“good”) cholesterol.

You may have noticed more food labels now market their products as “trans fat-free.” But don’t rely only on this label. In the United States, if a food contains less than 0.5 grams of trans fat a serving, it can be marked trans fat-free. It may not seem like much, but if you eat a lot of foods with a small amount of trans fat, it can add up quickly. Instead, read the ingredients list. If a food contains a partially hydrogenated oil, that’s a trans fat, and you should look for an alternative.

Limit your dietary cholesterol. Aim for no more than 300 milligrams (mg) of cholesterol a day — or less than 200 mg if you have heart disease. The most concentrated sources of cholesterol include organ meats, egg yolks and whole milk products. Use lean cuts of meat, egg substitutes and skim milk instead.
Select whole grains. Various nutrients found in whole grains promote heart health. Choose whole-grain breads, whole-wheat pasta, whole-wheat flour and brown rice. Oatmeal and oat bran are other good choices.
Stock up on fruits and vegetables. Fruits and vegetables are rich in dietary fiber, which can help lower cholesterol. Snack on seasonal fruits. Experiment with vegetable-based casseroles, soups and stir-fries.
Eat heart-healthy fish. Some types of fish — such as cod, tuna and halibut — have less total fat, saturated fat and cholesterol than do meat and poultry. Salmon, mackerel and herring are rich in omega-3 fatty acids, which help promote heart health.
Drink alcohol only in moderation. Moderate use of alcohol may increase your levels of HDL cholesterol — but the benefits aren’t strong enough to recommend alcohol for anyone who doesn’t drink already. If you choose to drink, do so in moderation. This means no more than one drink a day for women and one to two drinks a day for men.
Exercise regularly

Regular exercise can help improve your cholesterol levels. With your doctor’s OK, work up to 30 to 60 minutes of exercise a day. Take a brisk daily walk. Ride your bike. Swim laps. To maintain your motivation, keep it fun. Find an exercise buddy or join an exercise group. And, you don’t need to get all 30 to 60 minutes in one exercise session. If you can squeeze in three to six 10-minute intervals of exercise, you’ll still get some cholesterol-lowering benefits.

Don’t smoke

If you smoke, stop. Quitting can improve your HDL cholesterol level. And the benefits don’t end there. Just 20 minutes after quitting, your blood pressure decreases. Within 24 hours, your risk of a heart attack decreases. Within one year, your risk of heart disease is half that of a smoker’s. Within 15 years, your risk of heart disease is similar to that of someone who’s never smoked.

Statin side effects:

Weigh the benefits and risks
Statin side effects can be uncomfortable,

making it seem like the risks outweigh the benefits of these powerful cholesterol-lowering medications.

Consider the risks and benefits.
By Mayo Clinic Staff

Doctors often prescribe statins for people with high cholesterol to lower their total cholesterol and reduce their risk of a heart attack or stroke. Most people taking statins will take them for the rest of their lives unless they can achieve normal cholesterol levels through diet, exercise, weight loss and nutritional supplements. This can make statin side effects more difficult to manage.

For some people, statin side effects can make it seem like the benefit of taking a statin isn’t worth it. Before you decide to stop taking a statin, discover how statin side effects can be reduced.

What are statin side effects?

Muscle pain and damage
The most common statin side effect is muscle pain. You may feel this pain as a soreness, tiredness or weakness in your muscles. The pain can be a mild discomfort, or it can be severe enough to make your daily activities difficult. For example, you might find climbing stairs or walking to be uncomfortable or tiring.

Very rarely, statins can cause life-threatening muscle damage called rhabdomyolysis (rab-doe-mi-OL-ih-sis). Rhabdomyolysis can cause severe muscle pain, liver damage, kidney failure and death. Rhabdomyolysis can occur when you take statins in combination with certain drugs or if you take a high dose of statins.

Liver damage
Occasionally, statin use could cause your liver to increase its production of enzymes that help you digest food, drinks and medications. If the increase is only mild, you can continue to take the drug. Rarely, if the increase is severe, you may need to stop taking the drug. Your doctor might suggest a different statin. Certain other cholesterol-lowering drugs, such as gemfibrozil (Lopid) and niacin (Niacor, Niaspan), slightly increase the risk of liver problems in people who take statins.

Although liver problems are rare, your doctor will likely order a liver enzyme test before or shortly after you begin to take a statin. You shouldn’t need any additional liver enzyme tests unless you begin to have signs or symptoms of trouble with your liver. Contact your doctor immediately if you have unusual fatigue or weakness, loss of appetite, pain in your upper abdomen, dark-colored urine, or yellowing of your skin or eyes.

Digestive problems
Some people taking a statin may develop nausea, gas, diarrhea or constipation after taking a statin. These side effects are rare. Most people who have these side effects already have other problems with their digestive system. Taking your statin medication in the evening with a meal can reduce digestive side effects.

Rash or flushing
You could develop a rash or flushing after you start taking a statin. If you take a statin and niacin, either in a combination pill such as Simcor or as two separate medications, you’re more likely to have this side effect. Taking aspirin before taking your statin medication may help, but talk to your doctor first.

Increased blood sugar or type 2 diabetes
It’s possible your blood sugar (blood glucose) level may increase when you take a statin, which may lead to developing type 2 diabetes. The risk is small but important enough that the Food and Drug Administration (FDA) has issued a warning on statin labels regarding blood glucose levels and diabetes. Talk to your doctor if you have concerns.

Neurological side effects
The FDA warns on statin labels that some people have developed memory loss or confusion while taking statins. These side effects reverse once you stop taking the medication. Talk to your doctor if you experience memory loss or confusion. There has also been evidence that statins may help with brain function — in patients with dementia or Alzheimer’s, for example. This is still being studied. Don’t stop taking your statin medication before talking to your doctor.

Who’s at risk of developing statin side effects?

Not everyone who takes a statin will have side effects, but some people may be at a greater risk than are others. Risk factors include:

  • Taking multiple medications to lower your cholesterol
    Being female
    Having a smaller body frame
    Being age 65 or older
    Having kidney or liver disease
    Having type 1 or 2 diabetes
    Drinking too much alcohol (More than two drinks a day for men age 65 and younger and more than one drink a day for women of all ages and men older than 65)

What causes statin side effects?

It’s unclear what causes statin side effects, especially muscle pain.

Statins work by slowing your body’s production of cholesterol. Your body produces all the cholesterol it needs by digesting food and producing new cells on its own. When this natural production is slowed, your body begins to draw the cholesterol it needs from the food you eat, lowering your total cholesterol.

Statins may affect not only your liver’s production of cholesterol but also several enzymes in muscle cells that are responsible for muscle growth. The effects of statins on these cells may be the cause of muscle aches.

How to relieve statin side effects

To relieve statin side effects, your doctor may recommend several options.

