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if (window.onload && window.onload != null)
	DHTMLNavBarTemponload = window.onload;

function DHTMLFullyLoaded() {
	if (DHTMLNavBarTemponload != null) 
		DHTMLNavBarTemponload();
		DHTML_preloadImages('images/btn_physicians.gif','images/btn_physicians_on.gif','images/btn_hospitals.gif','images/btn_hospitals_on.gif','images/btn_departments.gif','images/btn_departments_on.gif','images/btn_offices.gif','images/btn_offices_on.gif','images/btn_services.gif','images/btn_services_on.gif');
	DHTMLrunMouseOvers = true;
	return true;
}	
function DHTMLNavBarMouseOutTimer() {
	if(DHTMLTimerID) 
		clearTimeout(DHTMLTimerID); 
	DHTMLTimerID = setTimeout("DHTMLNavBarLayerRestore()",5000);
}	
function DHTMLRestoreParent(layername) {
	for(var i=0;i < aryDHTMLLayerNames.length;i++)
	{
		if(!aryDHTMLNavBarLayerInfo[aryDHTMLLayerNames[i]].isDefault)
		{			
			if(!(aryDHTMLLayerNames[i] == layername) && aryDHTMLLayerNames[i].indexOf("grand") == -1) 
				DHTMLNavBarRestoreLayers(aryDHTMLLayerNames[i]);			
		}
	}
}	
function DHTMLRestoreAll() {
	DHTMLNavBarMouseoverRestore();
	DHTMLNavBarLayerRestore();
}	
function DHTMLNavBarMouseoverRestore() {
	var i = 0;
	var o = null;
	if (DHTMLrunMouseOvers)
	{
		for (var i=0; i < DHTMLimageList.length; i++)
		{
			if (aryDHTMLMoImages[imageList[i]].Moused && (o = aryDHTMLMoImages[imageList[i]].ptrImage)) {
				o.src = aryDHTMLMoImages[imageList[i]].OriginalSrc;
				aryDHTMLMoImages[imageList[i]].Moused = false;
			}
		}
	}
	return true;
}	
function DHTMLNavBarLayerRestore() {
	for(var i=0;i < aryDHTMLLayerNames.length;i++)
	{
		if(!aryDHTMLNavBarLayerInfo[aryDHTMLLayerNames[i]].isDefault) 
			DHTMLNavBarRestoreLayers(aryDHTMLLayerNames[i]);		
	}
}	
function DHTMLNavBarArrayPushUnique(aryArray, varNewElement){
	//only pushes if unique value
	var pushIt = true;
	for (var i=0;i < aryArray.length && pushIt;i++) 
	{
		pushIt = (varNewElement!=aryArray[i]);
	}
	if(pushIt) 
		DHTMLNavBarArrayPush(aryArray, varNewElement);	
	
	return pushIt;
}
function DHTMLNavBarArrayPush(aryArray, varNewElement) {
	//Implement Array Push 'cause IE cant handle it
	aryArray[aryArray.length]=varNewElement;
}	
function DHTMLNavBarArrayPop(aryArray) {
	//Implement Array Pop 'cause IE cant handle it before 5.5
	var varItemToPop = null;
	if(aryArray[aryArray.length-1]) {
		varItemToPop = aryArray[aryArray.length-1];
		aryArray[aryArray.length]=null;
	}
	return varItemToPop;
}
	
var registeredObjects = new Array();
//v3.0 name changed to avoid clash with possible other JS in content, this function complements of MM Dreamweaver
function DHTMLNavBarMM_findObj(n, d) {
	x = document.getElementById(n);
	return x;
}
	
var DHTMLNavBarTime         = 100;
var DHTMLNavBarTimes        = 2;
var DHTMLNavBarmoveDistance = 1;
var DHTMLNavBarThisLoc      = 325;
var aryDHTMLLayerNames      = new Array();
var aryDHTMLNavBarLayerInfo = new Array();
var aryDHTMLNavBarLayers    = new Array();
	
function DHTMLNavBarArrayContains()	{
	var a = DHTMLNavBarArrayContains.arguments;
	var foundit = false;
	for(var i=0; i < a[0].length && !foundit; i++) 
	{
		foundit = (a[1]==a[0][i]);
	}
	return foundit;
}
	
function DHTMLNavBarRegisterLayer()	{
	var a = DHTMLNavBarRegisterLayer.arguments;
	var n = a[0];
	var d = a[1];
	if(a[2] && a[2] == 'MOutLayer')
		var mo = true;
	else 
		var mo = false;	
	
	if(!(DHTMLNavBarArrayContains(aryDHTMLLayerNames,n)))
	{
		if(o = DHTMLNavBarMM_findObj(n))
		{
			aryDHTMLNavBarLayers[n] = o;
			DHTMLNavBarArrayPushUnique(aryDHTMLLayerNames,n);
			aryDHTMLNavBarLayerInfo[n] = new DHTMLNavBarLayer(n,d,mo);
		}
	}
}
	
