“The American Heart Association has set a goal of doubling the survival of cardiac arrest by 2030.

We know that in order to save more lives from the 350,000 cardiac arrests that occur outside of the hospital every year, we must increase the number of people who respond to cardiac arrest by calling 911, delivering high-quality CPR and using an AED as soon as it is available.

In every cardiac emergency, the real first responder is not always a uniformed professional but often an everyday bystander. Cardiac arrest can strike anywhere- at the gym, in the grocery store, or during a child’s soccer game. However, bystanders only intervene about 40% of the time, often
due to uncertainty or lack of training.

You do not need medical credentials to save a life. What’s required is knowledge, courage, and the readiness to act. This reimagining of heroism challenges the community to see themselves as empowered agents of change- ordinary people with the extraordinary power to make every future
moment possible for someone in crisis.

This American Heart Month the message is clear: anyone can save a life. In every cardiac emergency, the real first responder is not always a uniformed professional but often a friend, family member or even a stranger nearby. Ordinary people have extraordinary power. You are the first responder until professional help arrives. Join the Nation of Lifesavers by learning CPR today and check out the free resources in our 2026 American Heart Month Toolkit.”

American Heart Association (American Heart Month | American Heart Association)

          
Heart disease is the leading cause of death for men and women in the United States. Every year, 1 in 4 deaths are caused by heart disease. The good news? Heart disease can often be prevented when people make healthy choices and manage their health conditions.

First let’s understand what occurs to the heart with bad health habits over a long period of time:

If you are eating too much for too long that consist of foods high in sodium, fat and cholesterol your vessels will narrow in size due to high B/P and blockages due to the high fat and cholesterol foods. By allowing high B/P you expose yourself to increasing the pressure in the vessels that increases your blood pressure called hypertension.

If you are also inactive you are at risk of obesity which puts stress on the heart and in time causing high B/P.

Constantly being exposed to a high B/P or HTN in the body this could cause the vessel to rupture (at the heart=possible heart attack, also called MI, at the brain=possible stroke, also called CVA with both on high occurrences in our population of the US.).

With bad habits (especially poor diet, inactive, and smoking) you can cause over time atherosclerosis=a blockage in the artery with the resolution surgery (from what they call a cardiac catheterization which commonly starts up your groin at the femoral artery or if the surgeon is having difficulty than the procedure is done in the arm leading up to the heart where the cardiac catheter or also called an angiogram which could lead to a angioplasty with possibly a stent is performed if there is a blockage.  If they see the blockage (s) is very bad a CABG=coronary artery bypass=a 6hr plus operation where diversion of a vein from your leg or a stent (donor graft site) around the blockage is done. Smoking can lead to this. Also know smoking can cause your vessels to become brittle=arteriosclerosis.

Healthy Habits would impact a positive result for all people who have had this diagnosis CHF that is picked up or diagnosed early.  Most important healthy habits can be a great as a PREVENTATIVE measure for people not diagnosed with any cardiac disease.

There are 4 things you have no control over heredity, age, sex, and race but healthy habits are sure to benefit you by keeping the odds down of you inheriting, help your age factor, and race a lot can be associated with eating cultural habits.

If you make the decision to live a life that’s healthy for your heart through proper eating, doing some exercise or activity with balancing rest in your busy schedule would be a great direction or taking the right step.

Wouldn’t you want less chance of heart disease or obesity or diabetes for yourself and for others throughout the nation including the future generations?  Let’s build a stronger foundation regarding HEALTH in America=Prevention!

Communities, health professionals, and families can work together to create opportunities for people to make healthier choices.  February is American Heart Month, a time when all people—especially women—are encouraged to focus on their cardiovascular health. This Heart Month, the Division for Heart Disease and Stroke Prevention (DHDSP) is encouraging women to listen to their hearts and speak up for their health.

Make a difference in your community: Spread the word about strategies for preventing heart disease and encourage people to live heart healthy lives.

