Hypothyroidism Ultrasound: What You Need to Know Now!

Understanding Hypothyroidism and the Role of Ultrasound

Hypothyroidism, a condition characterized by an underactive thyroid gland, impacts millions worldwide. The thyroid, a small butterfly-shaped gland located at the base of the neck, plays a crucial role in regulating metabolism, energy levels, and overall bodily functions. When the thyroid fails to produce sufficient thyroid hormones, a cascade of adverse effects can ripple through the body.

This article aims to shed light on hypothyroidism, its impact on the thyroid gland, and the invaluable role of ultrasound as a diagnostic tool. It will equip you with the fundamental knowledge needed to understand this condition and the steps involved in its diagnosis.

Defining Hypothyroidism and Its Origins

Hypothyroidism occurs when the thyroid gland doesn’t produce enough thyroid hormones, primarily thyroxine (T4) and triiodothyronine (T3). These hormones are essential for regulating metabolism, which is the process by which the body converts food into energy.

Several factors can contribute to the development of hypothyroidism:

• Hashimoto’s thyroiditis: This autoimmune disorder is the most common cause of hypothyroidism. In Hashimoto’s, the immune system mistakenly attacks the thyroid gland, leading to chronic inflammation and reduced hormone production.

• Iodine deficiency: Iodine is a crucial component of thyroid hormones. Insufficient iodine intake can impair thyroid hormone production, leading to hypothyroidism. Although less common in developed countries due to iodized salt, it remains a significant concern globally.

• Thyroiditis: Inflammation of the thyroid gland, often caused by a viral infection or postpartum hormonal changes, can temporarily or permanently damage the thyroid and lead to hypothyroidism.

• Medications: Certain medications, such as lithium and amiodarone, can interfere with thyroid hormone production or function.

• Radiation therapy: Radiation treatment to the head or neck, often used for cancer, can damage the thyroid gland.

The Thyroid Gland: Function and Hypothyroid Impact

The thyroid gland, though small, wields significant influence over nearly every organ system in the body. It produces thyroid hormones, primarily T4 and T3, which regulate:

• Metabolic rate: Thyroid hormones control how quickly the body burns calories and uses energy.

• Heart rate and blood pressure: They influence cardiovascular function, ensuring adequate blood flow and oxygen delivery.

• Body temperature: Thyroid hormones contribute to maintaining a stable body temperature.

• Growth and development: They are crucial for normal growth and development, especially in children.

When hypothyroidism develops, the lack of thyroid hormones disrupts these vital functions. This can lead to a wide range of symptoms, including fatigue, weight gain, constipation, dry skin, hair loss, and depression. In severe cases, untreated hypothyroidism can lead to life-threatening complications.

Ultrasound: A Non-Invasive Window into the Thyroid

Ultrasound imaging has become an indispensable tool in evaluating the thyroid gland. It is a non-invasive, painless, and readily available imaging technique that uses high-frequency sound waves to create real-time images of the thyroid.

The ultrasound probe emits sound waves that bounce off the thyroid gland. These echoes are then processed by a computer to create detailed images of the thyroid’s structure.

Ultrasound allows doctors to:

• Assess the size and shape of the thyroid gland: Detecting enlargement (goiter) or asymmetry.

• Identify thyroid nodules: Characterizing their size, location, and internal composition (solid, cystic, or mixed).

• Evaluate the texture of the thyroid gland: Identifying patterns suggestive of autoimmune thyroiditis (Hashimoto’s).

• Guide fine needle aspiration (FNA) biopsies: Ensuring accurate sampling of suspicious nodules.

Overview of Key Thyroid Conditions

Throughout this article, we will delve into the role of ultrasound in assessing various thyroid conditions, including:

• Thyroid nodules: These are common growths within the thyroid gland, most of which are benign. Ultrasound helps determine which nodules require further investigation.

• Hashimoto’s thyroiditis: Ultrasound can reveal characteristic features of this autoimmune condition, such as an enlarged thyroid with a heterogeneous texture.

• Goiter: An enlarged thyroid gland, which can be caused by various factors, including iodine deficiency, Hashimoto’s, and thyroid nodules.

• Thyroid cancer: While relatively rare, ultrasound plays a critical role in identifying suspicious nodules that may require biopsy to rule out malignancy.

