The thyroid is a gland that produces hormones that regulate your metabolism and affect how quickly you burn calories—usually slower. So if you have hypothyroidism, you’ll gain weight because it’s harder to lose weight with a slower metabolism, although it often takes time for the weight gain to become noticeable.

It is not something most people think about when they talk about weight loss and obesity. But the idea that the thyroid affects weight loss is real. Scientists have been studying this relationship for decades to answer some of the more critical questions regarding obese patients. They still aren’t sure if there is a causal relationship between underactive thyroxine and a slower metabolic rate. Still, there is inevitably some link between these two things.

What is the thyroid?

Thyroxine produces tiny amounts of two different hormones that are important to the functioning of your body. T3 stimulating hormone – increases the rate of metabolism in all cells and therefore increases the speed at which compounds are burned up. T4 – regulates blood calcium levels and promotes growth. These hormones are important because they regulate how quickly your body burns fat and whether or not you can grow. As you can see, these things are essential for weight loss. If either of them is low, then your body won’t be able to burn fat as fast.

How does the thyroid affect weight loss?

It is responsible for regulating your metabolism. But what does that mean? Well, metabolism refers to how your body can break down compounds and produce energy. The more energy your body can use, the quicker it will burn fat.

That’s important because fat is stored in body tissues to provide an emergency source of energy when food isn’t available, and you need to be able to move. Unfortunately, if your metabolism is too slow, this emergency energy source will not be enough, and you’ll gain weight. There are two ways that the condition controls your metabolism. One of them increases metabolic rate while the other one reduces it.

1. Increasing metabolic rate

Reducing your metabolic rate is the most common way that the problem will affect your ability to lose weight. Hypothyroidism is the most common cause of an underperforming metabolism. Hypothyroidism is when there isn’t enough T3 and T4 in your body. When this happens, you’ll have a slower metabolism, and it’ll be harder for you to burn fat.

Besides having a slower metabolism, there are other effects you should understand. For example, your body will also use more of the fat you already have, and it’ll just get stored as excess. Another piece is that because fat has lower energy requirements than carbs, you’ll gain weight when your thyroid’s metabolic rate slows.

2. Decreasing metabolic rate

On the other hand, a second way affects weight loss. And this one isn’t as common, but it’s still genuine. Sometimes, there aren’t enough hormones in your body, and your metabolism will become too high, and it’ll be impossible for you to burn fat. It occurs when either the T3 or T4 levels in your body are low.

So, what causes this? It doesn’t happen to every individual, but it often happens enough to cause some concern. Sometimes, the thyroid can be damaged or destroyed, and either of these things will end up causing other problems.

The Effect on Weight Loss

Besides having a slower metabolism, there are other effects of low-functioning thyroxine that you should understand. For example, your body will also use more of the fat you already have, and it’ll just get stored as excess. Another piece is that fat has lower energy requirements than carbs; you’ll gain weight when your metabolic rate is slow.

Another effect is that your body will have a tough time using the protein in your muscles, which can lead to muscle wasting. Overall, these statements have clear implications for weight loss. The less efficient your metabolism is, the harder it’ll be to lose weight effortlessly.

What are its Symptoms?

The signs of hypothyroidism include:
• Weight gain. It is the most common sign that you have a problem. You may not even realize that you’re gaining weight, but if you eat less than others and the weight goes on.
• Sleep problems. Even if you do not think you have a sleeping problem, the chances are that you will. Night snoring and other problems dealing with sleep can signify the condition.

• Fatigue. Although this is only one of the symptoms, it’s an important one because it can make you lose interest in your dieting efforts, and you’ll feel tired. It might be hard to find out that you have this problem until it gets awful.

• Hair loss or baldness. People with hypothyroidism lose their hair. But if you notice that your hair is getting thinner or bald patches have appeared, it’s an indication that the condition has worsened.

If you feel that you suffer from this problem creating weight problems, arrange for an appointment with an endocrinologist in the Bay area located in Tampa. They will assist you in helping your thyroid function properly again.

The ideal weight depends on genetics, activity level, emotional state, and age. The more hormones you have that regulate weight loss and metabolism, the more likely it is that you’ll be able to maintain healthy body weight while still losing weight. It isn’t always easy to find out where those hormones are located or how they control your metabolism. That’s why our professionals are here to help you!