How can American Heart Month make a difference?  We can use this month to raise awareness about heart disease and how people can prevent it — both at home and in the community.

Here are just a few tips in prevention of heart disease:

• Encourage families to make small changes, like using spices to season their food instead of salt.  • Motivate teachers and administrators to make physical activity a part of the school. This can help students start good habits early.

• Ask doctors and nurses to be leaders in their communities by speaking out about ways to prevent heart disease.  How can you help spread the word?  We’ve made it easier for you to make a difference. This toolkit is full of ideas to help you take action today. For example:  Add information about living a heart healthy lifestyle to your newsletter. • Tweet about American Heart Month. • Host a community event where families can be active while learning about local health resources.

Also know smoking can cause your vessels to become brittle=arteriosclerosis.  SO STOP SMOKING!

So prevent surgery like a cardiac cath or an artery bypass=a 6hr plus operation where diversion of a vein from your leg or a stent (donor graft site) around the blockage is done.

Healthy Habits would impact a positive result for all people who have had this diagnosis CHF that is picked up or diagnosed early.  Most important healthy habits can be a great as a PREVENTATIVE measure for people not diagnosed with any cardiac disease.

There are 4 things you have no control over=Nonmodifiable risk factors: heredity, age, sex, and race but healthy habits are sure to benefit you by keeping the odds down of you inheriting CVD with helping your age factor, and race a lot can be associated with eating cultural habits.

If you make the decision to live a life that’s healthy for your heart through proper eating, doing some exercise or activity with balancing rest in your busy schedule would be a great direction or taking the right step.

Wouldn’t you want less chance of heart disease or obesity or diabetes for yourself and for others throughout the nation including the future generations?  Let’s build a stronger foundation regarding HEALTH in America.

Take action: Be the cure! Join the American Heart Association’s national movement in support of healthier communities and healthier lives!

“Heart disease is very common. In the United States, heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups. In 2023, almost 1 in every 4 deaths in the United States was caused by heart disease. High blood pressure is a leading cause of heart disease. Nearly half of U.S. adults have high blood pressure, which puts them at risk for heart disease and stroke. And just 1 in 4 people with high blood pressure has it under control. Heart disease is costly. The cost of health care services and medications from heart disease amounted to more than $168 billion between 2021 and 2022.”

Center for Disease Control and Prevention – CDC (American Heart Month Communications Toolkit | Heart Disease | CDC)

During the month of February, Americans see the human heart as the symbol of love. February is American Heart Month, a time to show yourself the love. Learn about your risks for heart disease and stroke and stay “heart healthy” for yourself and your loved ones.

Cardiovascular disease (CVD)—including heart disease, stroke, and high blood pressure—is the number 1 killer of women and men in the United States. It is a leading cause of disability, preventing Americans from working and enjoying family activities.¹ CVD costs the United States over $300 billion each year, including the cost of health care services, medications, and lost productivity.¹

Understanding the Burden of CVD

CVD does not affect all groups of people in the same way. Although the number of preventable deaths has declined in people aged 65 to 74 years, it has remained unchanged in people under age 65. Men are more than twice as likely as women to die from preventable CVD.²

Having a close relative who has heart disease puts you at higher risk for CVD. Health disparities based on geography also exist. During 2007–2009, death rates due to heart disease were the highest in the South and lowest in the West.

Race and ethnicity also affect your risk. Nearly 44% of African American men and 48% of African American women have some form of CVD. And African Americans are more likely than any other racial or ethnic group to have high blood pressure and to develop the condition earlier in life. About 2 in 5 African American adults have high blood pressure, yet fewer than half of them have the condition under control.

Many CVD deaths could have been prevented through healthier habits, healthier living spaces, and better management of conditions like high blood pressure and diabetes.