Hashimoto’s thyroiditis, iodine deficiency, and other factors we’ve discussed can disrupt the delicate balance of thyroid hormone production. But how do you know if your thyroid is underperforming? And what role does ultrasound play in uncovering these hidden issues?

Why Your Doctor Might Recommend a Thyroid Ultrasound

A thyroid ultrasound is a non-invasive imaging technique that uses sound waves to create a detailed picture of your thyroid gland. But what prompts a doctor to recommend this particular test? The decision to order a thyroid ultrasound is usually based on a combination of factors, including your symptoms, physical examination findings, and your medical history.

Recognizing the Red Flags: Symptoms that Warrant an Ultrasound

Hypothyroidism can manifest in a variety of ways, and the symptoms can often be subtle and easily attributed to other causes. Because of this, a physician might recommend a thyroid ultrasound as part of a more thorough diagnostic approach. Common symptoms that may warrant further investigation with ultrasound include:

• Unexplained fatigue: Persistent tiredness despite adequate rest is a hallmark of hypothyroidism.

• Weight gain: Difficulty losing weight or unexplained weight gain can signal a sluggish metabolism due to low thyroid hormone levels.

• Constipation: Reduced bowel movements and constipation are often associated with hypothyroidism.

• Dry skin and hair: These can indicate a decrease in metabolic activity affecting skin and hair health.

• Sensitivity to cold: Feeling unusually cold, even in warm environments, suggests impaired thermoregulation.

• Muscle aches and stiffness: These musculoskeletal symptoms may arise from decreased energy production in muscles.

If you experience several of these symptoms, it’s important to consult your doctor. They may order a thyroid ultrasound to assess the structure of your thyroid gland and rule out any underlying abnormalities.

Detecting Nodules and Goiters: Visual Clues for Diagnosis

One of the primary reasons for ordering a thyroid ultrasound is to investigate the presence of thyroid nodules or a goiter.

A thyroid nodule is an abnormal growth or lump within the thyroid gland. Nodules are quite common, and most are benign (non-cancerous). However, some nodules may be cancerous or require further evaluation.

A goiter refers to an enlargement of the thyroid gland. Goiters can occur in people with normal thyroid function, hypothyroidism, or hyperthyroidism. An ultrasound can help determine the size and characteristics of a goiter, and identify any nodules within it.

The ultrasound provides detailed images that help distinguish between solid and cystic nodules and also assess their size, shape, and location. These characteristics are crucial for determining the risk of malignancy and guiding further management.

Monitoring Hashimoto’s Thyroiditis: A Proactive Approach

For individuals diagnosed with Hashimoto’s thyroiditis, regular thyroid ultrasounds play a vital role in monitoring the progression of the disease and assessing the overall health of the thyroid gland.

In Hashimoto’s, the immune system attacks the thyroid, leading to chronic inflammation and gradual destruction of thyroid tissue. Ultrasound can help visualize these changes, including:

• Changes in thyroid size: The thyroid may initially enlarge (goiter) before shrinking over time as the disease progresses.

• Changes in echotexture: The normal homogeneous texture of the thyroid gland can become heterogeneous due to inflammation and fibrosis.

• Nodule development: Hashimoto’s thyroiditis increases the risk of developing thyroid nodules, which can be monitored with ultrasound.

Regular ultrasound monitoring allows doctors to detect any changes early on and adjust treatment plans accordingly.

Early Detection: A Cornerstone of Effective Management

The significance of early detection in managing hypothyroidism cannot be overstated. Early diagnosis and treatment can help prevent or minimize the long-term complications of the condition.

Thyroid ultrasound plays a crucial role in this process by:

• Identifying subtle abnormalities that may not be detected during a physical examination.

• Guiding further diagnostic tests, such as fine needle aspiration (FNA) biopsy, when necessary.

• Providing a baseline for monitoring the effectiveness of treatment.

By enabling early detection and accurate diagnosis, thyroid ultrasound empowers healthcare professionals to provide timely and effective management of hypothyroidism, improving patient outcomes and quality of life.

Hashimoto’s thyroiditis, iodine deficiency, and other factors we’ve discussed can disrupt the delicate balance of thyroid hormone production. But how do you know if your thyroid is underperforming? And what role does ultrasound play in uncovering these hidden issues?