Multiple things must happen in the body to achieve homeostasis, the state of balance among all the body systems required for the body to survive and function optimally. And one of those things is a thyroid gland that secretes the right amount of two life-sustaining hormones, thyroxine (T4) and triiodothyronine (T3). If this butterfly-shaped gland secretes too much or too little of these hormones, it can spell trouble. Too much or too little T4 or T3 can trigger hyperthyroidism or hypothyroidism. And both conditions will usually compel individuals to schedule an appointment with a licensed endocrinologist.

How Common Is Hyperthyroidism and Hypothyroidism?

Only 1% of the U.S. population suffers from hyperthyroidism. And only 5% suffer from hypothyroidism. So neither of these thyroid-related conditions are especially common in the U.S., but they can have a profound impact on those diagnosed with them. To put into perspective how these two thyroid-related conditions can affect someone’s life, it helps to look at some of the associated symptoms. The ones that go hand-in-hand with hyperthyroidism include the following: Chronic nervousness or irritability, fatigue, muscle weakness, heat intolerance, insomnia, tremors, arrhythmia, diarrhea, weight loss, mood swings, and developing a goiter or swollen neck, and difficulty breathing or swallowing.

As far as hypothyroidism is concerned, the most commonly reported symptoms to include the following: chronic fatigue, weight gain, a puffy face, cold intolerance,  muscle, and joint pain, constipation, dry skin, thinning hair, anhidrosis, Heavy or irregular menstrual periods, fertility issues in women, depression, and  bradycardia

Endocrinologists in Tampa Discuss Using Prescription Drugs to Treat Thyroid-Related Disorders

Thyroid hormone drugs can effectively treat hyperthyroidism. Some of the ones that physicians in Tampa, FL, including Dr. Pedro Troya, an endocrinology expert with Bay Area Endocrinology Associates in Tampa, Florida, prescribe the most include:

Methimazole (Tapazole) and propylthiouracil (PTU) – These particular drugs work by inhibiting the secretion of excessive amounts of t4 and t3 hormones. For this reason, they are among the go-to drugs for treating hyperthyroidism.

Radioactive iodine – Another go-to medication used to combat hyperthyroidism and the related symptoms is radioactive iodine. This medication works by destroying excessive t4 and t3 hormones and shrinking the overall size of an individual’s thyroid gland.

Beta-blockers – Although they are probably not the first drugs to come to mind for combating hyperthyroidism, they do work for that purpose, according to a study published by Cleveland Clinic. Along with being an excellent class of drugs for reducing high blood pressure, beta-blockers can help ease the tremors, rapid heartbeat, shakiness, and other symptoms associated with hyperthyroidism.

All of these treatment modalities to combat hyperthyroidism can sometimes cause side effects. Some of the ones commonly reported include developing a rash, itchy skin, unusual hair loss, and fever.

How Are Drugs Prescribed to Treat Hyperthyroidism Administered?

Methimazole, propylthiouracil, radioactive iodine, and beta-blockers are all taken orally, and they are generally safe when taken as prescribed by a physician. Studies show Methimazole and propylthiouracil, specifically, can reduce T4 and T3 hormone levels within 6 to 12 weeks. And most people also report experiencing relief from their hyperthyroidism symptoms. As far as radioactive iodine is concerned, most people will see a drop in their T4 and T3 levels within 1 to 3 months of being on the medication. Throughout that time, their struggles with hyperthyroidism symptoms will start to lessen. Beta-blockers work the fastest; studies show that individuals taking Propranolol and similar beta-blockers see a drop in T4 and T3 levels within minutes of administration, not to mention a noticeable easing of symptoms associated with hyperthyroidism.

Medications to Treat Hypothyroidism

Treating hypothyroidism typically entails using prescription-based drugs to replace T4 and T3 hormones that the body can no longer produce naturally. These hormone replacement drugs, available in tablet, capsule, and injectable form, might include Levoxyl, Synthroid, Tirosint, Unithroid, Unithroid Direct, and the generic levothyroxine. Studies show most individuals will see positive results in their hormone levels and experience relief from hypothyroidism symptoms within 6 to 8 weeks. That said, some unpleasant side effects can stem from taking levothyroxine and other hormone drugs, including unintended weight gain or weight loss, headache, vomiting and diarrhea, changes in appetite, and fever

All in all, thyroid-related disorders are rare, but they can be a nightmarish experience for those living with them. If you’re experiencing any of the symptoms detailed in this article, you’re encouraged to contact Bay Area Endocrinology Associates today.