Discuss these steps with your doctor before trying them:

Take a brief break from statin therapy. Sometimes it’s hard to tell whether the muscle aches or other problems you’re having are statin side effects or just part of the aging process. Taking a break of 10 to 14 days can give you some time to compare how you feel when you are and aren’t taking a statin. This can help you determine whether your aches and pains are due to statins instead of something else.
Switch to another statin drug. It’s possible, although unlikely, that one particular statin may cause side effects for you while another statin won’t. It’s thought that simvastatin (Zocor) may be more likely to cause muscle pain as a side effect than other statins when it’s taken at high doses. Newer statin drugs are being studied that may have may have fewer side effects.
Change your dose. Lowering your dose may reduce some of your side effects, but it may also reduce some of the cholesterol-lowering benefits your medication has. It’s also possible your doctor will suggest switching your medication to another statin that’s equally effective but can be taken in a lower dose. For example, if you’ve successfully taken atorvastatin (Lipitor) for a long time at higher doses, your doctor may keep you at this level. However, higher doses aren’t recommended if you’re new to this medication.
Take it easy when exercising. It’s possible exercise could make your muscle aches worse. Talk to your doctor about changing your exercise routine.
Consider other cholesterol-lowering medications. Taking ezetimibe (Zetia), a cholesterol absorption inhibitor medication, may help you avoid taking higher doses of statins. However, some researchers question the effectiveness of ezetimibe compared with statins in terms of its ability to lower your cholesterol.
Don’t try over-the-counter (OTC) pain relievers. Muscle aches from statins can’t be relieved with acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) the way other muscle aches are. Don’t try an OTC pain reliever without asking your doctor first.
Try coenzyme Q10 supplements. Coenzyme Q10 supplements may help to prevent statin side effects in some people, though more studies are needed to determine any benefits of taking it. If you’d like to try adding coenzyme Q10 to your treatment, talk to your doctor first to make sure the supplement won’t interact with any of your other medications.
Watch for drug interactions

Statins can have several potentially dangerous interactions with other medications and some foods. These interactions can make it more likely you’ll have statin side effects. These include:

All statins and grapefruit or grapefruit juice. Grapefruit juice contains a chemical that can interfere with the enzymes that break down (metabolize) the statins in your digestive system. This can be dangerous because it’s uncertain what the effect would be on your total cholesterol. You should still be able to have some grapefruit or grapefruit juice, but talk to your doctor about limiting how much grapefruit you can have.
Lovastatin (Mevacor, Altoprev) or simvastatin (Zocor) and amiodarone (Cordarone). People taking the statins lovastatin or simvastatin, either alone or in combination with amiodarone (Cordarone), a medication for irregular heart rhythms, are at a greater risk of severe statin side effects, such as rhabdomyolysis.
All statins and gemfibrozil (Lopid). People who take both gemfibrozil (Lopid) and a statin may be at a greater risk of statin side effects.
Mevacor (lovastatin) and HIV drugs. Medicines used to treat HIV (protease inhibitors) should never be taken with Mevacor.
All statins and some antibiotic and antifungal medications. If you have a fungal or bacterial infection, be sure to tell your doctor if you take a statin.
All statins and some antidepressant medications. It’s possible that taking antidepressants, such as nefazodone, and a statin could make you more likely to have muscle aches.
All statins and some immunosuppressant medications. If you take a medication to suppress your immune system, such as cyclosporine (Sandimmune), and a statin, you may be more likely to have muscle aches.
Weigh the risks and benefits

Although statin side effects can be annoying, consider the benefits of taking a statin before you decide to stop taking your medication. Remember that statin medications can reduce your risk of a heart attack or stroke, and the risk of life-threatening side effects from statins is very low.

Even if your side effects are frustrating, don’t stop taking your statin medication for any period of time without talking to your doctor first. Your doctor may be able to come up with an alternative treatment plan that can help you lower your cholesterol without uncomfortable side effects.

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And don’t forget to check out our Blue Zone Diet guide

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Food Facts…

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What is your thyroid gland?
The thyroid gland is a small, butterfly-shaped gland located in the base of the neck (just below the Adam’s apple in men). Although relatively small, the thyroid gland plays a huge role in our body, influencing the function of many of the body’s most important organs, including the heart, brain, liver, kidneys and skin. Ensuring that the thyroid gland is healthy and functioning properly is vitally important to the body’s overall well-being.

How prevalent is thyroid disease?
January is national Thyroid Awareness Month, which aims to bring to the public’s attention the need to take good care of this important tiny gland in the neck.
More than 30 million Americans suffer from a thyroid disorder, and many more go undiagnosed every year. Now is a good time to become aware of your thyroid and its relationship to your health — and how best to take care of it.

Thyroid nodules and enlarged thyroid glands are common problems, and they can harbor cancers within them. They require proper evaluation and treatment. When detected, patients with these thyroid disorders are usually referred for further work-up to an endocrinologist, or to an experienced head and neck surgeon.

Thyroid disease is more common than diabetes or heart disease. Thyroid disease is a fact of life for as many as 30 million Americans – and more than half of those people remain undiagnosed. Women are five times more likely than men to suffer from hypothyroidism (when the gland is not producing enough thyroid hormone). Aging is just one risk factor for hypothyroidism.

What does your thyroid gland do for you?
The thyroid gland produces thyroid hormone, which controls virtually every cell, tissue and organ in the body. If your thyroid is not functioning properly, it can produce too much thyroid hormone, which causes the body’s systems to speed up (hyperthyroidism); or it can create too little thyroid hormone, which causes the body’s systems to slow down (hypothyroidism).

Untreated thyroid disease may lead to elevated cholesterol levels and subsequent heart disease, as well as infertility and osteoporosis. Research also shows that there is a strong genetic link between thyroid disease and other autoimmune diseases, including types of diabetes, arthritis and anemia.

Simply put, if your thyroid gland isn’t working properly, neither are you.

How do you know if you have a thyroid problem?
First, you must understand how to recognize the symptoms and risk factors of thyroid disease. Since many symptoms may be hidden or mimic other diseases and conditions, the best way to know for sure is to ask your doctor for a TSH (thyroid-stimulating hormone) test, a simple blood test to verify your thyroid gland’s condition. Also, take a minute and perform a self Neck Check and because thyroid disease often runs in families, examinations of your family members and a review of their medical histories may reveal other individuals with thyroid problems.

When should you consider getting a thyroid evaluation?
Due to the increasing prevalence of thyroid disease, you should consider getting your thyroid checked if you have any one of the following risk factors for thyroid disease:

Family history: A familiar place to look for thyroid disorder signs and symptoms is your family tree. If you have a first-degree relative (a parent, sibling or child) with thyroid disease, you would benefit from thyroid evaluation. Women are much more likely to be thyroid patients than men; however, the gene pool runs through both.
Prescription medications: If you are taking Lithium or Amiodarone, you should consider a thyroid evaluation.
Radiation therapy to the head or neck: If you have had any of the following radiation therapies, you should consider a thyroid evaluation: radiation therapy for tonsils, radiation therapy for an enlarged thymus, or radiation therapy for acne.
Chernobyl: If you lived near Chernobyl at the time of the 1986 nuclear accident, you should consider a thyroid evaluation

How to perform a self Neck Check
An estimated 15 million of Americans have undiagnosed thyroid problems. To help with early detection and in some cases help you find lumps or enlargements in the neck that may point to a thyroid condition, you can perform a simple Neck Check self-exam. Here is a step-by-step guide.

How to take the Thyroid Neck Check
All you will need is a handheld mirror and a glass of water

1. Hold the mirror in your hand, focusing on the lower front area of your neck, above the collarbones, and below the voice box (larynx). Your thyroid gland is located in this area of your neck.

2. While focusing on this area in the mirror, tip your head back.

3. Take a drink of water and swallow.

4. As you swallow, look at your neck. Check for any bulges or protrusions in this area when you swallow. Reminder: Don’t confuse the Adam’s apple with the thyroid gland. The thyroid gland is located further down on your neck, closer to the collarbone. You may want to repeat this process several times.