// v3.0 name changed, this function complements of MM Dreamweaver with customizations
function DHTMLNavBarMM_showHideLayers()	{
	var i,p,v,x,obj,args = DHTMLNavBarMM_showHideLayers.arguments;
	if(args[args.length-1] != "menu") 
		DHTMLNavBarMouseOutTimer(); 
	for (var i=0; i<(args.length-2); i+=3)
	{
		if(!aryDHTMLNavBarLayers[args[i]]) {
			x = (args[i+2]=='show')?'hide':'show';
			DHTMLNavBarRegisterLayer(args[i],x);
		}
	 	if ((obj=aryDHTMLNavBarLayers[args[i]])!=null)
		{
			v = args[i+2];
			aryDHTMLNavBarLayerInfo[args[i]].isDefault = false;
	 		if(args[args.length-1] == "restore") 
				v = (v=='show')?'hide':'show';			
			if (obj.style)
				obj.style.visibility = (v=='show')?'visible':(v='hide')?'hidden':v;
			else 
				obj.visibility = v;			
		}
	}
}
	
// v3.0 name changed, this function complements of MM Dreamweaver with customizations
function DHTMLNavBarMM_showHideGrandLayers() {
	var i,p,v,x,obj,args = DHTMLNavBarMM_showHideGrandLayers.arguments;
	if(args[args.length-1] != "menu") 
		DHTMLNavBarMouseOutTimer();
	for (var i=0; i < (args.length-2); i+=3)
	{
		if(!aryDHTMLNavBarLayers[args[i]]) {
			x = (args[i+2]=='show')?'hide':'show';
			DHTMLNavBarRegisterLayer(args[i],x);
		}
	 	if ((obj=aryDHTMLNavBarLayers[args[i]])!=null)
		{
			v = args[i+2];
			aryDHTMLNavBarLayerInfo[args[i]].isDefault = false;
	 			if(args[args.length-1] == "restore"){
				v = (v=='show')?'hide':'show';		
			}
			if (obj.style)
				obj.style.visibility = (v=='show')?'visible':(v='hide')?'hidden':v;
			else 
	 			obj.visibility = v;			
		}
	}
}
function DHTMLNavBarRestoreLayers()	{
	var i,p,v,obj,args = DHTMLNavBarRestoreLayers.arguments;
	for (var i=0; i < (args.length); i++)
	{		
	 	if (obj = aryDHTMLNavBarLayers[args[i]])
		{
			v = aryDHTMLNavBarLayerInfo[args[i]].defaultVisibility;
			var strobjid = obj.id;
			if (obj.style)
			{
				obj=obj.style;				
				v=(v=='show')?'visible':(v='hide')?'hidden':v;
			}
			obj.visibility = v;
			if (!aryDHTMLNavBarLayerInfo[args[i]].MOutLayer) 
				aryDHTMLNavBarLayerInfo[args[i]].isDefault=true;			
		}
	}
}
function DHTMLNavBarLayer()	{
	var a = DHTMLNavBarLayer.arguments;
	this.defaultVisibility = a[1];
	this.isDefault = true;
	this.MOutLayer = a[2];
}
	
