Dx- Thyroid Cancer

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TESTS PROCEDURE NORMAL

RANGE

INTERPRETATION

S

NURSING

RESPONSIBILI

TIES

MRI -(magnetic

resonanceimaging) scanis a imaging

test that uses

powerfulmagnets and

radio waves to

create pictures

of the body. Itdoes not use

radiation (x-

rays).

And

CT SCAN- animaging

method thatuses x-rays tocreate pictures

of cross-sections of the

body.

You will be

positioned on the

moveableexamination

table. Straps and

bolsters may be

used to help you

stay still and

maintain the

correct position

during imaging.

Devices that

contain coils

capable of

sending and

receiving radio

waves may be

placed around or

adjacent to the

area of the body

being studied.

If a contrast

material will be

used in the MRI

exam, a nurse

ortechnologistwi

ll insert

anintravenous

(IV)catheter, also

known as an IV

line, into a vein in

your hand or arm.A saline solution

may be used. The

solution will drip

through the IV to

prevent blockage

of the IV catheter

until the contrast

material is

injected.

You will bemoved into the

magnet of the

MRI unit and the

radiologist and

technologist will

leave the room

A normalMRI,

MRA,MRS, orMRCP

result is

one thatshows the

patient's

physical

conditionto fall

within

normalranges forthe target

area

scanned.

Generally, MRI isprescribed only when

serious symptoms ornegative results fromother tests indicate a

need. There often exists

strong evidence of acondition that the scan

is designed to detect

and assess. Thus, the

results will often beabnormal, confirming

the earlier diagnosis. At

that point, furthertesting and appropriatemedical treatment is

needed. For example, if

the MRI indicates thepresence of a brain

tumor, an MRS may be

prescribed to determinethe type of tumor so

that aggressive

treatment can begin

immediately withoutthe need for a surgical

biospy.

BEFORE:

Your doctor willexplain the

procedure to you

and offer you theopportunity to ask

any questions that

you might have

about theprocedure.

If your procedureinvolves the use of

contrast dye, you

will be asked tosign a consent

form that gives

permission to dothe procedure.

Read the form

carefully and ask

questions ifsomething is not

clear.

Generally, there is

no special

restriction on dietor activity prior to

an MRI procedure.

Before the

examination, it is

extremelyimportant that you

inform thetechnologist if any

of the followingapply to you:

You are

claustrophobic

and think thatyou will be

unable to lie

still while

inside thescanning

machine, in

which case youmay be given a

sedative

You have a

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while the MRI

examination is

performed.

If a contrast

material is used

during the

examination, it

will be injected

into the

intravenous line

(IV) after an

initial series of

scans. Additional

series of images

will be takenduring or

following the

injection.

When the

examination is

completed, you

may be asked to

wait until the

technologist or

radiologist checksthe images in case

additional images

are needed.

Your intravenous

line will be

removed.

MRI exams

generally include

multiple runs

(sequences), someof which may last

several minutes.

Depending on the

type of exam and

the equipment

used, the entire

exam is usually

completed in 30

to 50 minutes.

pacemaker

inserted, orhave had heart

valves replaced

You have anytype of

implantedpump, such as

an insulin

pump

You have

metal plates,pins, metal

implants,

surgicalstaples, or

aneurysm clips

You have any

metallic

fragmentsanywhere in

the body

You have

permanent

eyeliner ortattoos

You arepregnant or

suspect you

may bepregnant

You have ever

had a bullet

wound

You have ever

worked with

metal (forexample, a

metal grinder

or welder)

You have anybody piercing

You have anintrauterine

device (IUD)

You are

wearing a

medication

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patch

As there is a

possibility that youmay receive a

sedative before theprocedure, you

should plan tohave someone

drive you home

afterward.

Based upon your

medical condition,your doctor may

request other

specificpreparation.

DURING:

Generally, MRI of

the spine and brainfollows this

process:

You will beasked to

remove anyclothing,

jewelry,

eyeglasses,hearing aids,

hairpins,

removabledental work, or

other objects

that mayinterfere withthe procedure.

If you are askedto remove

clothing, you

will be given agown to wear.

If you are to

have a

procedure done

with contrast,an intravenous

(IV) line will be

started in the

hand or arm forinjection of the

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contrast dye.

You will lie on

a scan table thatslides into a

large circularopening of the

scanningmachine.

Pillows and

straps may beused to prevent

movement

during the

procedure.

Thetechnologist

will be in

another room

where thescanner

controls are

located.However, you

will be in

constant sight

of the

technologistthrough a

window.Speakers inside

the scanner will

enable thetechnologist to

communicate

with and hear

you. You willhave a call

button so thatyou can let the

technologistknow if you

have any

problemsduring the

procedure. The

technologistwill be

watching you at

all times andwill be inconstant

communication.