5. If you do see any bulges or protrusions in this area, see your physician. You may have an enlarged thyroid gland or a thyroid nodule and should be checked to determine whether cancer is present or if treatment for thyroid disease is needed.

Every time you look in the mirror, a key to your well-being is staring back at your thyroid gland. The thyroid gland is a small, butterfly-shaped gland located in the lower front of the neck, above the collarbones, and below the voice box (larynx). Your thyroid gland makes hormones that help control the function of many of your body’s organs, including your heart, brain, liver, kidneys, and skin. Making sure that your thyroid gland is healthy is important to your body’s overall well-being.

Some patients who have an enlarged thyroid gland may also produce too much or too little thyroid hormone. Because many symptoms of thyroid imbalance may be hard to recognize and may be mistaken for symptoms caused by other conditions, the best way to know for sure about your thyroid health is to ask your doctor for a TSH (thyroid-stimulating hormone) test, a simple blood test that measures whether your thyroid gland is functioning normally. If you have a family member with thyroid disease, are over the age of 60, or have any symptoms or risk factors associated with thyroid disease, you should talk to your doctor about getting a TSH test.

Why should you get your thyroid checked if you have a positive Neck Check or any risk factors for thyroid disease?
If there is a problem with your thyroid, your metabolism may burn energy rapidly or not quickly enough, causing a problem. Fatigue, weight gain, sensitivity to hot or cold temperatures, rapid heart rate could be a result of an over or under-active thyroid. It is estimated that millions of people, mostly women, have thyroid disorders but have not received a diagnosis.

There are many different types of thyroid disorders, some of which are benign, others malignant. It is important to follow-up with a specialist to get your thyroid checked if you suspect you may have a thyroid disorder. Since thyroid cancers are highly curable, it is extremely important for the patient to undergo proper treatment and close follow-up. The initial treatment for most thyroid cancers is removal of the thyroid gland, and sometimes removal of lymph nodes which may contain metastatic cancer.

Following a thorough work-up, the patient may need to undergo a thyroidectomy (removal of part or all of the thyroid gland) for several reasons — for removal of thyroid cancer, removal of part of the thyroid gland for definitive diagnosis, treatment of a hyperactive thyroid gland, or an enlarged thyroid gland that is causing breathing or swallowing difficulties.

In the hands of a highly-skilled, experienced surgeon, the procedure can be accomplished with a low risk of complications and a short, overnight hospital stay. Depending on the type of cancer, some patients may require treatment with radioactive iodine after surgery.

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About Thyroid Disorders and Treatment

Below, some of the most common thyroid disorders and their treatments are discussed. Although treatments are generally standardized, it is important that you talk to your doctor about your specific treatment options if you have been diagnosed with one of the disorders listed below. Some individuals may not be candidates for some of the treatments we will discuss below, but the information provided intends to provide education about some of the most common thyroid disorders as well as the common treatments offered today.

Hashimoto’s Thyroiditis
Hashimoto’s thyroiditis (also called autoimmune or chronic lymphocytic thyroiditis) is the most common thyroid disease in the United States. It is an inherited condition that affects over 10 million Americans and is about seven times more common in women than in men. Hashimoto’s thyroiditis is characterized by the production of immune cells and auto-antibodies by the body’s immune system that can damage thyroid cells and compromise their ability to make thyroid hormone. Hypothyroidism occurs if the amount of thyroid hormone which can be produced is not enough for the body’s needs. The thyroid gland may also enlarge, forming a goiter.

Hashimoto’s thyroiditis results from a malfunction in the immune system. When working properly, the immune system is designed to protect the body against invaders such as bacteria, viruses and other foreign substances. The immune system of someone with Hashimoto’s thyroiditis mistakenly recognizes normal thyroid cells as foreign tissue, and it produces antibodies that may destroy these cells. Although various environmental factors have been studied, none have been positively proven to be the cause of Hashimoto’s thyroiditis.

Signs & Symptoms
Hashimoto’s thyroiditis may not cause symptoms for many years and may remain undiagnosed until an enlarged thyroid gland or abnormal blood tests are discovered as part of a routine examination. When symptoms do develop, they are either related to local pressure in the neck caused by the goiter itself or to the low levels of thyroid hormone.

The first sign of this disease may be painless swelling in the lower front of the neck. This enlargement may eventually become easily visible. It may be associated with an uncomfortable pressure sensation in the lower neck, and this pressure on surrounding structures may cause additional symptoms, including difficulty swallowing.

Although many of the symptoms associated with thyroid hormone deficiency occur commonly in patients without thyroid disease, patients with Hashimoto’s thyroiditis who develop hypothyroidism are more likely to experience the following:

Difficulty with learning
Dry, brittle hair and nails
Dry, itchy skin
Puffy face
Sore muscles
Weight gain
Heavy menstrual flow
Increased frequency of miscarriages
Increased sensitivity to many medications

The thyroid enlargement and/or hypothyroidism caused by Hashimoto’s thyroiditis progresses in many patients, causing a slow worsening of symptoms. Therefore, patients should be recognized and adequately treated with thyroid hormone. Optimal treatment with thyroid hormone will eliminate any symptoms due to thyroid hormone deficiency, usually prevent further thyroid enlargement, and may sometimes cause shrinkage of an enlarged thyroid gland.

A physician experienced in the diagnosis and treatment of thyroid disease can detect a goiter due to Hashimoto’s thyroiditis by performing a physical examination and can recognize hypothyroidism by identifying characteristic symptoms, finding typical physical signs and performing appropriate laboratory tests.

Antithyroid Antibodies-Testing for increased antithyroid antibodies provides the most specific laboratory evidence of Hashimoto’s thyroiditis, but the antibodies are not present in all cases.

TSH (Thyroid-Stimulating Hormone or Thyrotropin) Test –Increased TSH level in the blood is the most accurate indicator of hypothyroidism. TSH is produced by another gland, the pituitary, which is located behind the nose at the base of the brain. The level of TSH rises dramatically when the thyroid gland even slightly under produces thyroid hormone. So, in patients with normal pituitary function, a normal level of TSH reliably excludes hypothyroidism.

Free thyroxine estimate – the active portion of all of the thyroxine circulating in the blood. A low level of free thyroxine is consistent with thyroid hormone deficiency. However, free thyroxine values in the “normal range” may actually represent thyroid hormone deficiency in a particular patient, since a high level of TSH stimulation may keep the free thyroxine levels “within normal limits” for many years.

Fine-needle aspiration of the thyroid – usually not necessary for most patients with Hashimoto’s thyroiditis, but a good way to diagnose difficult cases and a necessary procedure if a thyroid nodule is also present.


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For patients with thyroid enlargement (goiter) or hypothyroidism, thyroid hormone therapy is clearly needed, since proper dosage corrects any symptoms due to thyroid hormone deficiency and may decrease the goiter’s size. Treatment generally consists of taking a single daily tablet of levothyroxine. Older patients who may have underlying heart disease are usually started on a low dose and gradually increased, while younger, healthy patients can be started on full replacement doses at once.