Everything You Need To Know About Endocrine Glands

How do cells communicate? How do cells influence the functions of other cells? The answer is simple. Hormones. Hormones are the main signaling molecules for the cell. Hormones are secreted from sites known as glands. There are two types of glands, depending on how the glands secrete their contents. The principal types of glands are endocrine and exocrine glands.

What Are Endocrine Glands?

Endocrine glands are body glands that secrete directly into the bloodstream. This is quite unlike exocrine glands, which secrete through a system of ducts onto an epithelial surface. Examples of epithelial surfaces are the skin and linings of hollow organs such as the stomach and intestines.

Examples Of Endocrine Glands

There are many endocrine glands in the body, primarily because of their vast functions. These glands can be found in the head, neck, thorax, abdomen, and other organs. However, their unique feature is that they are never too far from vascular bundles (veins and arteries).

Endocrine glands include:

The Pituitary Gland

The pituitary gland is the master endocrine gland and is found in the brain. It secretes many hormones, responsible for many functions ranging from metabolism to mood regulation and even sexual reproduction. The hormones secreted by the pituitary gland include:

• Growth hormones
• Adrenaline hormone
• Follicle-stimulating hormone
• Thyroid-stimulating hormone
• Oxytocin
• Dopamine
• Luteinizing hormone

There are many more hormones secreted by this crucial gland, and in addition to this, it has indirect influences on the secretion of other hormones by other glands.

Hypothalamus

The hypothalamus is another endocrine gland in the human body. Many of its functions are geared towards ensuring the maintenance of a constant internal environment in the body -homeostasis- and controlling other glands in the brain that are closely related to it. It produces the corticotrophin-releasing hormone, somatostatin, antidiuretic hormone, and many other hormones.

The Thyroid Gland

The thyroid gland directly influences the body’s metabolic activities. The hormone secreted by the thyroid gland is the thyroid hormone, which has an antagonist produced by the parathyroid gland, the parathyroid hormone. Regulation of temperature and internal energy levels by catabolism are a few of the many functions of this hormone.

Pineal Gland

Ever wondered where the sudden urge to sleep comes from? Fatigue might be generated after a long day’s work, but the sun’s setting slowly directs the brain to shut down temporarily even in its absence. This phenomenon can be credited to a relatively small gland known as the pineal gland in the brain. It is considered among the major glands in the human body.

The Pancreas

The pancreas has functions in the lower part of the digestive system, more specifically in the stomach and small intestines. It is considered a component of the gastrointestinal tract, but because of the obvious absence of ducts delivering hormones to the target locations, it is considered an endocrine gland. The pancreas secretes hormones such as insulin and glucagon, which play a pivotal role in regulating blood sugar levels.

There are many more glands in the human body, some small in size, while others have a relatively larger size. However, they are all equally important and are all necessary for maintaining the overall equilibrium of normal body functions. An imbalance in the amount of hormone secreted by these glands or impairment of the glands themselves could lead to a cascade of undesired effects.

Functions Of Endocrine Glands in The Human Body

Endocrine glands, as seen above, have several functions in the body. They serve to regulate different environments in the cells and have a role to play in many other metabolic pathways. The general functions of endocrine glands include:

Hormone Secretion

Arguably the most important function, all endocrine glands secrete hormones into the bloodstream. These glands have the capacity to manufacture, store and secrete hormones whenever the body requires them. The brain controls the secretion of these hormones throughout an individual’s life, some fluctuating on monthly cycles, such as the hormones responsible for the menstrual cycle. In contrast, others like testosterone fluctuate over longer periods. The study of endocrine glands is called Endocrinology

Response to Nervous Stimuli

The changes taking place within the gland leading to the eventual secretion of the hormones are under constant nervous regulation. Everything is regulated by the central nervous system by neurons terminating in the endocrine glands from the manufacture to the packaging. In this manner, the brain influences the activity of the endocrine glands ensuring hormone levels are maintained within acceptable levels.

In conclusion, the endocrine gland has many functions and influences on the human body. They are essential for all routine activities through their secretions, which are hormones. Hormones can be steroids or long chains of blocks of amino acids. The hormones from endocrine glands are transmitted via the bloodstream and affect target cells by binding to receptors specific to a single hormone. If you suspect you are suffering from hormone impairment in Tampa, it is imperative that you seek assistance from an endocrinologist.

There are different examples of endocrine glands, but each is essential in its unique way and function to sustain life.

