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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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This therapy was commonly used in the 1950s to treat enlarged thymus glands, adenoids and tonsils, and skin disorders. People who received radiation therapy as children have a higher incidence of thyroid cancer.</p><p>Other risk factors are a family history of thyroid cancer and chronic <a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=001178&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">goiter</a> . The disease affects 1 in 1,000 people.</p><p>There are several types of thyroid cancer:</p><ul><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=000352&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Anaplastic carcinoma</a>  (also called giant and spindle cell cancer) is the most dangerous form of thyroid cancer. It is rare, but does not respond to radioiodine therapy. Anaplastic carcinoma spreads quickly and invades nearby structures such as the trachea, causing <a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003075&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">breathing difficulties</a> .</li><li>Follicular <a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=001289&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">carcinoma</a>  accounts for about 30% of all cases and is more likely to come back and spread.</li><li>Medullary carcinoma is a cancer of non-thyroid cells in the thyroid gland and tends to occur in families. It requires different treatment than other types of thyroid cancer.</li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=000331&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Papillary carcinoma</a>  is the most common type, and usually affects women of childbearing age. It spreads slowly and is the least dangerous type of thyroid cancer.</li></ul><BR><BR></div><div id="AEAdamdiv3" class="adam_01"><b class="adam_01">Symptoms:</b> <ul><li>Cough or cough with bleeding</li><li>Difficulty swallowing</li><li>Enlargement of the thyroid gland</li><li>Hoarseness or changing voice</li><li>Neck swelling</li><li>Thyroid lump (nodule)</li></ul><p>Note: Symptoms may vary depending on the type of thyroid cancer</p><BR><BR></div><div id="AEAdamdiv4" class="adam_01"><b class="adam_01">Signs and tests:</b> <p>A physical examination can reveal a thyroid mass or nodule (usually in the lower part of the front of the neck), or enlarged lymph nodes in the neck.</p><p>Tests for thyroid cancer:</p><ul><li>Elevated <a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003699&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">serum calcitonin</a>  (for medullary cancer) or serum thyroglobulin (for papillary or follicular cancer)</li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003851&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Laryngoscopy</a>  showing paralyzed vocal cords</li><li>Thyroid biopsy showing anaplastic, follicular, medullary, or papillary cancer cells</li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003829&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Thyroid scan</a>  showing a nodule that does not light up on the scan (cold nodule)</li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003776&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">Ultrasound of the thyroid</a>  showing a <a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003230&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">nodule</a> </li></ul><p>This disease may also affect the results of the following tests:</p><ul><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003687&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">T3</a> </li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003517&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">T4</a> </li><li><a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=003684&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">TSH</a> </li></ul><BR><BR></div><div id="AEAdamdiv5" class="adam_01"><b class="adam_01">Treatment:</b> <p>Treatment varies depending on the type of tumor.</p><p>Surgery is usually the treatment of choice, and the entire thyroid gland is usually removed. If the physician suspects that the cancer has spread to lymph nodes in the neck, these will also be removed during surgery.</p><p>Radiation therapy with radioactive iodine is often used with or without surgery. Radiation therapy with beam radiation can also be used.</p><p>After treatment, you need to take thyroid hormone to replace what your glands used to make. The dose is usually a little higher than what your body needs, which helps keep the cancer from coming back.</p><p>If the cancer does not respond to surgery or radiation and has spread to other parts of the body, <a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=002324&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">chemotherapy</a>  may be used, but this is only effective for a third of patients.</p><BR><BR></div><div id="AEAdamdiv6" class="adam_01"><b class="adam_01">Support Groups:</b> <p>You can ease the stress of illness by joining a support group made up of people who share common experiences and problems. See <a href="http://www.uclahealth.org/body.cfm?xyzpdqabc=0&amp;id=477&amp;action=detail&amp;AEProductIDSRC=Adam2004_1&amp;AEArticleID=002166&amp;AEProductID=Adam2004_1&amp;AEProjectTypeIDURL=APT_1">cancer - support group</a> .</p><BR><BR></div><div id="AEAdamdiv7" class="adam_01"><b class="adam_01">Expectations (prognosis):</b> <p>Anaplastic carcinoma has the worst outcome of all the types of thyroid cancer. Follicular carcinomas are often fast growing and may invade other tissues, but the outlook is still good -- most patients are cured.</p><p>The outcome with medullary carcinoma varies. Women under age 40 have a better chance of a good outcome.</p><p>Papillary carcinomas are usually slower growing. Most people are cured and have a normal life expectancy.</p><p>Many patients who have surgery or radiation for thyroid cancer must take thyroid hormone pills for the rest of their lives.</p><BR><BR></div><div id="AEAdamdiv8" class="adam_01"><b class="adam_01">Complications:</b> <ul><li>Injury to the voice box or nerve and hoarseness after surgery</li><li>Low calcium levels from accidental removal of the parathyroid glands during surgery</li><li>Spread of the cancer to the lung or other parts of the body</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 notice a lump in your neck.</p><p>Also call if your symptoms get worse during treatment.</p><BR><BR></div><div id="AEAdamdiv10" class="adam_01"><b class="adam_01">Prevention:</b> <p>There is no known prevention. Awareness of risk (such as previous radiation therapy) can allow earlier diagnosis and treatment.</p><BR><BR></div><div id="AEAdamdiv12" class="adam_01"><b class="adam_01">References:</b> <p>Sherman SI, Angelos P, Ball DW, Byrd D, Clark OH, Daniels GH, et al. Thyroid carcinoma. <em>J Natl Compr Canc Netw</em>. 2007;5:568-621.</p><p>Sampson E, Brierley JD, Le LW, Rotstein L, Tsang RW. Clinical management and outcome of papillary and follicular (differentiated) thyroid cancer presenting with distant metastasis at diagnosis. <em>Cancer</em>. 2007;110:1451-1456.</p><p>Tuttle RM, Leboeuf R, Martorella AJ. Papillary thyroid cancer: monitoring and therapy. <em>Endocrinol Metab Clin North Am</em>. 2007;36:753-758.</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: 3/24/2008<br class="adam_01">Reviewed By: Stephen Grund, MD, PhD, Chief of Hematology/Oncology and Director of the George Bray Cancer Center at New Britain General Hospital, New Britain, CT. Review provided byVeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.<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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