You will be

given earplugs

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or a headset to

wear to helpblock out the

noise from the

scanner. Some

headsets mayprovide music

for you to listento.

During thescanning

process, a

clicking noise

will sound asthe magnetic

field is created

and pulses ofradio waves are

sent from the

scanner.

It will be

important foryou to remain

very still during

the

examination, as

any movementcould cause

distortion andaffect the

quality of the

scan.

At intervals,

you may beinstructed to

hold your

breath, or to notbreathe, for afew seconds,

depending on

the body partbeing

examined. You

will then betold when you

can breathe.

You should not

have to holdyour breath for

longer than a

few seconds.

If contrast dye

is used for your

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procedure, you

may feel someeffects when

the dye is

injected into the

IV line. Theseeffects include

a flushingsensation or a

feeling of

coldness, a

salty or metallictaste in the

mouth, a brief

headache,

itching, or

nausea and/orvomiting.

These effectsusually last for

a few moments.

You should

notify the

technologist ifyou feel any

breathing

difficulties,

sweating,numbness, or

heart

palpitations.

Once the scanhas been

completed, the

table will slide

out of thescanner and

you will beassisted off the

table.

If an IV linewas inserted for

contrast

administration,the line will be

removed.

AFTER:

You should moveslowly when

getting up from the

scanner table toavoid any

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dizziness or

lightheadednessfrom lying flat for

the length of the

procedure.

If any sedatives

were taken for theprocedure, you

may be required to

rest until thesedatives have

worn off. You will

also need to avoid

driving.

If contrast dye isused during your

procedure, you

may be monitored

for a period oftime for any side

effects or reactions

to the contrast dye,such as itching,

swelling, rash, or

difficulty

breathing.

If you notice anypain, redness,

and/or swelling at

the IV site afteryou return home

following your

procedure, you

should notify yourphysician as this

could indicate an

infection or othertype of reaction.

Otherwise, there isno special type of

care required after

a MRI scan of thespine and brain.

You may resume

your usual diet and

activities, unless

your physicianadvises you

differently.

Your doctor may

give you additionalor alternate

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instructions after

the procedure,depending on your

particular

situation.

BIOPSY- is

the removal of

a small pieceof tissue for

laboratory

examination.

There are various

kinds of biopsy

procedure,including:

Bone marrow

biopsy- a small

sample of bonemarrow (usually

from the hip) is

removed via aslender needle.

This type of

biopsy helps todiagnose diseases

such as

leukaemia.

Colposcopy-

directed biopsy-

a colposcope is a

small microscopeused to examine a

womans cervix

while a tissue

sample is taken.This biopsy is

usually performed

to investigate thereasons for an

abnormal Pap test

result.

Endoscopicbiopsy- the

endoscope is a

flexible tube thatcan be inserted

into an orifice

(such as the

mouth or anus) orthrough a small

skin incision.

Once the lump is

reached, cuttingtools are threaded

through the

endoscope so thata sample of tissue

can be taken.

Excisional

The tissue

removed is

normal.

An abnormal biopsy

means that the tissue or

cells have an unusual

structure, shape, size,

or condition.

This may mean you

have a disease, such ascancer, but it depends

on your biopsy.

BEFORE:

Before the biopsy,

your doctor mayorder urine tests,

blood tests, and x-

rays of your

kidneys.You should ask

your doctor when

you can expect toknow the biopsy

results.

Arrange for a ridehome after your

biopsy.

Your doctor may

ask you to fast oreat lightly before

your biopsy.

Talk to yourdoctor about your

medicines. You

may be asked to

stop taking somemedicines up to

one week before

the procedure like:Anti-inflammatory

drugs (eg, aspirin )

Blood thinners like

clopidogrel(Plavix) or

warfarin

(Coumadin)Anesthesia

You will receive alocal anesthetic tonumb your skin.

You may also

receive a light

sedative.DURING:

A needle biopsy is

called a

percutaneous

biopsy. It removes

tissue using a hollow

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biopsy- the lump

is entirelyremoved.

Depending on the

location of the

lump, the patientmay need to

undergo generalanaesthesia. This

type of biopsy

may be used for

breast lumps.

Incisional

biopsy- only a

small slice of the

lump is removed.

Depending on thelocation of the

lump, a general orlocal anaesthetic

may be needed.

This type ofbiopsy may be

used for lumps

located in

connective tissuesuch as muscle.

Needle biopsy- asmall sample ofthe lump is

removed via a

slender

hypodermicneedle. This can

be done either

with or withoutlocal anaesthetic.

This type of

biopsy may be

used to diagnoseconditions of the

liver or thyroid.