Understanding the Ultrasound Procedure: What to Expect

The prospect of any medical procedure can understandably cause anxiety. A thyroid ultrasound, however, is a straightforward and generally comfortable examination. Understanding what to expect can significantly alleviate any concerns you might have and allow you to approach the test with confidence. Let’s walk through the process, step by step.

Before the Ultrasound: Minimal Preparation Required

One of the benefits of a thyroid ultrasound is the minimal preparation involved. In most cases, no special preparation is required before the examination. You can typically eat, drink, and take medications as usual.

Your doctor might advise you to remove any jewelry or clothing that could interfere with the ultrasound, such as necklaces or high-collared shirts.

It’s always a good idea to inform the technician about any medications you are taking or any pre-existing medical conditions. This ensures they have a complete picture of your health profile.

During the Ultrasound: A Simple and Painless Process

The ultrasound procedure itself is relatively quick and painless, usually taking between 15 to 30 minutes. Here’s what you can anticipate during the examination:

1. Positioning: You will likely be asked to lie on your back on an examination table. A pillow may be placed under your shoulders to extend your neck, providing better access to the thyroid gland.

2. Gel Application: A clear, water-based gel will be applied to the skin over your neck. This gel acts as a conductor, allowing sound waves to travel effectively between the ultrasound transducer and your skin.

3. Transducer Movement: The technician will gently move a small, handheld device called a transducer over the area. The transducer emits high-frequency sound waves that bounce off the thyroid gland. These echoes are then processed to create a real-time image on a monitor.

4. Image Acquisition: The technician will carefully scan your thyroid from multiple angles, capturing images of its size, shape, and any abnormalities. You might feel slight pressure from the transducer, but the procedure should not be painful.

5. Doppler Assessment: In some cases, the technician might use Doppler ultrasound to assess blood flow within the thyroid gland or any nodules present. This involves the same process, but the images displayed will highlight blood vessel activity.

The technician may ask you to hold your breath briefly at certain points during the scan. This helps to improve image quality by minimizing movement. Communication is key, so don’t hesitate to let the technician know if you feel any discomfort.

After the Ultrasound: Quick and Easy

Once the ultrasound is complete, the gel will be wiped off your neck. There is no recovery time needed, and you can resume your normal activities immediately. The images from the ultrasound will be reviewed by a radiologist, who will then prepare a report for your doctor.

Comfort and Speed: Minimizing Anxiety

It’s worth reiterating that a thyroid ultrasound is generally a painless and quick procedure. The purpose of understanding the steps involved is to reduce anxiety and ensure you feel prepared and comfortable throughout the examination. If you have any lingering concerns, don’t hesitate to discuss them with your doctor or the ultrasound technician. Being informed is the best way to approach any medical test.

Interpreting Your Ultrasound Results: What the Images Reveal

Having undergone a thyroid ultrasound, you’re likely eager to understand the findings. But how are those grayscale images actually deciphered? Radiologists meticulously analyze various characteristics of the thyroid gland and any nodules present, using specific criteria to assess their nature and potential risk. Understanding these elements can help you better comprehend your ultrasound report and engage in informed discussions with your doctor.

Decoding the Thyroid Gland Itself: Size, Shape, and Texture

The radiologist’s initial assessment focuses on the overall size and shape of the thyroid gland. An enlarged thyroid, known as a goiter, can indicate various underlying conditions, including iodine deficiency or Hashimoto’s thyroiditis.

Beyond size, the texture of the thyroid tissue is carefully examined. A normal thyroid gland typically exhibits a homogenous, uniform appearance on ultrasound.

However, conditions like Hashimoto’s can cause the gland to appear heterogeneous, with varying areas of brightness and darkness, reflecting inflammation and structural changes. These subtle variations in the thyroid’s texture provide valuable clues about its health.

Understanding Thyroid Nodules: A Detailed Examination

If nodules are detected, the ultrasound provides a wealth of information about their characteristics, which are crucial for determining the next steps.

Solid vs. Cystic: Unpacking the Composition

Nodules can be classified as solid, cystic, or mixed. Solid nodules are composed primarily of tissue, while cystic nodules are filled with fluid. Mixed nodules contain both solid and cystic components.

Generally, purely cystic nodules are less likely to be malignant than solid nodules, though this is not always the case. The composition of a nodule is a key factor in the overall risk assessment.