var viz = "hide";
function DHTMLNavBarNavMove() {
	if(thisl==DHTMLNavBarMM_findObj("DHTMLNavBarScrollLayer"))	
	{
		if(thisl.style)
		{
			thisl=thisl.style;
			viz="hidden";
		}
		thisl.top = DHTMLNavBarThisLoc -= 3;
		if(DHTMLNavBarThisLoc < -750)
		{
			DHTMLNavBarThisLoc=325;
			DHTMLNavBarTimes--;
		}
	}
	if (DHTMLNavBarTimes<=0)
	{
		otherl=DHTMLNavBarMM_findObj("DHTMLNavBarLayer");
		otherl.visibility=viz;
	}
	else setTimeout("DHTMLNavBarNavMove()",DHTMLNavBarTime);	
}
function DHTML_swapImgRestore()	{ 	
 	var i,x,a=document.Sliding_sr;
 	for(var i=0; a && i < a.length && (x=a[i]) && x.oSrc; i++) 
	{			
		x.src = x.oSrc;
	}
}
function DHTML_preloadImages() { 
 	var d=document;
 	if(d.images)
 	{
 		if(!d.Sliding_p) 
			d.Sliding_p=new Array();	
		var i,j=d.Sliding_p.length,a=DHTML_preloadImages.arguments;
		for(var i=0; i < a.length; i++)
		{
	 		if (a[i].indexOf("#")!=0)
			{
				d.Sliding_p[j]=new Image;
				d.Sliding_p[j++].src=a[i];
			}
		}
	}
}
function DHTML_findObj(n, d) { 
	var p,i,x;
	if(!d) 
		d=document;	
	if((p=n.indexOf("?")) > 0 && parent.frames.length)
	{
	 	d=parent.frames[n.substring(p+1)].document;
		n=n.substring(0,p);
	}
	if(!(x=d[n]) && d.all) 
		x=d.all[n];
	for (var i=0; !x && i < d.forms.length; i++) 
	{
		x = d.forms[i][n];	
	}
	for(var i=0; !x && d.layers && i < d.layers.length; i++) 
	{
		x = DHTML_findObj(n,d.layers[i].document);
	}
	 if(!x && d.getElementById) 
		x=d.getElementById(n);	
		
	return x;
}
function DHTML_swapImage() { 
	var i,j=0,x,a=DHTML_swapImage.arguments;
	document.Sliding_sr=new Array;
	for(var i=0; i < (a.length-2); i+=3)
	{
		if ((x=DHTML_findObj(a[i]))!=null)
		{
			document.Sliding_sr[j++] = x;
			if(!x.oSrc)
				x.oSrc=x.src;			
			x.src = a[i+2];
		}
	}
}
function DHTMLNavBarSwapRollover(swapimage,defaultimage,imageID) {
	if(imageID.length > 0 && document.getElementById(imageID))
	{
		if(swapimage.length > 0) 
			document.getElementById(imageID).src = "images/" + swapimage;
		else
			document.getElementById(imageID).src = "images/" + defaultimage;		
	}
}
window.onload = DHTMLFullyLoaded;
			

