Sheila D. Waller, FNP, MS, CRNP

Although biopsy is most often associated with cancer, it can also be used to check for other diseases, such as infections. A biopsy sample can be scraped, cut, collected with a needle, taken with a machine that punches out a tiny piece, or removed with the tiny tools in an endoscope.

In most cases, a biopsy is a simple outpatient procedure. Depending on the procedure, patients may need to stop taking certain medications beforehand, such as blood thinners. It is important for patients to tell doctors if they are pregnant, as certain biopsies require the use of x-rays to guide the needle to the right location. There is usually very little pain associated with a biopsy. Patients will have to wait a few days to hear the results.

Flaps are used to reconstruct large or deep wounds, as well repair physical deformities. For example, some nasal defects can be corrected using forehead flaps. Another common procedure that uses flaps is breast reconstruction, which is surgery to restore the appearance of the breast after mastectomy (breast removal). The ability to use musculocutaneous tissue makes flaps ideal for this type of reconstructive surgery. In addition, the included blood supply in flaps brings needed oxygen and nutrients to the recipient site, promoting healing.

During flap surgery, an enormous amount of attention needs to be paid to the blood vessels (arteries, veins, and capillaries). To retain the flap's blood supply, the surgeon might form a pedicle, which is a bridge of tissue and blood vessels that connects the flap to the site it originates from. The flap is connected to its blood supply through this pedicle. It is removed only after the surgical team has made sure that the flap has healed enough to survive without it. This type of flap is called a pedicled flap.

Blood vessels may also be detached from the flap when it is harvested, and then reattached at the new location. Since the flap is not pedicled to its donor site, it is referred to as a free flap. To be able to connect blood vessels with accuracy, surgeons must use very tiny tools and special microscopes. For this reason, this type of flap reconstruction is also often called microvascular flap surgery. One advantage of free or microvascular flaps is that they are ideal for repairing larger areas, like an extensive wound or defect on the leg.

Depending on how involved a patient's flap reconstruction is, they may have to stay in the hospital for several days after the procedure. It may take six to eight weeks for the incisions to heal, and a year or more for the scars to fully fade.

Both hypothyroidism and goiters are caused by an autoimmune reaction where the body produces antibodies that attack the thyroid cells for unknown reasons. The thyroid reacts by releasing too little or too much T3 and T4 thyroid hormones, impairing thyroid function and causing irregular metabolism. Goiters develop from the autoimmune reaction causing continued antibody damage to the thyroid over time. Thyroid goiters are large, swollen lumps that can be felt near the base of the neck. Obstructive goiters can cause pain, coughing, and abnormal breathing. Hypothyroidism may also be caused by iodine deficiency, as iodine is needed to produce thyroid hormones.

The exact cause of thyroid cancer and thyroid nodules or cysts is unknown. While thyroid cancer and thyroid nodules or cysts can occur in individuals with thyroid disorders, they are not associated with a malfunctioning thyroid.

Physicians may prescribe thyroid surgery if blood tests reveal patients' thyroid stimulating hormones (TSA) are outside of the acceptable range, indicating a malfunctioning thyroid. Thyroid biopsies (tissue samples) and tests for thyroid-attacking antibodies are also criteria for surgery.

An ENT or general surgeon performs thyroid surgery. While a patient is placed under anesthesia, the surgeon makes an incision at the center of the neck and removes the thyroid gland. Two alternative methods of thyroid surgery are transoral (incision through the mouth) and endoscopic, where a surgeon operates a video camera for live footage to help guide the removal process.

Thyroid surgery requires minimal aftercare. Most patients recover quickly and resume normal activities within a few days of surgery. However, thyroid surgery patients must take daily synthetic thyroid medication (levothyroxine) for life to replace their removed thyroid.