Echogenicity: Gauging Brightness and Density

Echogenicity refers to the nodule’s brightness on the ultrasound image, relative to the surrounding thyroid tissue. Nodules can be described as hyperechoic (brighter), hypoechoic (darker), or isoechoic (similar brightness).

Hypoechoic nodules (darker) are often associated with a higher risk of malignancy compared to hyperechoic or isoechoic nodules. This characteristic is carefully considered along with other features.

Margins: Defining Boundaries

The margins of a nodule – how well-defined its borders are – are another important indicator. Nodules with smooth, well-defined margins are generally more likely to be benign.

Conversely, nodules with irregular or poorly defined margins may raise suspicion for malignancy, as they can indicate invasive growth.

The sharpness and clarity of the nodule’s boundaries are therefore carefully assessed.

Differentiating Benign from Potentially Malignant Nodules

Ultrasound is a powerful tool for distinguishing between benign and potentially malignant thyroid nodules. Radiologists use a combination of the characteristics described above – size, shape, texture, echogenicity, and margins – to assess the overall risk of a nodule.

Certain ultrasound patterns are strongly suggestive of benignity, while others warrant further investigation, such as a fine needle aspiration (FNA) biopsy. Risk stratification systems, like the Thyroid Imaging Reporting and Data System (TI-RADS), are often used to standardize the assessment and guide management decisions. These systems help doctors determine which nodules require biopsy based on their ultrasound appearance.

Doppler Ultrasound: Assessing Blood Flow

Doppler ultrasound is a specialized technique that assesses blood flow within the thyroid gland and nodules. Increased blood flow within a nodule can sometimes be associated with malignancy, as rapidly growing tumors often require a greater blood supply.

However, increased blood flow can also be seen in benign nodules, particularly those that are actively growing. The Doppler findings are therefore interpreted in conjunction with other ultrasound characteristics to provide a comprehensive assessment.

The Role of TSH and Free T4 in Conjunction with Ultrasound

Ultrasound imaging provides a detailed structural snapshot of the thyroid gland, but it’s only one piece of the diagnostic puzzle. To truly understand thyroid function, doctors rely on blood tests that measure thyroid hormone levels, particularly Thyroid Stimulating Hormone (TSH) and Free Thyroxine (Free T4). These hormones work in concert to regulate metabolism, and their levels offer critical insights into whether the thyroid is functioning properly.

Understanding the TSH and Free T4 Connection

TSH, produced by the pituitary gland, acts as the conductor of the thyroid orchestra. When thyroid hormone levels (primarily Free T4) are low, the pituitary releases more TSH to stimulate the thyroid to produce more hormone. Conversely, when Free T4 levels are high, TSH production decreases. This feedback loop ensures that the body maintains a stable level of thyroid hormones.

In hypothyroidism, the thyroid gland isn’t producing enough thyroid hormone. As a result, Free T4 levels are low, and TSH levels are elevated as the pituitary tries to compensate for the deficiency. Therefore, elevated TSH is often the first indicator of hypothyroidism, prompting further investigation.

Confirming Hypothyroidism with Hormone Levels

While ultrasound can reveal structural abnormalities like nodules or an enlarged thyroid, hormone levels are essential for confirming a diagnosis of hypothyroidism. A consistently elevated TSH level, coupled with a low Free T4 level, definitively indicates that the thyroid gland is underactive.

Sometimes, a patient may have a normal Free T4 level despite an elevated TSH. This condition, known as subclinical hypothyroidism, may not require immediate treatment but warrants monitoring.

The severity of hypothyroidism is classified based on TSH and Free T4 levels, guiding treatment decisions.

Ultrasound and Hormone Levels: A Synergistic Approach to Treatment

Ultrasound findings and hormone levels are not isolated pieces of information; they are complementary tools that guide treatment decisions. Ultrasound can reveal the underlying cause of hypothyroidism, such as Hashimoto’s thyroiditis (an autoimmune condition that damages the thyroid gland), while hormone levels quantify the degree of thyroid dysfunction.

For instance, if a patient has elevated TSH and low Free T4, indicating hypothyroidism, an ultrasound might be performed to determine if Hashimoto’s is the cause.

The ultrasound could reveal a heterogeneous (uneven) texture of the thyroid gland, characteristic of Hashimoto’s.