//-->
</script>
			
	
<table border="0" cellpadding="0" cellspacing="0">
	<tr>
		<td valign="top">
		<div id="lryParentmain54" class="Parentmain1"  onmouseover="DHTMLRestoreAll();DHTML_swapImage('btn_physicians_1_54','','images/btn_physicians_on.gif',54);DHTMLNavBarMM_showHideLayers('lyr54','','show','lyrTopMO1','','show','lyrLeftMO1','','show','menu');" onmouseout="DHTML_swapImgRestore();" onclick="DHTMLNavBar_configureCookie('54');">
			<table border="0" class="ParentNav1" width="100%" cellpadding="0" cellspacing="0">
				<tr id="pRow54" style="vertical-align: top; background-color: transparent;" >
					<td valign="top" style="" id="pLink54"><a href="body.cfm?id=54" target="" class="clMain1"><img src="images/btn_physicians.gif" border="0" id="btn_physicians_1_54" alt="UCLA Physicians" ></a></td>
				</tr>
			</table>
			<div id="lyr54" class="clLeft1" onMouseOut="DHTMLRestoreAll();">
				<table cellpadding="0" cellspacing="0" class="ChildNav1" border="0">
					<tr id="cRow54_1" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink54_1"><a href="body.cfm?id=479" target="" class="clSubb1">Physician Directory</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow54_2" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink54_2"><a href="body.cfm?id=308" target="" class="clSubb1">Physician Referral Service</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow54_3" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink54_3"><a href="body.cfm?id=1087" target="" class="clSubb1">Cancer Specialists</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow54_4" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink54_4"><a href="http://www.uclahealth.org/body_mattel.cfm?id=956&amp;oTopID=956" target="" class="clSubb1">Pediatric Physicians</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow54_5" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink54_5"><a href="body.cfm?xyzpdqabc=0&amp;id=479&amp;action=list&amp;subaction=specialty&amp;searchaction=simple&amp;specialtygroups=family%20medicine,internal%20medicine,pediatrics,obstetrics%20&amp;%20gynecology" target="" class="clSubb1">Primary Care Physicians by Specialty</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow54_6" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink54_6"><a href="body.cfm?xyzpdqabc=0&amp;id=479&amp;action=list&amp;subaction=location&amp;searchaction=simple" target="" class="clSubb1">Primary Care Physicians by Location</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow54_7" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink54_7"><a href="body.cfm?id=932" target="" class="clSubb1">Voted Best Doctors</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow54_8" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink54_8"><a href="body.cfm?id=1162" target="" class="clSubb1">Voted Super Doctors</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
				</table>
				<!--[if lte IE 6.5]>
				<div id="endTablelyr54" style="height:1px;overflow:hidden;"></div><iframe id="Framelyr54" frameborder="0" style="background-color:transparent;left:0px;position:absolute;top:0px;width:100%;height:120;z-index:-1;filter:mask();"></iframe>
				<![endif]-->
			</div>
		</div>
		</td>
		<td valign="top">
		<div id="lryParentmain56" class="Parentmain1"  onmouseover="DHTMLRestoreAll();DHTML_swapImage('btn_hospitals_1_56','','images/btn_hospitals_on.gif',56);DHTMLNavBarMM_showHideLayers('lyr56','','show','lyrTopMO1','','show','lyrLeftMO1','','show','menu');" onmouseout="DHTML_swapImgRestore();" onclick="DHTMLNavBar_configureCookie('56');">
			<table border="0" class="ParentNav1" width="100%" cellpadding="0" cellspacing="0">
				<tr id="pRow56" style="vertical-align: top; background-color: transparent;" >
					<td valign="top" style="" id="pLink56"><a href="body.cfm?id=56" target="" class="clMain1"><img src="images/btn_hospitals.gif" border="0" id="btn_hospitals_1_56" alt="UCLA Hospitals" ></a></td>
				</tr>
			</table>
			<div id="lyr56" class="clLeft1" onMouseOut="DHTMLRestoreAll();">
				<table cellpadding="0" cellspacing="0" class="ChildNav1" border="0">
					<tr id="cRow56_1" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink56_1"><a href="homepage_med.cfm?id=264" target="" class="clSubb1">Ronald Reagan UCLA Medical Center</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow56_2" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink56_2"><a href="homepage_sanmon.cfm?id=265" target="" class="clSubb1">Santa Monica UCLA Medical Center and Orthopaedic Hospital</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow56_3" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink56_3"><a href="homepage_mattel.cfm?id=266" target="" class="clSubb1">Mattel Children's Hospital UCLA</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow56_4" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink56_4"><a href="homepage_neuro.cfm?id=267" target="" class="clSubb1">Resnick Neuropsychiatric Hospital at UCLA</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
				</table>
				<!--[if lte IE 6.5]>
				<div id="endTablelyr56" style="height:1px;overflow:hidden;"></div><iframe id="Framelyr56" frameborder="0" style="background-color:transparent;left:0px;position:absolute;top:0px;width:100%;height:60;z-index:-1;filter:mask();"></iframe>