In the United States, thyroid disease affects an estimated 20 million people. Issues with your energy levels, sleep, and appetite are all common when this gland is not functioning properly. This vital hormone gland plays a critical role in ensuring that multiple body functions are regulated. If you are having symptoms that indicate a thyroid issue, it is important to understand the tests that your doctor may recommend and why they are important so that you can take an active role in your health.

Hyperthyroidism and Hypothyroidism
If any blood tests are abnormal, it could indicate that your gland is either overactive (hyperthyroidism) or underactive (hypothyroidism). Both of these conditions require medical treatment due to the impact that they have on your health and daily living.

With hypothyroidism, your body sort of just slows down due to not getting adequate amounts of hormones from the gland. This can result in symptoms, such as:

-Fatigue
-Constipation
-Brain fog
-Weight gain
-Dry hair and skin
-Digestive issues

On the other hand, with hyperthyroidism, your body is essentially sped up. This can occur when your body is not getting the proper balance of hormones that this gland produces. With hyperthyroidism, symptoms can include:

-Nervousness and anxiety
-Weight loss
-Shaking
-Feeling overheated or too hot
-Hair loss
-Irregular menstrual cycles
-Hyperactivity

For some people, this gland is just overactive or underactive. However, for others, one of these issues stems from a different medical problem. For example, people with Graves’ disease often have hyperthyroidism, and those with Hashimoto’s disease experience hypothyroidism.

In the US, hypothyroidism is the most common of these issues. However, it is possible for someone to be overactive at some point in life and then become underactive, and vice versa. Because of the complexities of this gland and the hormones that it produces, it is critical to work with an experienced doctor for a diagnosis and proper treatment.

Free T4 Test
The free T4 test looks at levels of thyroxine hormone in your blood. Whether there is too little or too much this indicates that this gland is not functioning properly. If your thyroid-stimulating hormone (TSH) levels are abnormal, your doctor might recommend a free T4 test.

In adults, the normal range for this test is 0.8 to 1.8 ng/dL. If your levels are too high, this could indicate hyperthyroidism. When levels are too low, this could mean that you have hypothyroidism.

To test your free T4 levels, your doctor will obtain a blood sample. You do not have to do any special preparation for this test. However, since certain factors can affect your results, make sure that your doctor knows about your medical and medication histories. For example, the medication phenobarbital and conditions, such as cirrhosis of the liver and chronic renal failure, may alter your results.

Free T3 Test
The free T3 test is used to look at the levels of the triiodothyronine hormone levels in your blood. In most cases, this test is recommended when your doctor suspects hyperthyroidism. Your endocrinologist will likely order this test along with TSH and free T4 tests.

In adults, the normal range for this test is 0.2 to 0.5 ng/dL. If your doctor does abound T3 along with a free T3, the normal range is 75 to 195 ng/dL,

A blood sample is necessary to test your free T3 levels. You do not need to do anything special to prepare for this test. However, it is important that your doctor is aware of your medication and medical history since there are some things that could affect your results. For example, eating a lot of foods high in iodine, or taking methadone or estrogen can alter your test results.

Reverse T3 Test
The reverse T3 blood test looks at the inactive form of the triiodothyronine (T3) hormone. If your body is under a lot of stress, this can trigger the production of reverse T3. For example, a serious injury, insulin-dependent diabetes, malnutrition and kidney or liver disease.

Your doctor will draw some blood to test your reverse T3 levels. In many cases, if they are testing your reverse T3 levels, they will also order a free T4 test since the metabolism of T4 is what produces reverse T3.

Your test results are considered normal when they range from 10 to 24 ng/dL. There is no special preparation before this blood test. If your levels are too high, this could indicate that you have hypothyroidism.

Healthy thyroid function is critical for both health and general well-being. If you are having symptoms that indicate an issue with this gland, talk to your doctor about having testing performed. The endocrinologists at Bay Area Endocrinology Associates offer multiple locations throughout Tampa to ensure convenient access when you need it.

Thyroid ultrasound is a diagnostic imaging technique that uses high-frequency sound waves to create an image of the thyroid. It is a gland located in your neck that secretes hormones that help control heart rate, blood pressure, body temperature, breathing, digestion, and weight. It is used to help identify swelling or enlargement of the gland.

Why Do I Need Ultrasonography?