In cases where nodules are present, hormone levels help determine whether the nodule is affecting thyroid function. A "hot" nodule, which produces excess thyroid hormone, can cause hyperthyroidism (overactive thyroid), while a "cold" nodule, which doesn’t produce hormone, may be benign or potentially malignant.

A Comprehensive Assessment

By combining ultrasound imaging with thyroid hormone testing, clinicians gain a comprehensive understanding of the patient’s thyroid health. Ultrasound provides structural information, while hormone levels reflect functional status. This holistic approach enables accurate diagnosis, targeted treatment, and effective management of hypothyroidism.

The interplay between these diagnostic tools is vital. Relying solely on one without the other can lead to incomplete or inaccurate assessments. Ultimately, the goal is to restore optimal thyroid function and improve the patient’s overall well-being.

The interplay between TSH, Free T4, and ultrasound imaging provides a comprehensive overview of thyroid health. However, in certain cases, these tools alone may not be sufficient to definitively determine the nature of thyroid abnormalities. This is where further investigation, specifically Fine Needle Aspiration (FNA), becomes a crucial step in the diagnostic process.

Further Investigation: Fine Needle Aspiration (FNA) and When It’s Necessary

Following a thyroid ultrasound, the possibility of needing a Fine Needle Aspiration (FNA) biopsy may arise. This section will explain what FNA is, why it might be recommended, and address any anxieties you might have about the procedure.

Understanding Fine Needle Aspiration (FNA)

Fine Needle Aspiration (FNA) is a minimally invasive procedure used to collect cells from a thyroid nodule for further examination under a microscope. It’s often recommended when an ultrasound reveals suspicious characteristics that raise concerns about the possibility of cancer.

Not every nodule requires an FNA. The decision is typically based on the nodule’s size, ultrasound appearance (echogenicity, margins, presence of calcifications), and the patient’s risk factors.

Why Might FNA Be Recommended After an Ultrasound?

An FNA is usually recommended to rule out malignancy in thyroid nodules that exhibit certain worrisome features on ultrasound, such as:

• Large size (typically greater than 1 cm).
• Irregular margins or microcalcifications.
• Increased blood flow within the nodule.
• Suspicious lymph nodes in the neck.

These characteristics don’t necessarily mean that a nodule is cancerous, but they warrant further investigation to ensure an accurate diagnosis.

The FNA Procedure: What to Expect

The FNA procedure is usually performed in a doctor’s office or radiology clinic. Here’s what you can expect:

1. Positioning: You’ll lie on your back with your neck slightly extended.

2. Cleaning: The skin over the thyroid gland will be cleaned with an antiseptic solution.

3. Numbing (Optional): Local anesthetic may be injected to numb the area, although many find it unnecessary.

4. Needle Insertion: Using ultrasound guidance to ensure accuracy, a very thin needle is inserted into the nodule.

5. Cell Sampling: Cells are gently aspirated (suctioned) into the needle. This may be repeated a few times to collect enough samples.

6. Withdrawal and Bandaging: The needle is withdrawn, and a small bandage is applied to the puncture site.

The entire procedure usually takes only about 15-30 minutes.

The Role of FNA in Determining Benign vs. Malignant Nodules

The cells collected during FNA are sent to a cytopathologist, a doctor who specializes in diagnosing diseases by examining cells under a microscope.

The cytopathologist will analyze the cells to determine whether they are benign (non-cancerous), malignant (cancerous), suspicious, or non-diagnostic.

• Benign Result: Indicates that the nodule is not cancerous. Follow-up ultrasounds may still be recommended to monitor the nodule’s growth.

• Malignant Result: Confirms the presence of thyroid cancer. Treatment options will be discussed, which may include surgery.

• Suspicious Result: Suggests a possible risk of cancer, but the cells are not definitively malignant. Further testing or surgery may be recommended.

• Non-Diagnostic Result: Means that the sample did not contain enough cells to make a diagnosis. The FNA may need to be repeated.

Addressing Anxieties About FNA

It’s normal to feel anxious about undergoing an FNA, but it’s important to remember that it’s a relatively safe and well-tolerated procedure.

• Pain: Most people experience only mild discomfort during the FNA, similar to a blood draw.

• Safety: Serious complications are rare. The most common side effects are minor bleeding or bruising at the puncture site.

• Accuracy: FNA is a highly accurate method for determining whether a thyroid nodule is cancerous.