While you may improve in many ways within a week, the full impact of thyroid medicine may take quite some time. For example, skin changes may take up to 3-6 months to resolve. Because of the generally permanent and often progressive nature of Hashimoto’s thyroiditis, it is usually necessary to treat it throughout one’s lifetime and to realize that dosage of medicine required may have to be adjusted from time to time.
Optimal adjustment of thyroid hormone dosage, guided by laboratory tests rather than symptoms alone, is critical, since the body is very sensitive to even small changes in thyroid hormone levels. Levothyroxine tablets come in 12 different strengths, and it is essential to take them in a consistent manner every day. If the dose is not adequate, the thyroid gland may continue to enlarge and symptoms of hypothyroidism will persist. This may be associated with increased serum cholesterol levels, possibly increasing the risk for atherosclerosis and heart disease. If the dose is too strong, it can cause symptoms of hyperthyroidism, creating excessive strain on the heart and an increased risk of developing osteoporosis.

Hyperthyroidism develops when the body is exposed to excessive amounts of thyroid hormone. This disorder occurs in almost one percent of all Americans and affects women five to 10 times more often than men. In its mildest form, hyperthyroidism may not cause recognizable symptoms. More often, however, the symptoms are discomforting, disabling or even life-threatening.

Graves’ Disease: Graves’ disease (named after Irish physician Robert Graves) is an autoimmune disorder that frequently results in thyroid enlargement and hyperthyroidism. In some patients, swelling of the muscles and other tissues around the eyes may develop, causing eye prominence, discomfort or double vision. Like other autoimmune diseases, this condition tends to affect multiple family members. It is much more common in women than in men and tends to occur in younger patients.

Postpartum Thyroiditis: Five to 10 percent of women develop mild to moderate hyperthyroidism within several months of giving birth. Hyperthyroidism in this condition usually lasts for approximately one to two months. It is often followed by several months of hypothyroidism, but most women will eventually recover normal thyroid function. In some cases, however, the thyroid gland does not heal, so the hypothyroidism becomes permanent and requires lifelong thyroid hormone replacement. This condition may occur again with subsequent pregnancies.

Silent Thyroiditis: Transient (temporary) hyperthyroidism can be caused by silent thyroiditis, a condition which appears to be the same as postpartum thyroiditis, but is not related to pregnancy. It is not accompanied by a painful thyroid gland.

Subacute Thyroiditis: This condition may follow a viral infection and is characterized by painful thyroid gland enlargement and inflammation, which results in the release of large amounts of thyroid hormones into the blood. Fortunately, this condition usually resolves spontaneously. The thyroid usually heals itself over several months, but often not before a temporary period of low thyroid hormone production (hypothyroidism) occurs.

Toxic Multinodular Goiter: Multiple nodules in the thyroid can produce excessive thyroid hormone, causing hyperthyroidism. Typically diagnosed in patients over the age of 50, this disorder is more likely to affect heart rhythm. In many cases, the person has had the goiter for many years before it becomes overactive.

Toxic Nodule: A single nodule or lump in the thyroid can also produce more thyroid hormone than the body requires and lead to hyperthyroidism. This disorder is not familial.

Excessive Iodine Ingestion: Various sources of high iodine concentrations, such as kelp tablets, some expectorants, amiodarone (Cordarone, Pacerone – medications used to treat certain problems with heart rhythms) and x-ray dyes may occasionally cause hyperthyroidism in patients who are prone to it.

Overmedication with thyroid hormone: Patients who receive excessive thyroxine replacement treatment can develop hyperthyroidism. They should have their thyroid hormone dosage evaluated by a physician at least once each year and should NEVER give themselves “extra” doses.

Signs & Symptoms
When hyperthyroidism develops, a goiter (enlargement of the thyroid) is usually present and may be associated with some or many of the following features:

Fast heart rate, often more than 100 beats per minute
Becoming anxious, irritable, argumentative
Trembling hands
Weight loss, despite eating the same amount or even more than usual
Intolerance of warm temperatures and increased likelihood to perspire
Loss of scalp hair
Tendency of fingernails to separate from the nail bed
Muscle weakness, especially of the upper arms and thighs
Loose and frequent bowel movements
Smooth skin
Change in menstrual pattern
Increased likelihood for miscarriage
Prominent “stare” of the eyes
Protrusion of the eyes, with or without double vision (in patients with Graves’ disease)
Irregular heart rhythm, especially in patients older than 60 years of age
Accelerated loss of calcium from bones, which increases the risk of osteoporosis and fractures

Sometimes a general physician can diagnose and treat the cause of hyperthyroidism, but assistance is often needed from an endocrinologist, a physician who specializes in managing thyroid disease. Characteristic symptoms and physical signs of the disease can be detected by a trained physician. In addition, tests can be used to confirm the diagnosis and to determine the cause.

TSH (Thyroid-Stimulating Hormone or Thyrotropin) Test – A low TSH level in the blood is the most accurate indicator of hyperthyroidism. The body shuts off production of this pituitary hormone when the thyroid gland even slightly overproduces thyroid hormone. If the TSH level is low, it is very important to also check thyroid hormone levels to confirm the diagnosis of hyperthyroidism.

Estimates of free thyroxine and free triiodothyronine – the active thyroid hormones in the blood. When hyperthyroidism develops, free thyroxine and free triiodothyronine levels rise above previous values in that specific patient (although they may still fall within the normal range for the general population) and are often considerably elevated.

TSI (thyroid-stimulating immunoglobulin) – a substance often found in the blood when Graves’ disease is the cause of hyperthyroidism.

Radioactive iodine uptake (RAIU) – a measurement of how much iodine the thyroid gland can collect, and thyroid scan, which shows how the iodine is distributed throughout the thyroid gland. This information can be useful in determining the cause of hyperthyroidism and, ultimately, its treatment.

Appropriate management of hyperthyroidism requires careful evaluation and ongoing care by a physician experienced in the treatment of this complex condition.

Before the development of current treatment options, the death rate from severe hyperthyroidism was as high as 50 percent. Now several effective treatments are available and, with proper management, death from hyperthyroidism is rare. Deciding which treatment is best depends on what caused the hyperthyroidism, its severity and other conditions present.

Antithyroid Drugs
In the United States, two drugs are available for treating hyperthyroidism: propylthiouracil (PTU) and methimazole (Tapazole). Except for early pregnancy, methimazole is preferred because PTU can rarely cause fatal liver damage. These medications control hyperthyroidism by slowing thyroid hormone production. They may take several months to normalize thyroid hormone levels. Some patients with hyperthyroidism caused by Graves’ disease experience a spontaneous or natural remission of hyperthyroidism after a 12- to 18-month course of treatment with these drugs, and may sometimes avoid permanent underactivity of the thyroid (hypothyroidism), which often occurs as a result of using the other methods of treating hyperthyroidism. Unfortunately, the remission is frequently only temporary, with the hyperthyroidism recurring after several months or years off medication and requiring additional treatment, so relatively few patients are treated solely with antithyroid medication in the United States.
Antithyroid drugs may cause an allergic reaction in about five percent of patients who use them. This usually occurs during the first six weeks of drug treatment. Such a reaction may include rash or hives; but after discontinuing use of the drug, the symptoms resolve within one to two weeks and there is no permanent damage.

A more serious side effect, but occurring in only about one in 250-500 patients during the first four to eight weeks of treatment, is a rapid decrease of white blood cells in the bloodstream. This could increase susceptibility to serious infection. Symptoms such as a sore throat, infection or fever should be reported promptly to your physician, and a white blood cell count should be done immediately. In nearly every case, when a person stops using the medication, the white blood cell count returns to normal. Very rarely, antithyroid drugs may cause severe liver problems, which can be detected by monitoring blood tests or joint problems characterized by joint pain and/or swelling. Your physician should be contacted if there is yellowing of the skin jaundice, fever, loss of appetite or abdominal pain.