The ultrasound identifies the cause of swelling or enlargement of the thyroid-gland. The ultrasound can help determine whether the gland enlarges due to a fluid-filled cyst or inflammation. Also, it helps to identify nodules, abnormal masses, and other thyroid-abnormalities. It would be best to visit any of our facilities in tampa, to consult a qualified doctor. Our medical personnel can perform ultrasounds, biopsies, and lab services. Also, we treat complex metabolic conditions like diabetes and obesity. For obesity, we have a comprehensive weight loss program.

Role of Ultrasonography in Thyroid-Disease

The ultrasound works to:

• diagnose and monitor treatment of thyroid-cancer or goiter – makes it possible to detect and manage abnormal growth in the gland (a nodule, tumor, cyst).
• Help diagnose another condition that affects the gland, such as infection or inflammation.

What Are the Risks of an Ultrasound?

No radiation remains in a person’s body from the ultrasound procedure. Risks associated with exposure to high-intensity sound waves during an ultrasound include:

• No radiation remains in a person’s body from an ultrasound exam.
• There are no known long-term risks associated with diagnostic levels of ultrasound.
• Pain, brief discomfort, or mild irritation where the transducer is placed on your neck, if a person has inflamed tissues due to thyroiditis
• Bruising at the site of the ultrasound

Preparing for the Ultrasound

Your endocrinologist will explain the procedure and offer you the chance to ask questions about the possible risks and benefits.

You should let them know if you:

• have a pacemaker or any other implanted medical devices
• have concerns about anesthesia (numbing medication) and want to discuss the options with your anesthesiologist

What Should Tell My Doctor?

Explain any allergies, including drug allergies you have. Let them know if you have anything that might interfere with imaging, such as metal objects in your body. Discuss past surgeries and procedures. Tell them about medications you take, including prescription and over-the-counter medicine, herbs, vitamins, and supplements. Diagnostic tests may be recommended to help determine the cause of a thyroid disorder.

What Do I Need To Do?

You will be asked to sign a consent form that permits the procedure. Read the form carefully and ask questions if anything is not clear. Tell them about your past and current health history, including recent illnesses, accidents, or trauma. Let them know if you have had any anesthesia in the past and how long it has been since you had surgery or anesthesia. Also, inform the physician if you are pregnant or suspect that you may be pregnant. You can refuse treatment at any time during this process by saying “no” or refusing to sign the consent form.

How Is Ultrasonography Conducted?

The ultrasound is done in a doctor’s office or an outpatient center. If necessary, the doctor may do the test as an outpatient at a hospital or ambulatory clinic. The free-standing facility works for high-risk patients with difficult imaging studies or more complex procedures. The sonographer applies a conductive gel to the transducer and then presses it against your skin. You may feel pressure as they move it or discomfort when applying the gel, but the procedure is typically not painful for most people. Do not eat anything for four hours before having this test performed. Make sure you drink plenty of fluids before the test. Wear comfortable clothing for your exam. You may be asked to wear a gown.

The Different Types of Ultrasounds

Several types of thyroid-ultrasounds may be done based on your specific medical needs, including:

• Thyroid-sonogram – if your health care provider suspects you have a nodule or abnormal growth in the thyroid-gland. A sonogram can also help detect fluid around the thyroid-gland (cyst or goiter).
• Follicular imaging – sometimes done if you have hyperthyroidism.
• Thyroid-vascular imaging – helps the endocrinologist assess the vascular supply to the thyroid-gland. A thyroid-vascular ultrasound may check for abnormal blood flow in or near the thyroid-gland.

Who Will Help You Understand Thyroid-Ultrasound Results?

A radiologist interprets your thyroid-ultrasound. This is a doctor who specializes in giving and interpreting diagnostic imaging studies. They will send their written report to your physician or health care provider within 24 hours of completing the test.

Normal: The ultrasound shows a smooth, soft gland without any nodules, cysts, or asymmetry and normal vascular pattern and compressibility.

Unusual: The ultrasound reveals the gland’s nodules, cysts, or asymmetry and an abnormal vascular pattern.

How You Will Get Your Results

Your health care provider will contact you with your test results within 24 hours. If needed, you will be scheduled for further testing or additional procedures at that time. If you have a follow-up appointment with your healthcare provider, be sure to tell the staff that you had an ultrasound and when. Now that you understand ultrasonography and our services you can visit our facilities in Tampa, Florida for more information. We have many offices around this area for your convenience. Contact us. We will be more than happy to talk to you.