You can control a number of risk factors for CVD, including:

• Diet
• Physical activity
• Tobacco use

Diseases putting you at risk for CVD:

• Obesity
• High blood pressure
• High blood cholesterol
• Diabetes

As you begin your journey to better heart health that can last a lifetime, keep these things in mind:

• Try not to become overwhelmed. Every step brings you closer to a healthier heart, and every healthy choice makes a difference!
• Partner up. The journey is more fun—and often more successful—when you have company. Ask friends and family to join you.
• Don’t get discouraged. You may not be able to take all of the steps at one time. Get a good night’s sleep—also important for a healthy heart—and do what you can tomorrow.
• Reward yourself. Find fun things to do to decrease your stress. Round up some colleagues for a lunchtime walk, join a singing group, or have a healthy dinner with your family or friends

“Although a typical, adult human heart is only about the size of a closed fist and weighs less than a pound, this main organ in your cardiovascular system is quite complex—and relies on the proper functioning of muscle and other tissues, chambers, valves, and an electrical conduction system to keep you healthy and strong.

The various components of your heart work together to move blood through your body, send oxygen to your cells, and remove waste like carbon dioxide. When one of these parts is misfiring, valves inappropriately functioning, heart muscle tissue swelling and it can prompt health issues, including heart disease and high blood pressure.”

Health Central – HC (Anatomy of the Heart: Visual Guide to Anatomy and Function)

The heart works like a pump and beats 100,000 times a day.  For the heart to do its function therapeutically it needs another organ to be involved called the lungs or the body could not live.  If one of these organs gets damaged in time the other organ gets affected with no treatment the person will die sooner in life (Ex. Heart Failure in time affects the lungs to some degree, even respiratory failure).  A good metaphor for this is the car; if the engine gets damaged with no repair, in time the transmission will get affected; with no repair at all the car will die.

One of the main functions of the red blood cells (RBCs) is to carry oxygen throughout the body to give all tissues our food to stay alive, that would be oxygen.  For this to take place this is done through the heart beating nonstop which allows the flow of blood to be running continuous in our blood stream (circulatory system) and at the same time this allows our cells in the blood stream to get to the lungs for oxygen and carbon dioxide exchange.   These 3 functions could not take place if the heart wasn’t pumping blood to and from the heart/lungs 24 hrs a day.  Your pulse or heart rate does the pumping.

This is what takes place when the heart pumps our blood:  

The red blood cells carry oxygen and remove the ending result of oxygen used by our tissues, called carbon dioxide=CO2.   To get rid of the CO2 (a toxin) in our body the gas is carried from our body by carrying CO2 to the lungs through the RBCs.  The high CO2 with low oxygen (O2)  concentration RBCs go to one side of the heart (being the right side) to get CO2 removed in exchange for more O2 in a red blood cell (RBC) this is done at the base of the lungs.  This is done through breathing.   Then these RBCs get highly oxygenated which then proceed to the left side of the heart.  These RBCs get pumped throughout the body where the tissues utilize the oxygen in the RBCs by transferring O2 from the RBCs to the tissue as their food to stay alive.  Without oxygen our tissues would starve and we would die.  For the oxygen to be transported to the tissues of the body (as their food) it works like this:  After the right side of the heart pumps blood to the lungs with high CO2 concentration RBCs, while we inhale to allow more oxygen in the cells at the bottom of the lungs an exchange of gas concentration in the RBCs takes place.  The cells release CO2 which is released out of our body through exhaling but also when we inhale more 02 is transported into the RBCs to take another trip around the body releasing the high 02 levels to the tissues that need to utilize it BUT to do this the blood now is sent to the left side of the heart.  For all this to take place the heart pumps to transport the oxygen throughout the body giving nutrition to the tissues, without it=cellular starvation but at the same time sends high CO2 RBCs to the right side for a 02/CO2 exchange at the lungs by going through the right side of the heart.   