Radioactive Iodine Treatment
Iodine is an essential ingredient in the production of thyroid hormone. Each molecule of thyroid hormone contains either four (T4) or three (T3) molecules of iodine. Since most overactive thyroid glands are quite hungry for iodine, it was discovered in the 1940s that the thyroid could be “tricked” into destroying itself by simply feeding it radioactive iodine. The radioactive iodine is given by mouth, usually in capsule form, and is quickly absorbed from the bowel. It then enters the thyroid cells from the bloodstream and gradually destroys them. Maximal benefit is usually noted within three to six months.
It is not possible to eliminate “just the right amount” of the diseased thyroid gland, since radioiodine eventually damages all thyroid cells. Therefore, most endocrinologists strive to completely destroy the diseased thyroid gland with a single dose of radioiodine. This results in the intentional development of an underactive thyroid state (hypothyroidism), which is easily, predictably and inexpensively corrected by lifelong daily use of oral thyroid hormone replacement therapy. Although every effort is made to calculate the correct dose of radioiodine for each patient, not every treatment will successfully correct the hyperthyroidism, particularly if the goiter is quite large and a second dose of radioactive iodine is occasionally needed.

Thousands of patients have received radioiodine treatment, including former President of the United States George H. W. Bush and his wife, Barbara. The treatment is a very safe, simple and reliably effective one. Because of this, it is considered by most thyroid specialists in the United States to be the treatment of choice for hyperthyroidism cases caused by overproduction of thyroid hormone.

Surgical Removal of the Thyroid
Although seldom used now as the preferred treatment for hyperthyroidism, operating to remove most of the thyroid gland may occasionally be recommended in certain situations, such as a pregnant woman with severe uncontrolled disease in whom radioiodine would not be safe for the baby. Surgery usually leads to permanent hypothyroidism and lifelong thyroid hormone replacement therapy.


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Other Treatments
A drug from the class of beta-adrenergic blocking agents (which decrease the effects of excess thyroid hormone) may be used temporarily to control hyperthyroid symptoms until other therapies take effect. In cases where hyperthyroidism is caused by thyroiditis or excessive ingestion of either iodine or thyroid hormone, this may be the only type of treatment required.
Iodine drops are prescribed when hyperthyroidism is severe or prior to undergoing surgery for Graves’ disease.

An underactive thyroid, or hypothyroidism, occurs when the thyroid gland produces less than the normal amount of thyroid hormone. The result is the “slowing down” of many bodily functions. Although hypothyroidism may be temporary, it usually is a permanent condition. Of the nearly 30 million people estimated to be suffering from thyroid dysfunction, most have hypothyroidism.

Autoimmune Thyroiditis: The body’s immune system may produce a reaction in the thyroid gland that results in hypothyroidism and, most often, a goiter (enlargement of the thyroid). Other autoimmune diseases may be associated with this disorder, and additional family members may also be affected.

Central or Pituitary Hypothyroidism: TSH (Thyroid-stimulating hormone) is produced by the pituitary gland, which is located behind the nose at the base of the brain. Any destructive disease of the pituitary gland or hypothalamus, which sits just above the pituitary gland, may cause damage to the cells that secrete TSH, which stimulates the thyroid to produce normal amounts of thyroid hormone. This is a very rare cause of hypothyroidism.

Congenital Hypothyroidism: An infant may be born with an inadequate amount of thyroid tissue or an enzyme defect that does not allow normal thyroid hormone production. If this condition is not treated promptly, physical stunting and/or mental damage (cretinism) may develop.

Medications: Lithium, high doses of iodine and amiodarone — an antiarrhythmic agent used for various types of cardiac dysrhythmias — can cause hypothyroidism.

Postpartum Thyroiditis: Five percent to 10 percent of women develop mild to moderate hyperthyroidism within several months of giving birth. Hyperthyroidism in this condition usually lasts for approximately one to two months. It is often followed by several months of hypothyroidism, but most women will eventually recover normal thyroid function. In some cases, however, the thyroid gland does not heal, so the hypothyroidism becomes permanent and requires lifelong thyroid hormone replacement. This condition may occur again with subsequent pregnancies.

Radioactive Iodine Treatment: Hypothyroidism frequently develops as a desired therapeutic goal after the use of radioactive iodine treatment for hyperthyroidism.

Silent Thyroiditis: Transient (temporary) hyperthyroidism can be caused by silent thyroiditis, a condition which appears to be the same as postpartum thyroiditis but not related to pregnancy. It is not accompanied by a painful thyroid gland.

Subacute Thyroiditis: This condition may follow a viral infection and is characterized by painful thyroid gland enlargement and inflammation, which results in the release of large amounts of thyroid hormone into the blood. Fortunately, this condition usually resolves spontaneously. The thyroid usually heals itself over several months, but often not before a temporary period of hypothyroidism occurs.

Thyroid Surgery: Hypothyroidism may be related to surgery on the thyroid gland, especially if most of the thyroid has been removed.

Signs & Symptoms
In its earliest stage, hypothyroidism may cause few symptoms, since the body has the ability to partially compensate for a failing thyroid gland by increasing the stimulation to it, much like pressing down on the accelerator when climbing a hill to keep the car going the same speed. As thyroid hormone production decreases and the body’s metabolism slows, a variety of features may result, including any of the following:

Pervasive fatigue
Difficulty with learning
Dry, brittle hair and nails
Dry, itchy skin
Puffy face
Sore muscles
Weight gain and fluid retention
Heavy and/or irregular menstrual flow
Increased frequency of miscarriages
Increased sensitivity to many medications

Characteristic symptoms and physical signs, which can be detected by a physician, can signal hypothyroidism. However, the condition may develop so slowly that many patients do not realize that their body has changed, so it is critically important to perform diagnostic laboratory tests to confirm the diagnosis and to determine the cause of hypothyroidism.

TSH (Thyroid – Stimulating Hormone or Thyrotropin) Test: An increased TSH level in the blood is the most accurate indicator of primary (non-pituitary) hypothyroidism. Production of this pituitary hormone is increased when the thyroid gland even slightly under produces thyroid hormone.

Estimates of free thyroxine – the active thyroid hormone in the blood. It is important to note that there is a range of free thyroxine levels in the blood of normal people, similar to the range for height, and that a value of free thyroxine that is “within normal limits” for the general population may not be appropriate for a particular individual.
Thyroid auto-antibodies – indicates the likelihood of auto-immune thyroiditis being the cause of hypothyroidism.

A primary care physician may make the diagnosis of hypothyroidism, but assistance is often needed from an endocrinologist, a physician who is a specialist in thyroid diseases.

Hypothyroidism is generally treated with a single daily dose of levothyroxine, given as a tablet. An experienced physician can prescribe the correct form and dosage to return the thyroid balance to normal. Older patients who may have underlying heart disease are usually started at a low dose and gradually increased while younger healthy patients can be started on full replacement doses at once. Thyroid hormone acts very slowly in some parts of the body, so it may take several months after treatment for some features to improve.

Levothyroxine tablets come in 12 different strengths, and it is essential to take them in a consistent manner every day. A dose of thyroid hormone that is too low may fail to prevent enlargement of the thyroid gland, allow symptoms of hypothyroidism to persist, and be associated with increased serum cholesterol levels, which may increase the risk for atherosclerosis and heart disease. A dose that is too high can cause symptoms of hyperthyroidism, create excessive strain on the heart, and lead to an increased risk of developing osteoporosis.