The thyroid gland lives in the front of the neck. A diseased gland may become inflamed and swollen. Because an enlarged gland can impede breathing and swallowing, getting tested as soon as you notice any change in the gland is critical.

Signs There May Be A Problem With Your Endocrine System

Symptoms of a diseased gland can include a variety of conditions.

You may notice

• a change in your weight for no reason
• a change in your skin condition
• a change in your mood, from feeling agitated to feeling depressed
• constantly feeling worn out
• always being too hot or too cold
• an irregular menstrual cycle

If you are feeling tired and your period stops, the first assumption is that you may be pregnant. In addition to getting a pregnancy test, you will probably also want to get your gland checked so you can get in front of any illness or imbalances that need to be addressed quickly.

How an Endocrinologist Checks Your Glands

When you go in for a hormone test, you can expect to undergo a blood draw. This gland secretes the hormones thyroxine (T4) and triiodothyronine (T3). This illness can impact your body weight and your menstrual cycle, but it can also impact the regularity of your heartbeat.

In the event that your gland is overactive or underactive, you will need to have the gland itself scanned. Because the easiest way to look at the gland is to highlight the tissue with a radioactive product, your fertility status will need to be checked first. If you are currently breastfeeding, pregnant, or planning a pregnancy, you are not a good candidate for any radioactive product.

The Scan Procedure

The scan procedure requires that you receive a radionuclide. Once ingested or injected, this radionuclide will embed itself in your gland so the gland will show up in a nuclear scan.

The risk to a woman who is pregnant is that there is a possibility that the radionuclide will cross the placental barrier. While changing up the dosages and extending the scan time can reduce the risk of breaching the placental barrier, avoiding this treatment unless absolutely necessary is wisest.

Radio Line Treatment

In the event that your gland is found to be diseased, cancerous, overactive or underactive, you may need to have radioiodine treatment to destroy the gland to avoid more serious disease in the future.

Radioiodine treatment is taken as a liquid or a capsule. The process of killing off the thyroid gland can take up to six months, so it is critical that you discuss your fertility plans with your endocrinologist before you undergo this treatment. The radioactive material will stay in your tissues for an extended time and may pass through the placental barrier should you become pregnant. This therapy is also not recommended for a woman who is breastfeeding.

Pregnancy Risks

One of the biggest risks in determining the best treatment for glandular disease is the chance of missing an undetected pregnancy in the earliest stages. When discussing your symptoms with your physician, carefully review your calendar to make certain there is no risk of an early stage pregnancy. Your Tampa endocrinologist can help you schedule a test to be absolutely certain.

For adolescent women under the care of a parent, the ability to have a frank conversation with your physician may be a worry. If your physician recommends the test as a matter of course, take it so you can be sure.

Other Glandular Connections

It is also possible that a problem with your thyroid is connected to other glandular concerns. The pituitary gland tells the other gland to release T3 and T4. When T3 rates go up, the pituitary gland is informed that it needs to back off stimulating hormone production. Any breakdown in that communication loop can lead to too much or too little hormone production.

One step further up the line is the hypothalamus. The hypothalamus is not a gland, but is the core of your brainstem. This primitive region of the brain is closely tied to the function of your responses to emotional stress, such as the panic response or the fight or flight response.

In the event that the hypothalamus is not functioning well, or the pituitary gland is not transmitting the right data, this critical gland could appear to the cause of the problem. A blood test will probably not be enough to track down the source of your condition.

In the event that your hormone levels are not within normal levels, you will need to get additional testing done. If you are of child-bearing age, take the opportunity to get a pregnancy test to avoid the risk of transmitting radiation across the placental barrier to the fetus.

Cytology adequacy assessment is the process of determining if a specimen meets the requirements defined by law for adequate cellularity. If a specimen does not meet these requirements, it may be rejected and/or re-examined.

Adequate cellularity consists of two components: appropriate numbers of cells for adequate interpretation and the presence of both squamous epithelial cells (SCC) and endocervical cells. The first assessment is made using the microscopic evaluation, while the second can only be ascertained by taking a cytology brush specimen from an area that has not been previously sampled.

This article will include what cytology adequacy assessment is, why cytology inadequacy assessment occurs, and some examples of this in practice.

What is Cytology Adequacy Assessment?

Adequacy assessment is the process of determining if a specimen meets the requirements defined by law for adequate cellularity. If a specimen does not meet these requirements, it may be rejected and/or requalified. Adequate cellularity has two components: appropriate numbers of cells for adequate interpretation and the presence of both squamous epithelial cells (SCC) and endocervical cells.