The heart has two sides, separated by an inner wall called the septum.  The septum divides the right from the left side of the heart since the right and left chambers do different functions, as described above.  Remember the right side of the heart is sending RBCs with highier CO2 concentration and a low oxygen concentration.  You have these RBCs coming from above the heart finally entering the Rt upper chamber (Right Atrium=RA) called the Superior Vena Cava with below the heart the Inferior Vena Cava the meet into each other dumping the high CO2 blood into the RA.  Then the blood goes through a valve called the tricuspid valve dumping the blood into the Rt.lower chamber called Rt. Ventricle and through the pulmonary valve going via the pulmonary artery (one of the few arteries with high CO2 concentration, usually arteries high in 02 concentration) dumping the blood at the base of the lungs for 02 and CO2 exchange when we inhale and exhale.  After the gas exchange takes place the red blood cells become higher oxygenated in levels and much lower in carbon dioxide levels.  Inside a cell is never 100%  02 or CO2.  Now this high oxygenated blood goes to the left side of the heart leaving the lungs via the pulmonary vein (one of the few veins high in O2).  The blood dumps now in the L upper chamber=Lt. atrium down through the mitral valve to the left ventricle proceeding to the aorta where the high concentrated RBCs go throughout the body dispensing oxygen to our tissues where it is needed.

If you look the right side sends blood from the heart to lungs back to heart=short distance so the muscle on the right side is thin compared to the left side.  The reason for this is the left side of the heart receives the oxygen-rich blood from the lungs and pumps it to throughout the body.  The left side of the heart has to dispense the high (O2) blood throughout the body so that side of the heart works out more in pumping; so the muscle on the left side is larger than the right side.  The muscle of the heart is called myocardium (myo=muscle and cardium=the heart).

Let’s review the heart anatomy.  It has 4 chambers in it.  Two chambers are on the right side and another two on the left.  The right side of the heart has only higher concentrated CO2-carbon dioxide in the blood going through that side to get to the lungs for more oxygen. To do this the blood first is entered to the lungs from the right side of the heart.  Here it removes the toxin CO2 from our body through us breathing to get more 02-oxygen into our RBCs (red blood cells).  Then this blood enters to the left side of the heart  where it has more high oxygenated blood entering that side to have our food, being O2, get dispensed throughout our tissues to stay alive.  Without 02 we would go through cellular/tissue starvation.  The heart moves the oxygen throughout the body via its pumping action whereas the lungs provide us the oxygen via inhaling with removing the toxin CO2 from the RBCs via exhaling.

Now to do all these functions from pumping to getting 02 and C02 properly dispensed in and out of our bodies how does the heart do this?????????

Well he don’t fill the heart up with gas but instead has a conduction pathway that operates through electrical activity taking place by certain electrolytes.  We have sodium, potassium and calcium channels that are the major ones in doing this.

We also have a natural pacemaker of the heart and this is called the SA NODE.  It sits in the the upper Rt. chamber (atrium) of the heart.  This natural pacemaker conducts impulses from the top to the bottom of the heart with these electrolytes (mentioned above) involved to let this conduction take place in allowing the heart to beat; allowing the heart to pump the blood throughout our system to give oxygen to all tissues and remove carbon dioxide from the body bringing it to the lungs where we expel it via breathing.  Inspiration brings the 02 via the lungs to the bottom of them to get dispensed into our red blood cells at the same time during expiration removes the C02 from the RBCs to be expelled out via the lungs to the exit port our mouth.  Knowing the anatomy of the heart is so important especially to understand heart disease. 

We know there is a right and left side of the heart and each side having 2 chambers with completely different functions, which we will discuss another day.

“Winter isn’t easy … and we’re not just talking about shoveling snow off the driveway. The cold-weather months bring a blizzard of health issues ranging from flu bugs to dry skin to the winter blues.  But there are steps you can take to minimize problems and remain healthy and happy until spring. (An added bonus? These steps don’t require snow boots.)