It is extremely important that women planning to become pregnant are kept well adjusted, since hypothyroidism can affect the development of the baby. During pregnancy, thyroid hormone replacement requirements often change, so more frequent monitoring is necessary. Various medications and supplements (particularly iron) may affect the absorption of thyroid hormone; therefore, the levels may need more frequent monitoring during illness or change in medication and supplements.

Thyroid hormone is critical for normal brain development in babies. Infants requiring thyroid hormone therapy should NOT be treated with purchased liquid suspensions, since the active hormone may deteriorate once dissolved and the baby could receive less thyroid hormone than necessary. Instead, infants with hypothyroidism should receive their thyroid hormone by crushing a single tablet daily of the correct dose and suspending it in one teaspoon of liquid and administering it properly.

Since most cases of hypothyroidism are permanent and often progressive, it is usually necessary to treat this condition throughout one’s lifetime. Periodic monitoring of TSH levels and clinical status are necessary to ensure that the proper dose is being given, since medication doses may have to be adjusted from time to time. Optimal adjustment of thyroid hormone dosage is critical, since the body is very sensitive to even small changes in thyroid hormone levels.

Appropriate management of hypothyroidism requires continued care by a physician experienced in the treatment of this condition.

Grave’s Disease
Graves’ disease, also known as toxic diffuse goiter, is an autoimmune disorder that is the most common cause of hyperthyroidism in the United States, a condition in which the thyroid gland produces excessive hormones. The disease is named after Sir Robert Graves, who first described the condition in the early 19th century.

Normally, the immune system protects the body from infection by identifying and destroying bacteria, viruses and other potentially harmful foreign substances. But in autoimmune diseases, the immune system attacks the body’s own cells and organs. With Graves’ disease, the immune system makes an antibody called thyroid-stimulating immunoglobulin (TSI) — sometimes called TSH (thyroid stimulating hormone) receptor antibody — that attaches to thyroid cells. TSI mimics TSH and stimulates the thyroid to make too much thyroid hormone. Sometimes the TSI antibody instead blocks thyroid hormone production, leading to conflicting symptoms that may make correct diagnosis more difficult. In some patients, swelling of the muscles and other tissues around the eyes may develop, causing eye prominence, discomfort or double vision.

Exactly why the immune system begins to produce these antibodies is unclear. Like other autoimmune diseases, this condition tends to affect multiple family members. It is much more common in women than in men and tends to occur in younger patients.

Signs & Symptoms
Common signs and symptoms of Graves’ disease include the following:
Difficulty sleeping
A rapid or irregular heartbeat
A fine tremor of your hands or fingers
An increase in perspiration or warm, moist skin
Sensitivity to heat
Weight loss, despite normal eating habits
Enlargement of your thyroid gland (goiter)
Change in menstrual cycles
Erectile dysfunction or reduced libido
Frequent bowel movements or diarrhea
Graves’ ophthalmopathy (GO) – a condition associated with Graves’ disease that occurs when cells from the immune system attack the muscles and other tissues around the eyes, resulting in inflammation and a buildup of tissue and fat behind the eye socket, causing the eyeballs to bulge out. In rare cases, inflammation is severe enough to compress the optic nerve that leads to the eye, thus causing vision loss.
Graves’ dermopathy – a small number of people with Graves’ disease also experience thickening and reddening of the skin on their shins or tops of feet

Health care providers can sometimes diagnose Graves’ disease based only on a physical examination and a medical history. Blood tests and other diagnostic tests, such as the following, then confirm the diagnosis.

TSH (Thyroid – Stimulating Hormone or Thyrotropin) Test: An increased TSH level in the blood is the most accurate indicator of primary (non-pituitary) hypothyroidism. Production of this pituitary hormone is increased when the thyroid gland even slightly under produces thyroid hormone.

T3 and T4 test – another blood test used to diagnose Graves’ disease measures T3 and T4 levels. In making a diagnosis, health care providers look for below-normal levels of TSH, normal to elevated levels of T4, and elevated levels of T3.

Radioactive iodine uptake (RAIU) – this test measures the amount of iodine the thyroid collects from the bloodstream. High levels of iodine uptake can indicate Graves’ disease.

Thyroid scan – this scan shows how and where iodine is distributed in the thyroid. With Graves’ disease the entire thyroid is involved, so the iodine shows up throughout the gland. Other causes of hyperthyroidism such as nodules—small lumps in the gland—show a different pattern of iodine distribution.

Graves’ disease is often diagnosed and treated by an endocrinologist—a doctor who specializes in the body’s hormone-secreting glands. People with Graves’ disease have three treatment options: radioiodine therapy, medications and thyroid surgery. Radioiodine therapy is the most common treatment for Graves’ disease in the United States.

Thyroid Nodules
A thyroid nodule is a lump in or on the thyroid gland. Thyroid nodules are common, but are usually not diagnosed. They are detected in about six percent of women and one to two percent of men. They are 10 times as common in older individuals than in younger ones. Sometimes several nodules will develop in the same person. Any time a lump is discovered in thyroid tissue, the possibility of malignancy (cancer) must be considered. Fortunately, the vast majority of thyroid nodules are benign (not cancerous).

Nodules can be caused by a simple overgrowth of “normal” thyroid tissue, fluid-filled cysts, inflammation (thyroiditis), or a tumor (either benign or cancerous).

Signs & Symptoms
Most patients with thyroid nodules have no symptoms whatsoever. Many are found by chance to have a lump in the thyroid gland on a routine physical exam or an imaging study of the neck done for unrelated reasons (for example, a CT or MRI scan of the spine or chest, a carotid ultrasound, etc.). In addition, a substantial number of nodules are first noticed by patients or those they know who see a lump in the front portion of the neck, which may or may not cause symptoms, such as a vague pressure sensation or discomfort when swallowing.

Obviously, finding a lump in the neck should be brought to the attention of your physician, even in the absence of symptoms.


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Thyroid Scan-A thyroid scan is a picture of the thyroid gland taken after a small dose of a radioactive isotope normally concentrated by thyroid cells has been injected or swallowed. The scan tells whether the nodule is hyperfunctioning (a “hot” nodule), or taking up more radioactivity than normal thyroid tissue does; taking up the same amount as normal tissue (a “warm” nodule); or taking up less (a “cold” nodule). Because cancer is rarely found in hot nodules, a scan showing a hot nodule eliminates the need for fine needle biopsy. If a hot nodule causes hyperthyroidism, it can be treated with radioiodine or surgery.

Thyroid needle biopsy-A thyroid fine needle biopsy that employs a very thin needle, usually smaller than one used to draw blood, is a simple procedure that can be performed in the physician’s office. Many physicians numb the skin over the nodule prior to the biopsy, but it is not necessary to be put to sleep, and patients can usually return to work or home afterward with no ill effects. This test provides specific information about a particular patient’s nodule, information that no other test can offer short of surgery. Although the test is not perfect, a thyroid needle biopsy will provide sufficient information on which to base a treatment decision more than 75 percent of the time, eliminating the need for additional diagnostic studies.