Punch biopsy- aspecial tool is

used to punch a

hole through the

uppermost layersof the skin. The

anaesthetic used

may be local ortopical. This type

of biopsy can

help diagnose

various skinconditions.

Stereotactic

biopsy- a series

tube called a

syringe. The needle

is passed several

times through the

tissue being

examined. Thesurgeon uses the

needle to remove

the tissue sample.

Needle biopsies are

often done usingCT

scanorultrasound.

These imaging tools

help guide the

surgeon to the right

area.

An open biopsy is

surgery that uses

local or general

anesthesia. This

means you are

relaxed (sedated) or

asleep and pain-free

during the

procedure. It is done

in a hospital

operating room. The

surgeon makes a cut

into the affected

area, and the tissue

is removed.

Closed biopsy uses

a much smaller

surgical cut than

open biopsy. A small

cut is made so that a

camera-like

instrument can be

inserted. This

instrument helps

guide the surgeon to

the right place to

take the sample.

AFTER:

You will bemonitored for a

few hours afteryour biopsy. You

will be asked to

remain lying down

to reduce the

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of x-rays help to

guide thesurgeons needle

to the lump. This

type of biopsy is

usually performedwhenever the

lump is hard tosee or feel.

chance of

bleeding. Yourpulse and blood

pressure will be

monitored. Your

biopsy sampleswill be sent to the

laboratory fortesting. Once you

are feeling well

and the doctor

feels it is safe, youwill be sent home.

At Home

When you return

home, do thefollowing to help

ensure a smoothrecovery:

Rest to preventbleeding. You

should usually rest

for the first 24-48

hours after thebiopsy. Do not lift

or exercise until

your doctor says itis okay.

Keep your biopsy

site clean and dry.

Check your urine.You may notice

some blood in

your urine. This isnormal for the first

24 hours. If there

is bleeding for

longer than 24hours or a lot of

bleeding, call your

doctor.Be sure to follow

your doctor's

instructions .

Thyroid Scanuses

aradioactive

tracerand aspecial camera

to measure

how much

tracerthethyroidgla

nd absorbs

A radionuclide iseither injected

into a vein or

given to you as apill. Timing of thetest then depends

on the type of

radionuclide yourdoctor uses, and

whether you will

The thyroidappears the

correct

size, shape,and in theproper

location. It

appears aneven gray

color on

A thyroid that is

enlarged or pushed off

to one side could be a

sign of atumor.

Nodules will absorb

more or less iodine and

will look darker or

lighter on the scan

(usually lighter if there

BEFORE:

Do not eat or

drink 2 hoursbefore or 1 hourafter you receive

the dose of the

compound. Youmay have only a

thyroid scan, or a

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from

theblood.Thetracer can be

swallowed or

can be

injected into avein. It travels

through yourbody, giving

offradiationsi

gnals. The

camera "sees"the signals

and can

measure how

much tracer

the thyroidabsorbs from

the blood.

also have an

uptake test. If youare having only a

thyroid scan and

your doctor

prefers to give aradionuclide by

intravenousinjection, the scan

can be done

within 30-60

minutes. If youare given

radioactive iodine

in pill form, you

need to wait four

to six hours, andpossibly as long

as a day, beforehaving the scan.

(This gives the

radioactive iodinetime to reach your

thyroid.) If you're

having both a

scan and theuptake test, you

are likely toreceiveradioactive iodine

in pill form. This

allows one

radionuclide to beused for both the

scan and uptake

test, instead oftwo, and

eliminates the

need for an

injection.

After you've

received theradionuclide and

have waited the

appropriateamount of time, a

technician places

a radioactivitydetector-a camera

specially

designed to take

pictures ofradioactive

objects - against

your neck and

takes several

the

computerimage.

is a tumor). If part of

the thyroid appears

lighter, it could be a

thyroid problem.

The computer will alsoshow the percentage of

iodine that has

collected in your

thyroid gland. If your

gland collects too much

or too little of the

radiotracer, this can be

due to

anunderactiveorovera

ctivethyroid gland.

thyroid scan with

thyroid uptakes

DURING:

You will be givena small amount of

radioactive iodineto take by mouth 4

hours before the

scan. After this

time, the scan willbe started. You

will lie down on an

examination table.

A pillow will be

placed under yourshoulders to

extend your neckso that the thyroid

can be easily

scanned. Pictureswill be taken with

a very sensitive

machine, called a

gamma camera,that receives and

records theradiation in yourthyroid gland.

You will be given

a small amount of

radioactive iodine

by mouth. You

will be asked to

return either 4

hours and 24 hours

later, or only 24hours later. You

will be asked to sit

in a chair while a

small probe is

placed in front of

your neck. This

probe detects any

change from

normal in your

thyroid gland.