1-Winter can be rough on your lips. The cold air outside and the furnace-dried air inside work in tandem to dry out your lips, which can leave them painfully chapped and cracked.  Lip balms and ointments, drinking more water and running a humidifier can help eliminate dry lips.

2- Caring for your hair during the winter months since it can make the hair brittle.  Winter can be tough on your hair. The air outside is colder. The air inside is dry. You’re dealing daily with static electricity, harsh water treatment chemicals and hat hair.   “You should treat your hair like a cashmere sweater,” says dermatologist Wilma Bergfeld, MD. “The first rule of thumb is to limit how often you beat it up by scorching it with an iron, overheating it with a dryer or using a caustic chemical on it. Remember, hair is a fiber.”

Everyone’s hair types differ, Dr. Bergfeld says, and while it’s important that everyone treat their hair gently (particularly in the winter), it’s especially important if you have fragile, damaged or fine hair.

Overall, in the winter it’s important to take it easy when brushing your hair, especially when it’s wet, Dr. Bergfeld says. Wet hair is more fragile, so wait to comb it after washing until it’s less damp, she says.

Brushing your hair gently is also important when you hair is drier than normal, which can happen more often in winter months.

Air drying your hair is always best since it uses less heat (heat can make everything worse). Whenever possible, skipping the styling tools is always recommended.  Bleaching, lightening or lifting your hair lighter is the worst thing you can do for your hair because they penetrate the hair strands and break down the fatty acids and proteins to remove your hair’s pigment. It can take a long time for your hair to recover. In winter when your hair is drier than in other months, the recovery can take longer.

3-Winter weather can leave your skin itchy, red and flaky. That can turn into a BIG pain given that we’re talking about your body’s largest organ.  A long, hot shower feels great when it’s chilly outside — but it’s not the best for your skin.

Once you get out of that quick shower and towel off, applying a moisturizer can help keep your skin hydrated and healthy.

“The function of most moisturizers is to trap moisture in your skin,” says Dr. Piliang. “When your skin is damp after a shower, applying moisturizer helps lock that in. The timing is important.”

Once you get out of that quick shower and towel off, applying a moisturizer can help keep your skin hydrated and healthy.

“The function of most moisturizers is to trap moisture in your skin,” says Dr. Piliang. “When your skin is damp after a shower, applying moisturizer helps lock that in. The timing is important.”

“Products with added fragrance can lead to micro-irritations,” she says. “All of those little irritations accumulate, and, over time, that eventually could cause your skin to be dry, itchy and cracked.”

So, try to lean toward unscented moisturizing products, like the old standby petroleum jelly (Vaseline®).

4-Sniffing dry winter air can dry out your sinuses. And while the thought of less gooey mucus in your nasal cavities might sound enticing, it’s not ideal. The reason? That gunk protects you by trapping germs before they infect you.

That’s part of the reason why respiratory ailments such as bronchitis, sinusitis and even nosebleeds are so common during winter.  Winter asthma can be a big issue, too.

“Limit time outside as best you can when the conditions really seem to affect you,” recommends Dr. Thakur.

This is especially true when exercising, as cold air plus physical activity can be a double trigger. Lean toward indoor workouts when it’s freezing outside if you’re prone to exercise-induced asthma.

So cover your mouth and nose in cold air, wear a scarf or a mask can be effective, add moisture in the air have a running humidifier in the home.

5- Avoid germs, so take precautions by:

• Limiting contact with people who are sick
• Staying away from crowds when illnesses are going around
• Washing your hands often
• Disinfecting commonly touched surfaces”

Cleveland Clinic (9 Tips to Stay Healthy During Winter)

We all know in many states this winter so far has been nothing but for some areas in the U.S., just take Boston, but know winter isn’t over and February hasn’t even hit yet!  The CDC recommends the following to stay safe and healthy in the winter:

“Winter storms and cold temperatures can be dangerous. Stay safe and healthy by planning ahead. Prepare your home and vehicles. Prepare for power outages and outdoor activity. Check on older adults.