Use of fine needle biopsy has drastically reduced the number of patients who have undergone unnecessary operations for benign nodules. However, about 10 to 20 percent of biopsy specimens are interpreted as inconclusive or inadequate; that is, the pathologist cannot be certain whether the nodule is cancerous or benign. This situation is particularly common with cystic (fluid-filled) nodules, which contain very few thyroid cells to examine, and with those nodules composed of clusters of thyroid or follicular cells that cannot be conclusively determined to be either benign or malignant. In such cases, a physician who is experienced with thyroid disease can use other criteria to make a decision about whether or not to operate. The fine needle biopsy can be repeated in those patients whose initial attempt failed to yield enough material to make a diagnosis. Many physicians use thyroid ultrasonography (ultrasound) to guide the needle’s placement.

Thyroid ultrasonography-Thyroid ultrasonography is a procedure for obtaining pictures of the thyroid gland by using high-frequency sound waves that pass through the skin and are reflected back to the machine to create detailed images of the thyroid. It can visualize nodules as small as two to three millimeters. Ultrasound distinguishes thyroid cysts (fluid-filled nodules) from solid nodules. Many nodules have both solid and cystic components, and very few purely cystic nodules occur. Recent advances in ultrasonography help physicians identify nodules that are more likely to be cancerous.
Thyroid ultrasonography is also utilized for guidance of a fine needle for aspirating thyroid nodules. Ultrasound guidance enables physicians to biopsy the nodule to obtain an adequate amount of material for interpretation. Such guidance allows the biopsy sample to be obtained from the solid portion of those nodules that are both solid and cystic, and it avoids getting a specimen from the surrounding normal thyroid tissue if the nodule is small.

Even when a thyroid biopsy sample is reported as benign, the size of the nodule should be monitored. A thyroid ultrasound examination provides an objective and precise method for detection of a change in the size of the nodule. A nodule with a benign biopsy that is stable or decreasing in size is unlikely to be malignant or require surgical treatment.

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Your endocrinologist will use the tests mentioned above to arrive at a recommendation for optimal management of your nodule. Most patients who appear to have benign nodules require no specific treatment and can simply be followed by their physician. Some physicians prescribe levothyroxine with hopes of preventing nodule growth or reducing the size of cold nodules, while radioiodine may be used to treat hot nodules.

If cancer is suspected, surgical treatment will be recommended. The primary goal of therapy is to remove all thyroid nodules that are cancerous and, if malignancy is confirmed, remove the rest of the thyroid gland along with any abnormal lymph nodes. If surgery is not recommended, it is important to have regular follow-up of the nodule by a physician experienced in such an evaluation.

Thyroid Cancer
The thyroid gland is located in the lower front of the neck, above the collarbones and below the voice box (larynx). Thyroid cancer (carcinoma) usually appears as a painless lump in this area. In most cases, the lump is only on one side, and the results of thyroid function tests (blood tests) are usually normal.

There are four main types of thyroid cancer (papillary, follicular, medullary and anaplastic), but the vast majority of cases are either papillary or follicular.

Papillary thyroid cancer is the most common type of thyroid cancer, accounting for 70 to 80 percent of all cases. It is most commonly diagnosed in women 30-40 years old and most frequently spreads to cervical (neck) lymph nodes.

Follicular thyroid cancer is the second most common type of thyroid cancer, accounting for 10 to 15 percent of cases. Although it usually does not spread, when it does it goes to the lungs and bones through the bloodstream.

Most common types of thyroid cancer are “sporadic” or isolated, and not inherited. However, an uncommon type of thyroid cancer, medullary cancer, which makes up about five percent of all thyroid cancers, can be familial, or run in families. When medullary cancer is inherited as a familial disease, it can be detected by a genetic blood test. Unless the disease is inherited, your children will not be affected.

Anaplastic thyroid cancer accounts for less than five percent of thyroid cancer patients. It is the most aggressive form of thyroid cancer and treatment is rarely effective.
Because the most common thyroid cancers, papillary and follicular, tend to grow slowly, usually do not spread beyond the neck and respond to treatment, most patients with thyroid cancers have excellent prognoses. For example, the 20-year survival of the most common type, papillary thyroid cancer, is almost 95 percent.

The estimated number of newly diagnosed thyroid cancer patients has continued an upward trend for more than 15 years! This represents an alarming and rapid percentage increase for any form of cancer, especially since most all other cancers are either stable or declining in their incidence rates. Fortunately, virtually the entire rate of increasing thyroid cancer patients annually is due to newly diagnosed papillary cancer, rather than other types of more aggressive thyroid cancer. The exact cause (or causes) is not clear; but, this rise in the incidence of papillary thyroid cancer has been attributed to better and earlier diagnostic imaging with ultrasound. However, other background environmental causes are difficult to exclude and there are continuing efforts to analyze this incidence trend.


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Causes of Thyroid cancer
As with many types of cancer, the specific reason for developing thyroid cancer remains a mystery in the vast majority of patients. Some major risk factors are:
External radiation to the head or neck, especially during childhood
Genetic predisposition (the influence of heredity), particularly for the medullary type of thyroid cancer

Signs & Symptoms
Many patients with thyroid cancer have no symptoms and are found by chance to have a lump in the thyroid gland during a routine physical exam, or an imaging study of the neck done for unrelated reasons such as a carotid ultrasound, CT or MRI scan of the spine or chest. Other patients with thyroid cancer become aware of a gradually enlarging lump in the front portion of the neck, which usually moves with swallowing. Occasionally, the lump may cause a feeling of pressure. Obviously, finding a lump in the neck should be brought to the attention of your physician, even in the absence of other symptoms.

First, your physician takes a detailed history and performs a careful physical examination, especially of the thyroid gland. The best diagnostic approach for a specific patient will be determined by your physician after careful consideration of all the facts. The tests available to your physician for evaluation of the thyroid lump include, but are not limited to, the following:

Fine-needle aspiration biopsy – this is usually done first and, if positive, significantly reduces the need for more elaborate and expensive testing

Ultrasonography– this may be required for guidance of the fine needle biopsy if the nodule is difficult to feel

Thyroid scan– this can be done to see if the mass is capable of concentrating radioiodine, particularly in those patients with low TSH levels, who are likely to have hot nodules, which are almost always benign.

Blood studies


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The great majority of patients with thyroid cancer have a disease that can be successfully treated. In order to ensure your chances for a successful outcome, it is important to receive treatment and follow-up care from those with a great deal of experience in the diagnosis and treatment of thyroid cancer. This is usually an endocrinologist, a doctor who specializes in hormone-related disorders.

What treatment will I require?
Treatment depends on the type and extent of cancer. Treatment options include surgery, radioactive iodine, external radiation (see below), and chemotherapy. All patients require thyroid surgery and many receive radioiodine after surgery (see below).

What kind of surgery?
Removal of part or all of the thyroid gland (thyroidectomy) is the first step in management. Lymph nodes with cancer in them are also removed. A surgeon who has experience with thyroid cancer is the best choice for performing your surgery.
You may be thinking, “shouldn’t I be seeing an oncologist?”. The answer is usually no. An endocrinologist is the physician who deals primarily with the diagnosis, treatment and follow-up of most patients with thyroid cancer. However, if/when standard therapy fails to control the progression of thyroid cancer and chemotherapy is being considered, then consultation with an oncologist is appropriate.

Will I require radiation? What type?
Conventional radiation therapy, the type that is generally used for cancer, is not used very often to treat thyroid cancer. It is reserved to treat thyroid cancer that cannot be removed surgically or eliminated with radioactive iodine. Fortunately, it is only required to treat a small minority of thyroid cancer cases. This type of radiation treatment is often referred to as external radiation therapy because the source of the radiation comes from outside the body.