The scan,without uptake,

lasts about 1 hour.

The scan,with uptake, lastsabout 1 1/2 hours.

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images. The

camera itselfdoesn't expose

you to any

radiation. This

portion of the testusually takes

about half anhour.

An uptake testonly takes several

minutes and is

performed while

you are sitting up.Using a device

that resembles aGeiger counter,the doctor or

technician places

a probe several

inches in front ofyour neck, where

the thyroid gland

is located, andmeasures the

percentage of

radioactivity thatis retained by thethyroid gland.

You return the

next day forfollow-up testing

to obtain a second

set of uptakereadings, whichare then

compared with

the first set to

determine howmuch hormone

has been formed

and secreted inthe interim.

AFTER:

There are no

adverse effects.

Your body rids

itself of the

compound as itdoes the food you

eat.

If you have

questions about theprocedure, please

ask. Your nurse

and doctor are

ready to assist youat all times.

Radioactive

Iodine

Uptake- is a

test of thyroid

function. Itmeasures how

much

radioactiveiodine is taken

up by the

thyroid gland

You are asked to

swallow a liquid

or capsule

containingradioactive

iodine.

After a certain

period of time

(usually 6 and 24

hours later), you

6

hou

rs:

3 -16

%

24

hou

rs:

8 -

Increased hormone

levels may be due to an

overactive thyroid

gland caused by:

An enlarged

thyroid gland

that contains

nodules

producing too

Before:

Do not eat for 8

hours before the

test.

Your health care

provider will

instruct you, if

needed, to stop

taking drugs that

may affect the test

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in a certain

time period.must return to the

testing center so

that the amount of

radioactivity in

the thyroid gland

can be measured.This is done using

a device called a

gamma probe.

The probe is

placed over your

thyroid gland

along the outside

of your neck. You

will be asked to

lie on a tablewhile the scanner

moves over your

neck.

The scan takes

about 30 minutes.

25

%

Note:

Some

laboratoriesonly

measure at

24 hours.

Values

may vary

depending

on the

amount of

iodine in

your diet.

Normalvalue

ranges may

vary

slightly

among

different

laboratories

. Talk to

your doctor

about the

meaning of

your

specific

test results.

much thyroid

hormone (toxic

nodular goiter)

A singlethyroid

nodulethat is

producing toomuch thyroid

hormone

Graves disease

Decreased levels may

be due to:

Factitious

hyperthyroidism

Iodine overload

Subacutethyroiditis

Silent (or

painless)

thyroiditis

results.

Tell your doctor if

you have:

Diarrhea(may

decrease

absorption

of the

radioactive

iodine)

Recent x-

ray test

using

iodine-

basedcontrast

(within the

past 2

weeks)

Too little

or too

much

iodine in

your diet

DURING:

For this test,

you take a

small, oral

dose of

radioactive

iodine

(radioiodine)

. Over time,

the iodine

collects in

your thyroid

gland

because

your thyroid

uses iodine

to

manufacture

hormones.

You'll be

checkedafter two, six

or 24 hours

and

sometimes

after all

three time

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periods to

determine

how much

iodine your

thyroid

gland hasabsorbed.

AFTER:

You can eat

beginning

about 1 - 2

hours after

swallowing

the

radioactive

iodine. You

can go back

to a normal

diet when

the test is

finished.

The

radioactive

iodine

leaves your

body

through your

urine. You

may need to

take special

precautions,

such as

flushing

twice after

urinating, for24 - 48

hours after

the test. Ask

your health

care

provider or

the

radiology/nu

clear

medicine tea

mperforming

the scan.

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Thyroid

Suppression-used to

diagnose

difficult cases

ofhyperthyroidis

m, nowlargely

replaced by

the

thyrotropin-releasing

hormone

stimulation

test;

triiodothyronine is

administeredfor a week to

10 days, and a

reduction ofits uptake by

the thyroid

gland to less

than half ofthe initial

uptake is anormalresponse.

Patients treated

for differentiated

thyroid cancer

take a daily

thyroid hormone

replacement pill

called

levothyroxine

(also known as

T4). They take it

both to avoid

hypothyroidism

(underactive

thyroid

condition) and

to prevent

growth or

recurrence of

their thyroid

cancer.

Usually they

receive a T4dose large

enough to

suppress their

blood level of

thyroid

stimulating

hormone (TSH)

below the

normal TSH

range.

Normal

referencerange is

approximat

ely 0.5 to

5.0

Levels below 0.5 are

considered possibleevidence of

hyperthyroidism, and

levels above 5.0

would be consideredpossible evidence of

hypothyroidism.

TSH suppression to