Although winter comes as no surprise, many of us may not be ready for its arrival. If you are prepared for the hazards of winter, you are more likely to stay safe and healthy when temperatures start to fall.

Prepare Your Home

Staying inside is no guarantee of safety. Take these steps [PDF – 344 KB] to keep your home safe and warm during the winter months.

• Winterize your home.
  • Install weather stripping, insulation, and storm windows.
  • Insulate water lines that run along exterior walls.
  • Clean out gutters and repair roof leaks.
• Check your heating systems.
  • Have your heating system serviced professionally to make sure that it is clean, working properly, and ventilated to the outside.
  • Inspect and clean fireplaces and chimneys.
  • Have a safe alternate heating source and alternate fuels available.
• If you do not have working smoke detectors, install one inside each bedroom, outside each sleeping area, and on every level of the home, including the basement. Test batteries monthly and replace them twice a year.
• Prevent carbon monoxide (CO) poisoning emergencies.
  • Install a battery-operated or battery backup CO detector to alert you of the presence of the deadly, odorless, colorless gas. Check or change the battery when you change your clocks in the fall and spring.
  • Learn the symptoms of CO poisoning: headache, dizziness, weakness, upset stomach, vomiting, chest pain, and confusion.

Prepare Your Vehicle

Get your vehicle ready for cold weather use before winter arrives.

• Service the radiator and maintain antifreeze level.
• Check your tires’ tread or, if necessary, replace tires with all-weather or snow tires.
• Keep the gas tank full to avoid ice in the tank and fuel lines.
• Use a wintertime formula in your windshield washer.
• Prepare a winter emergency kit to keep in your car in case you become stranded. The kit should include:
  • Cell phone, portable charger, and extra batteries.
  • Items to stay warm, such as extra hats, coats, mittens, blankets, or sleeping bags.
  • Food and water.
  • Booster cables, flares, tire pump, and a bag of sand or cat litter (for traction).
  • Compass and maps.
  • Flashlight, battery-powered radio, and extra batteries.
  • First-aid kit; and
  • Plastic bags (for sanitation).

Prepare for Emergencies

Be prepared for weather-related emergencies, including power outages.

• Stock food that needs no cooking or refrigeration and water stored in clean containers.
• Ensure that your cell phone is fully charged.
• When planning travel, be aware of current and forecast weather conditions.
• Keep an up-to-date emergency kit, including:
  • Battery-operated devices, such as a flashlight, a National Oceanic and Atmospheric Administration (NOAA) Weather Radio, and lamps.
  • Extra batteries.
  • First-aid kit and extra medicine.
  • Baby items; and
  • Cat litter or sand for icy walkways.
• Protect your family from carbon monoxide (CO).
  • Keep grills, camp stoves, and generators out of the house, basement, and garage.
  • Locate generators at least 20 feet from the house.
  • Leave your home immediately if the CO detector sounds and call 911.

Take Precautions Outdoors

Outdoor activities can expose you to several safety hazards, but you can take these steps to prepare for them:

• Wear appropriate outdoor clothing: wear a tightly woven, preferably wind-resistant coat or jacket; inner layers of light, warm clothing; mittens; hats; scarves; and waterproof boots.
• Sprinkle cat litter or sand on icy patches.
• Learn safety precautions to follow when outdoors.
  • Work slowly when doing outside chores.
  • Take a buddy and an emergency kit when you are participating in outdoor recreation.
  • Carry a cell phone.

Do This When You Plan to Travel

When planning travel, be aware of current and forecast weather conditions.