Most often patients with thyroid cancer who require radiation treatment receive radioactive iodine. This type of radiation works internally once it enters your body. It is administered by either swallowing a capsule or drinking a radioactive liquid containing a radioactive form of iodine.

Thyroid Disorders During Pregnancy
Even before conception, thyroid conditions that have lingered untreated can hinder a woman’s ability to become pregnant or can lead to miscarriage. Fortunately, most thyroid problems that affect pregnancy are easily treated. The difficulty lies in recognizing a thyroid problem during a time when some of the chief complaints — fatigue, constipation and heat intolerance — can be either the normal side effects of pregnancy or signals that something is wrong with the thyroid.

Although detecting a thyroid problem is important, it is equally necessary for those already diagnosed with a condition to have the thyroid checked if they are planning to become pregnant or are pregnant. Thyroid hormone is necessary for normal brain development. In early pregnancy, babies get thyroid hormone from their mothers. Later on, as the baby’s thyroid develops, it makes its own thyroid hormone. An adequate amount of iodine is needed to produce fetal and maternal thyroid hormone. The best way to ensure adequate amounts of iodine reach the unborn child is for the mother to take a prenatal vitamin with a sufficient amount of iodine. Not all prenatal vitamins contain iodine, so be sure to check labels properly.

Thyroid Disorders and Miscarriage
A woman with untreated hypothyroidism is at the greatest risk for a miscarriage during her first trimester. Unless the case is mild, women with untreated hyperthyroidism are also at risk for miscarriage.

Who should be tested?
Despite the impact thyroid diseases can have on a mother and baby, whether to test every pregnant woman remains controversial. As it stands, doctors recommend that all women at high risk for thyroid disease or women who are experiencing symptoms should have a TSH and an estimate of free thyroxine blood tests and other thyroid blood tests, if warranted. A woman is at a high risk if she has a history of thyroid disease or thyroid autoimmunity, a family history of thyroid disease, type 1 diabetes mellitus or any other autoimmune condition. Anyone with these risk factors should be sure to tell their obstetrician or family physician. Ideally, women should be tested prior to becoming pregnant at prenatal counseling and as soon as they know they are pregnant.

Hypothyroidism & pregnancy
When a woman is pregnant, her body needs enough thyroid hormone to support a developing fetus and her own expanded metabolic needs. Healthy thyroid glands naturally meet increased thyroid hormone requirements. If someone has Hashimoto’s thyroiditis or an already overtaxed thyroid gland, thyroid hormone levels may decline further. So, women with an undetected mild thyroid problem may suddenly find themselves with pronounced symptoms of hypothyroidism after becoming pregnant.
Most women who develop hypothyroidism during pregnancy have mild disease and may experience only mild symptoms or sometimes no symptoms. However, having a mild, undiagnosed condition before becoming pregnant may worsen a woman’s condition. A range of signs and symptoms may be experienced, but it is important to be aware that these can be easily written off as normal features of pregnancy. Untreated hypothyroidism, even a mild version, may contribute to pregnancy complications. Treatment with sufficient amounts of thyroid hormone replacement significantly reduces the risk for developing pregnancy complications associated with hypothyroidism, such as premature birth, preeclampsia, miscarriage, postpartum hemorrhage, anemia and abruptio placentae.

For a woman being treated for hypothyroidism, it’s imperative to have her thyroid checked as soon as the pregnancy is detected so that medication levels may be adjusted. TSH levels may be checked one to two weeks after the initial dose adjustment to be sure it’s normalizing. Once the TSH levels drop, less frequent check-ups are necessary during the pregnancy. Although thyroid hormone requirements are likely to increase throughout the pregnancy, they tend to eventually stabilize by the middle of pregnancy. The goal is to keep TSH levels within normal ranges, which are somewhat different than proper levels in a non-pregnant woman. Pre-pregnancy doses are usually resumed after giving birth.

There is no difference between treating hypothyroidism when a woman is pregnant than when she isn’t. Levothyroxine sodium pills are completely safe for use during pregnancy. They will be prescribed in dosages that are aimed at replacing the thyroid hormone the thyroid isn’t making so that the TSH level is kept within normal ranges. Once it is consistently in the normal range, the doctor will check TSH levels every six weeks or so. The physician may also counsel patients to take their thyroid hormone pills at least one-half hour to one hour before or at least four hours after eating or taking iron-containing prenatal vitamins and calcium supplements, which can interfere with the absorption of thyroid hormone.

Hyperthyroidism & pregnancy
Diagnosing hyperthyroidism based on symptoms can be tricky because pregnancy and hyperthyroidism share a host of features. Still, one should be aware of the symptoms and bring them to the attention of a doctor if they are experiencing them. For instance, feeling a heart flutter or suddenly becoming short of breath, both symptoms of hyperthyroidism, can be normal in pregnancy, but a doctor still may want to investigate these symptoms. An individual with any risk factors for thyroid disease should make certain they are tested.

Very mild hyperthyroidism usually does not require treatment, only routine monitoring with blood tests to make sure the disease does not progress. More serious conditions require treatment. However, treatment options are limited for pregnant women. Radioactive iodine, which is typically used to treat Graves’ disease, cannot be used during pregnancy because it easily crosses the placenta, potentially damaging the baby’s thyroid gland and causing hypothyroidism in the baby.

Due to its potential risks, the goal of treatment is to use the minimal amount of antithyroid drugs possible to maintain a patient’s T4 and T3 levels at or just above the upper level of normal, while keeping TSH levels low. When hormones reach the desired levels, drug doses can be reduced. This approach controls hyperthyroidism while minimizing the changes of a baby developing hypothyroidism.

Hyperthyroidism, if untreated, can lead to stillbirth, premature birth, or low birth weight for the baby. Sometimes it leads to fetal tachycardia, which is an abnormally fast pulse in the fetus. Women with Graves’ disease have antibodies that stimulate their thyroid gland. These antibodies can cross the placenta and stimulate a baby’s thyroid gland. If antibody levels are high enough, the baby could develop fetal hyperthyroidism, or neonatal hyperthyroidism.

A woman with hyperthyroidism while pregnant is at an increased risk for experiencing any of the signs and symptoms of hyperthyroidism. And unless the condition is mild, if it is not treated promptly a woman could miscarry during the first trimester; develop congestive heart failure, preeclampsia, or anemia; and, rarely, develop a severe form of hyperthyroidism called thyroid storm, which can be life threatening.

Graves’ disease tends to strike women during their reproductive years, so it should come as no surprise that it occasionally occurs in pregnant women. Pregnancy may worsen a preexisting case of Graves’ disease. Graves’ disease can also emerge for the first time, typically during the first trimester of pregnancy. The disease is usually at its worst during the first trimester. It tends to then improve in the second and third trimesters and flare up again after delivery.

Final Comments
Although thyroid disease is common across the world, the true numbers of people with thyroid disease are unknown due to under-diagnosis. If you, or someone you know, has either the risk factors listed above or is experiencing symptoms listed above, please talk to your doctor today. Thyroid disease is treatable and, in some cases, even curable. For more information, see the references listed below:

American Association of Endocrine Surgeons:
American Thyroid Association:
Graves Disease & Thyroid Foundation:
International Thyroid Federation:
Light of Life Foundation:
National Insitute of Health/Medline Plus:
ThyCa: Thyroid Cancer Survivors’ Association:
Thyroid Patient Advocate Stacey Thureen’s website:




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