				<![endif]-->
			</div>
		</div>
		</td>
		<td valign="top">
		<div id="lryParentmain977" class="Parentmain1"  onmouseover="DHTMLRestoreAll();DHTML_swapImage('btn_departments_1_977','','images/btn_departments_on.gif',977);DHTMLNavBarMM_showHideLayers('lyr977','','show','lyrTopMO1','','show','lyrLeftMO1','','show','menu');" onmouseout="DHTML_swapImgRestore();" onclick="DHTMLNavBar_configureCookie('977');">
			<table border="0" class="ParentNav1" width="100%" cellpadding="0" cellspacing="0">
				<tr id="pRow977" style="vertical-align: top; background-color: transparent;" >
					<td valign="top" style="" id="pLink977"><a href="body.cfm?id=977" target="" class="clMain1"><img src="images/btn_departments.gif" border="0" id="btn_departments_1_977" alt="Departments" ></a></td>
				</tr>
			</table>
			<div id="lyr977" class="clLeft1" onMouseOut="DHTMLRestoreAll();">
				<table cellpadding="0" cellspacing="0" class="ChildNav1" border="0">
					<tr id="cRow977_1" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink977_1"><a href="body.cfm?xyzpdqabc=0&amp;id=453&amp;action=detail&amp;ref=10" target="" class="clSubb1">Anesthesiology</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow977_2" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink977_2"><a href="body.cfm?xyzpdqabc=0&amp;id=453&amp;action=detail&amp;ref=12" target="" class="clSubb1">Dental Services</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow977_3" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink977_3"><a href="http://clinicaltrials.ucla.edu" target="" class="clSubb1">Clinical Trials</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow977_4" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink977_4"><a href="http://www.donatedbodyprogram.ucla.edu" target="" class="clSubb1">Donated Body Program</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow977_5" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink977_5"><a href="body.cfm?xyzpdqabc=0&amp;id=453&amp;action=detail&amp;ref=31" target="" class="clSubb1">Emergency Medicine</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow977_6" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink977_6"><a href="body.cfm?xyzpdqabc=0&amp;id=453&amp;action=detail&amp;ref=14" target="" class="clSubb1">Family Medicine</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow977_7" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink977_7"><a href="body.cfm?xyzpdqabc=0&amp;id=453&amp;action=detail&amp;ref=15" target="" class="clSubb1">Medicine</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow977_8" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink977_8"><a href="body.cfm?xyzpdqabc=0&amp;id=453&amp;action=detail&amp;ref=16" target="" class="clSubb1">Neurology</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
					</tr>
					<tr id="cRow977_9" style="vertical-align: top; background-color: transparent;"  onmouseover="">
						<td valign="top" class="ChildNav1" style="" id="cLink977_9"><a href="http://neurosurgery.ucla.edu/default.cfm" target="" class="clSubb1">Neurosurgery</a></td>
					</tr>
					<tr>
						<td valign="top"><img src='images/c_btwn.gif' alt=""></td>
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scintiscan" title ="Thyroid enlargement - scintiscan" border="0"><br>Thyroid enlargement - scintiscan</a><br></td></tr></table></td></tr></table></td></tr><tr class="adam_01"><td align="left" class="adam_01"><table width="100%" align="left" border="0" class="adam_01"><tr align="center" class="adam_01"><td valign="top" align="center" width="105" class="adam_01"><table cellpadding="2" cellspacing="3" class="adam_01"><tr class="adam_01"><td align="center" valign="top" class="adam_01"></td></tr><tr class="adam_01"><td align="center" valign="top" class="adam_01"><br><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=8966&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_2" > <img border="0" class="" src="http://www.uclahealth.org/ae_images/adam04/graphics/tnail/8966t.jpg" alt="Thyroid gland" title ="Thyroid gland" border="0"><br>Thyroid gland</a><br></td></tr></table></td></tr></table></td></tr></table></td></tr><tr class="adam_01"><td class="adam_01"><hr class="adam_01"><h2 class="adam_01">Thyroid cancer - papillary carcinoma</h2><b class="adam_01">Definition:</b> <p>Papillary carcinoma of the thyroid is the most common cancer of the thyroid gland.</p><p>See also: <a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=001213&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Thyroid cancer</a> </p><BR><BR><div id="AEAdamdiv1" class="adam_01"><b class="adam_01">Alternative Names:</b> Papillary carcinoma of the thyroid<BR><BR></div><div id="AEAdamdiv2" class="adam_01"><b class="adam_01">Causes, incidence, and risk factors:</b> <p>About 75-85% of all thyroid cancers diagnosed in the United States are papillary carcinoma. It is more common in women than in men. It may occur in childhood, but is typically seen in people between ages 20 and 40.</p><p>The cause of this cancer is unknown. A genetic defect may be involved.