• Avoid non-essential travel when the National Weather Service has issued advisories.
• If you must travel, inform a friend or relative of your proposed route and expected time of arrival.
• Follow these safety rules if you become stranded in your vehicle.
  • Make your vehicle visible to rescuers. Tie a brightly colored cloth to the antenna, raise the hood (if it is not snowing), and turn on the inside overhead lights (when your engine is running).
  • Move anything you need from the trunk into the passenger area. Stay with your vehicle unless safety is no more than 100 yards away.
  • Keep your body warm. Wrap your entire body, including your head, in extra clothing, blankets, or newspapers. Huddle with other people if you can.
  • Stay awake and stay moving. You will be less vulnerable to cold-related health problems. As you sit, keep moving your arms and legs to improve circulation and stay warmer.
  • Run the motor (and heater) for about 10 minutes per hour, opening one window slightly to let in air. Make sure that snow is not blocking the exhaust pipe—this will reduce the risk of carbon monoxide (CO) poisoning.

Be ready to check on family and neighbors who are especially at risk from cold weather hazards: young children, older adults, and the chronically ill.

If you have pets, bring them inside. If you cannot bring them inside, provide adequate, warm shelter and unfrozen water to drink.

No one can stop the onset of winter. However, if you follow these suggestions, you will be ready for it when it comes.”

So be safe this winter by being prepared!

“Thyroid nodules are quite common. When examined with ultrasound imaging, as many as one-third of women and one-fifth of men have small thyroid nodules.

Most thyroid nodules are too small to see or feel. They tend to be found when you have an imaging test done for some other reason.

A large nodule or goiter may cause a sense of tightness or pain in your neck, and can sometimes grow large enough to interfere with breathing or swallowing.

If your thyroid function is affected, you might notice other symptoms. If your gland is producing too much thyroid hormone it will exhibit signs or symptoms of hyperthyroidism.  If your gland is producing not enough thyroid hormone it will produce signs and symptoms of hypothyroidism.

A goiter is an enlargement of the thyroid, the H-shaped gland that wraps around the front of your windpipe, just below your Adam’s apple.

A goiter can be smooth and uniformly enlarged, called diffuse goiter, or it can be caused by one or more nodules within the gland, called nodular goiter. Nodules may be solid, filled with fluid, or partly fluid and partly solid.”

University of California San Francisco Health – USCF Health (Thyroid Nodules and Goiter | Conditions | UCSF Health)

Goiter in the thyroid

A goiter is simply an enlarged thyroid gland. Multiple conditions can lead to goiter, including hypothyroidism, hyperthyroidism, excessive iodine intake, or thyroid tumors. Goiter is a non-specific finding that warrants medical evaluation.

History: The doctor will take a detailed history, evaluating both past and present medical problems. If the patient is younger than 20 or older than 70 years, there is increased likelihood that a nodule is cancerous. Similarly, the nodule is more likely to be cancerous if there is any history of radiation exposure, difficulty swallowing, or a change in the voice. It was actually customary to apply radiation to the head and neck in the 1950s to treat acne! Significant radiation exposures include the Chernobyl and Fukushima disasters. Although women tend to have more thyroid nodules than men, the nodules found in men are more likely to be cancerous. Despite its value, the history cannot differentiate benign from malignant nodules. Thus, many patients with risk factors uncovered in the history will have benign lesions. Others without risk factors for malignant nodules may still have thyroid cancer.

Physical examination: The physician should determine if there is one nodule or many nodules, and what the remainder of the gland feels like. The probability of cancer is higher if the nodule is fixed to the surrounding tissue (unmovable). In addition, the physical exam should search for any abnormal lymph nodes nearby that may suggest the spread of cancer. In addition to evaluating the thyroid, the physician should identify any signs of gland malfunction, such as thyroid hormone overproduction (hyperthyroidism) or underproduction (hypothyroidism).