The first assessment is made using the microscopic evaluation, while the second can only be ascertained by taking a cytology brush specimen from an area that has not been previously sampled. This article will include what cytology adequacy assessment is, why cytology inadequacy assessment occurs, and some examples of this in practice.

Cytology Adequacy Assessment for the Thyroid

Cytology adequacy assessment is used in various ways for all types of fine-needle aspiration biopsies, including some which are not yet standardized, such as thyroid FNAB performed by an endocrinologist. The use of cytology adequacy assessment is most commonly associated with the evaluation for malignancy, where any tumor cells present must be adequately sampled to allow the pathologist to make an accurate diagnosis. Small amounts of neoplastic cells or relatively poor cellularity may preclude an adequate sample from being taken. Cytologic adequacy assessment is also used when there is a question of contamination.

Contamination can be present in a FNAB when there are cells that appear to be benign on cytology but could represent a hematogenous spread of malignant cells from another site. In this case, further evaluation (fine needle aspiration or open biopsy) is warranted to evaluate for the presence of cancer. However, in some instances, it could also occur due to inadequate specimen cellularity if the sample has not been taken high enough into the gland. This results in an interpretation that does not accurately reflect the true tumor extent, and treatment decisions may be based on incorrect information leading to unnecessary surgeries or radiation therapy.

Cytology adequacy assessment is performed by looking at both endocervical and squamous epithelial cells. Therefore, the specimen should include both cells from the uterine cervix and thyroid gland for evaluation of adequacy. In addition to looking at the adequacy of cellularity, one must also evaluate the extent of sampling concerning needle tract length (the distance between initial puncture site and final location where tissue is collected) within the gland as well as the position of needle tip when collecting sample.

How is the Procedure Performed?

To evaluate for adequacy, the cytologist in Tampa must assess the amount of aspirate collected and the number of cells present in an adequate sample. The technologist will note if there was an adequate amount of fluid obtained and also count how many cells are present on a slide at low power. If the amount of fluid is inadequate, another cell block may be prepared from the same area and submitted for evaluation.

The second assessment involves the interpretation of endocervical cells as well as squamous epithelial cells (SCC). Looking for both SCC and cervical epithelium allows identification of non-epithelial contaminants within FNAB specimens, which could be misdiagnosed as malignancies. Looking specifically for SCC has been shown to be more accurate than looking at all squamous epithelial cells, as SCC makes up only about 20% of the total squamous population.

The presence of cervical endocervical and glandular tissue is also important for the evaluation of adequacy in cervical cancer biopsies, though some institutions evaluate adequacy using cellularity alone.

Limitations:

There are limitations with cytology adequacy assessment which include the fact that it can only be used for evaluable specimens. Therefore not all patients will have their specimen reviewed by a pathologist trained or experienced in stringent criteria required for adequate criteria. In addition, this review is not performed in every institution, and there exists variation between different medical facilities on the interpretation of; adequate, adequate with modification, or inadequate categories. The adequacy rating also does not take into account the presence of nodules which may have significant risk for malignancy, and therefore additional evaluation and follow-up would be needed for patients with these findings.

If low cellularity is present in a suspected malignant FNAB, it is likely due to sampling error as opposed to a true tumor defect. However, if SCCs are identified, this could indicate a hematogenous spread of neoplastic cells from cervical or upper aerodigestive tract sites. Furthermore, cytology adequacy assessment cannot assess adequacy using frozen sectioned tissue, so it does not give an accurate interpretation of sampled areas when dealing with patients who had previously undergone surgery.

In summary, cytology adequacy assessment is a tool used to evaluate whether the sample was collected high enough in the gland, whether it was collected long enough (the needle tract), and how many cells were adequate for interpretation of diagnosis and clinical management.

No single assessment criterion or rating system can completely replace the pathologist’s visual examination of adequacy during the evaluation of FNAB specimens. However, having this information available as an adjunct to clinical and radiologic features as well as pathology allows for a complete review. The physician should also be made aware that no guidelines have been established for frozen section adequacy, but some studies have shown that cytology adequacy assessment using frozen sections gives similar evaluations to those obtained from formalin-fixed tissues.

Reference:

Bomeli, S. R., LeBeau, S. O., & Ferris, R. L. (2010, April). Evaluation of a thyroid nodule. Otolaryngologic clinics of North America. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2879398/.