</p><p>High-dose external radiation to the neck increases the risk of developing thyroid cancer. Papillary thyroid cancer in children has also been linked to atomic bomb testing in the Marshall Islands and the 1986 Chernobyl nuclear disaster in the Ukraine.</p><p>Radiation given through a vein (through an IV) during medical tests and treatments does NOT increase the risk of developing thyroid cancer.</p><BR><BR></div><div id="AEAdamdiv3" class="adam_01"><b class="adam_01">Symptoms:</b> <p>Thyroid cancer usually begins as a small bump (nodule) in the thyroid gland, which is located at the front of the neck. However, it should be emphasized that most thyroid bumps are harmless and noncancerous (benign).</p><BR><BR></div><div id="AEAdamdiv4" class="adam_01"><b class="adam_01">Signs and tests:</b> <p>If you have a lump on your thyroid, your doctor will order blood tests and an <a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003336&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">ultrasound</a>  of the thyroid gland. </p><p>If the ultrasound shows that the lump is bigger than 1.0 centimeter, a special biopsy called a <a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003899&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">fine needle aspiration</a>  (FNA) will be performed. This test determines if the lump is cancerous or benign (not cancerous).</p><p><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003444&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Thyroid function tests</a>  are usually normal in patients with thyroid cancer.</p><BR><BR></div><div id="AEAdamdiv5" class="adam_01"><b class="adam_01">Treatment:</b> <p>There are three types of thyroid cancer treatment:</p><ul><li>Surgery</li><li>Radioactive iodine</li><li>Medication</li></ul><p>Surgery is done to remove as much of the cancer as possible. The bigger the lump, the more of the thyroid gland must be removed. Frequently, the entire gland is taken out.</p><p>After the surgery, most (but not all) patients receive radioactive iodine, which is usually taken by mouth. This substance kills any remaining thyroid tissue. It also helps make medical images more clear, so doctors can see if there is any additional cancer.</p><p>If surgery is not an option, external radiation therapy can be useful.</p><p>After surgery, the patient will need to take medication called levothyroxine sodium for the rest of their life. This replaces the hormone that the thyroid would normally make.</p><p>The patient will need a blood test every 3 to 6 months to check thyroid levels, and an imaging test called a <a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003689&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">radioactive iodine (I-131) uptake scan</a>  once a year.</p><BR><BR></div><div id="AEAdamdiv6" class="adam_01"><b class="adam_01">Support Groups:</b> <p /><BR><BR></div><div id="AEAdamdiv7" class="adam_01"><b class="adam_01">Expectations (prognosis):</b> <p>The survival rate for papillary thyroid cancer is excellent. More than 95% of adults with such cancer survive at least 10 years. The prognosis is better for patients younger than 40 and for those with smaller tumors.</p><p>The following factors may decrease the survival rate:</p><ul><li>Age over 40</li><li>Cancer has spread to distant parts of the body</li><li>Cancer has spread to soft tissue</li><li>Large tumor</li></ul><BR><BR></div><div id="AEAdamdiv8" class="adam_01"><b class="adam_01">Complications:</b> <p>Complications include:</p><ul><li>Accidental removal of the parathyroid gland, which helps regulate blood calcium levels</li><li>Damage to a nerve that controls the vocal cords</li><li>Spreading of cancer to lymph nodes (rare)</li><li>Spreading of cancer to other sites (<a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=002260&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">metastasis</a> )</li></ul><BR><BR></div><div id="AEAdamdiv9" class="adam_01"><b class="adam_01">Calling your health care provider:</b> <p>Call your health care provider if you have a lump in your neck. </p><BR><BR></div><div id="AEAdamdiv10" class="adam_01"><b class="adam_01">Prevention:</b> <p /><BR><BR></div><div id="AEAdamdiv12" class="adam_01"><b class="adam_01">References:</b> <p>Larsen PR, Kronberg HM, Schlomo M, et al. <em>Williams Textbook of Endocrinology</em>. 10th ed. St. Louis, MO: WB Saunders; 2003:469-473.</p><p>Hemminki K. Familial risks for nonmedullary thyroid cancer. <em>J Clin Endocrinol Metab</em>. 2005; 90(10): 5747-5753.</p><p>Kumar V, Abbas AK, Fausto N. <em>Robbins and Cotran Pathologic Basis of Disease</em>. 7th ed. St. Louis, MO: WB Saunders; 2005:1177-1180.</p><BR><BR></div></td></tr><tr class="adam_01"><td class="adam_01"><hr class="adam_01"></td></tr><tr class="adam_01"><td class="adam_01">Review Date: 3/21/2008<br class="adam_01">Reviewed By: Stephen Grund, M.D. Ph.D., Chief of Hematology/Oncology and Director of the George Bray Cancer Center at New Britain General Hospital, New Britain, CT. Review provided by VeriMed Healthcare Network.<br class="adam_01"></td></tr><tr class="adam_01"><td align="left" valign="top" width="470" class="adam_01"><br class="adam_01"><font size="1" class="adam_01">
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