If you have any concerns about the FNA procedure, be sure to discuss them with your doctor. They can address your questions and help you feel more comfortable.

The interplay between TSH, Free T4, and ultrasound imaging provides a comprehensive overview of thyroid health. However, in certain cases, these tools alone may not be sufficient to definitively determine the nature of thyroid abnormalities. This is where further investigation, specifically Fine Needle Aspiration (FNA), becomes a crucial step in the diagnostic process.

Now, assuming that an FNA has been performed and the results are in, it is important to consider the next layer of expertise in navigating your thyroid health journey. The interpretation of these results, and the subsequent creation of a treatment plan, often necessitates the guidance of specialized medical professionals.

Consulting with an Endocrinologist and Radiologist: The Importance of Expert Opinions

Navigating thyroid health can be complex, often requiring more than just a primary care physician’s perspective. While your family doctor plays a crucial role in initial screenings and overall wellness, the intricate nature of thyroid disorders often benefits from the specialized knowledge of endocrinologists and radiologists. Their expertise ensures accurate diagnoses and tailored treatment plans, ultimately leading to better patient outcomes.

The Endocrinologist: Orchestrating Your Thyroid Health

An endocrinologist is a physician specializing in hormone-related disorders, including those affecting the thyroid gland. Their deep understanding of the endocrine system allows them to effectively manage hypothyroidism and interpret the often-nuanced results of thyroid ultrasound and FNA biopsies.

Deciphering Ultrasound Results and Hormone Levels

Endocrinologists are skilled at correlating ultrasound findings with hormone levels (TSH, Free T4, etc.) to gain a comprehensive understanding of thyroid function.

They can assess whether nodules are producing hormones independently, contributing to hyperthyroidism, or whether the gland’s overall hormone production is deficient. This holistic view informs their treatment decisions.

Guiding Treatment Strategies

Based on a complete assessment, the endocrinologist will develop a personalized treatment plan. This may involve medication to replace deficient thyroid hormones, careful monitoring of nodule growth, or recommendations for further intervention, such as surgery.

The endocrinologist acts as the principal coordinator in managing your thyroid condition, adjusting treatment as needed based on ongoing monitoring and your individual response.

The Radiologist: An Expert Eye in Imaging

The radiologist plays a pivotal, yet often unseen, role in thyroid care. These physicians are experts in interpreting medical images, including thyroid ultrasounds.

Their detailed analysis of the images provides crucial information about the size, shape, and characteristics of the thyroid gland and any nodules present.

Performing and Interpreting Thyroid Ultrasounds

Radiologists possess specialized training in performing and interpreting thyroid ultrasounds. Their expertise allows them to identify subtle yet significant features that may indicate benign or malignant conditions.

They meticulously document the echogenicity, margins, and vascularity of nodules, using standardized reporting systems like the Thyroid Imaging Reporting and Data System (TI-RADS) to communicate their findings clearly.

Providing Critical Insights

The radiologist’s report is a vital tool for endocrinologists and surgeons, guiding decisions about further investigation and treatment.

Their detailed interpretation can help differentiate between nodules that require immediate attention and those that can be safely monitored over time.

The Synergy of Expertise: A Collaborative Approach

Optimal thyroid care is rarely a solo effort. It thrives on collaboration between different specialists.

The endocrinologist relies on the radiologist’s interpretation of the ultrasound to understand the structural characteristics of the thyroid gland.

The radiologist, in turn, benefits from the endocrinologist’s insights into the patient’s overall hormonal status and medical history.

When surgery is considered, the surgeon also joins the team, bringing their expertise in surgical techniques and patient management.

This multidisciplinary approach ensures that all aspects of the patient’s condition are considered, leading to the most appropriate and effective treatment strategy.

Seeking Expert Opinions: Empowering Your Health Journey

Ultimately, seeking expert opinions from both an endocrinologist and a radiologist is an investment in your health and well-being. Their specialized knowledge, combined with a collaborative approach, ensures accurate diagnoses, personalized treatment plans, and optimal outcomes in managing thyroid disorders. Don’t hesitate to advocate for yourself and seek the care of these essential specialists.

Hopefully, this exploration of hypothyroidism ultrasound gave you a clearer picture. Remember, staying informed is half the battle! Best of luck with your health journey, and don’t hesitate to discuss your concerns with your doctor.