Blood tests: Initially, blood tests should be done to assess thyroid function. These tests include:

• The free T4 and thyroid stimulating hormone (TSH) levels. Elevated levels of the thyroid hormones T4 or T3 in the context of suppressed TSH suggests hyperthyroidism
• Reduced T4 or T3 in the context of high TSH suggests hypothyroidism
• Antibody titers to thyroperoxidase or thyroglobulin may be useful to diagnose autoimmune thyroiditis
• (for example, Hashimoto’s thyroiditis).
• If surgery is likely to be considered for treatment, it is strongly recommended that the physician als determine the level of thyroglobin. Produced only in the thyroid hormone in the blood. Thyroglobulin carries thyroid hormone in the blood. Thyroglobulin levels should fall quickly within 48 hours in the thyroid gland is completely remobed. If thyroglobulin levels start to climb.
• Ultrasonography: A physician may order an ultrasound examination of the thyroid to:
• Detect nodules that are not easily felt
• Determine the number of nodules and their sizes
• Determine if a nodule is solid or cystic
• Assist obtaining tissue for diagnosis from the thyroid with a fine needle aspirate (FNA)Radionuclide scanning: Radionuclide scanning with radioactive chemicals is another imaging technique a physician may use to evaluate a thyroid nodule. The normal thyroid gland accumulates iodine from the blood and uses it to make thyroid hormones. Thus, when radioactive iodine (123-iodine) is administered orally or intravenously to an individual, it accumulates in the thyroid and causes the gland to “light up” when imaged by a nuclear camera (a type of Geiger counter). The rate of accumulation gives an indication of how the thyroid gland and any nodules are functioning. A “hot spot” appears if a part of the gland or a nodule is producing too much hormone. Non-functioning or hypo-functioning nodules appear as “cold spots” on scanning. A cold or non-functioning nodule carries a higher risk of cancer than a normal or hyper-functioning nodule. Cancerous nodules are more likely to be cold, because cancer cells are immature and don’t accumulate the iodine as well as normal thyroid tissue. However, cold spots can also be caused by cysts. This makes the ultrasound a much better tool for determining the need to do an FNA.
• Fine needle aspiration: Fine needle aspiration (FNA) of a nodule is a type of biopsy and the most common, direct way to determine what types of cells are present. The needle used is very thin. The procedure is simple and can be done in an outpatient office, and anesthetic is injected into tissues traversed by the needle. FNA is possible if the nodule is easily felt. If the nodule is more difficult to feel, fine needle aspiration can be performed with ultrasound guidance. The needle is inserted into the thyroid or nodule to withdraw cells. Usually, several samples are taken to maximize the chance of detecting abnormal cells. These cells are examined microscopically by a pathologist to determine if cancer cells are present. The value of FNA depends upon the experience of the physician performing the FNA and the pathologist reading the specimen. Diagnoses that can be made from FNA include:
• Despite its value, the ultrasound cannot determine whether a nodule is benign or cancerous.
• Benign thyroid tissue (non-cancerous) can be consistent with Hashimoto’s thyroiditis, a colloid nodule, or a thyroid cyst. This result is reported from approximately 60% of biopsies.
• Cancerous tissue (malignant) can be consistent with diagnosis of papillary, follicular, or medullary cancer. This result is reported from approximately 5% of biopsies. The majority of these are papillary cancers.
• Suspicious biopsy can show a follicular adenoma. Though usually benign, up to 20% of these nodules are found ultimately to be cancerous.
• Non-diagnostic results usually arise because insufficient cells were obtained. Upon repeat biopsy, up to 50% of these cases can be distinguished as benign, cancerous, or suspicious.

One of the most difficult problems for the pathologist is to be confident that a follicular adenoma – usually a benign nodule – is not a follicular cell carcinoma or cancer. In these cases, it is up to the physician and the patient to weigh the option of surgery on a case-by-case basis, with less reliance on the pathologist’s interpretation of the biopsy. It is also important to remember that there is a small risk (3%) that a benign nodule diagnosed by FNA may still be cancerous. Thus, even benign nodules should be followed closely by the patient and physician. Another biopsy may be necessary, especially if the nodule is growing. Most thyroid cancers are not very aggressive; that is, they do not spread rapidly. The exception is poorly differentiated (anaplastic) carcinoma, which spreads rapidly and is difficult to treat.