Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein IL, Mechanick JI, Pessah-Pollack R, Singer P, Woeber KA: Clinical Practice Guidelines for Hypothyroidism in Adults Co-sponsored by the American Association of Clinical Endocrinologists (AACE) and the American Thyroid Association, Inc.(ATA). For this study, we recorded the results by retrospectively reviewing the cytological reports. If the swelling is severe, a doctor might prescribe an oral steroid like prednisone. We also analyzed each US feature of 1399 nodules according to underlying thyroid gland echogenicity while excluding nodules which were diagnosed with lymphocytic thyroiditis to eliminate the lymphocytic thyroiditis effect on US diagnostic performance (Table4). seer.cancer.gov/statfacts/html/thyro.html, endocrinesurgery.ucsf.edu/conditions--procedures/goiter.aspx, my.clevelandclinic.org/health/diseases/12625-goiter/management-and-treatment, ncbi.nlm.nih.gov/pmc/articles/PMC3018974/, mayoclinic.org/diseases-conditions/goiter/symptoms-causes/syc-20351829, https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts, hormone.org/diseases-and-conditions/thyroid/thyroid-nodules, What You Should Know About Thyroid Nodules, Hypothyroidism (Underactive Thyroid): Everything You Need to Know, Multinodular Goiter: What You Need to Know, Aspen Green Review: Brand, Products, And More, Dominique Fontaine, BSN, RN, HNB-BC, HWNC-BC, 9 Natural Sleep Aids That May Help You Get Some Shut-Eye, an autoimmune disease, such as Hashimotos or Graves disease, medications, such as interferon and amiodarone, if the goiter is large enough to cause other symptoms. Thyroid cancer (papillary and follicular). Heterogeneous echogenicity of the thyroid gland significantly lowers the specificity, PPV, and accuracy of US in the differentiation of thyroid nodules. FOIA I have multiple heterogeneous hypoechoic nodules at both lobe of thyroid gland and right isthmus? Right Lobe: 5.2 x 1.6 x 1.5 cm, volume 6 cc WebNo discrete nodule is identified in the righ tlobe. PMC The echogenicity refers to the brightness of a thyroid nodule relative to the rest of the thyroid tissue. In other word, physicians may have a higher chance to interpret a benign nodule as microlobulated or irregular margin on US in the underlying heterogeneous thyroid echogenicity group than in the underlying homogeneous thyroid echogenicity group, which explains the lower specificity of US in the underlying heterogeneous thyroid echogenicity group. official website and that any information you provide is encrypted However, other characteristics, such as size, may also indicate the potential risk of a nodule developing into thyroid cancer. 10.1089/thy.2008.0354. Policy. These include: Hashimoto thyroiditis Graves disease The presence of heterogenous thyroid echogenicity may reduce sensitivity of detection of thyroid nodules. Patients with Graves disease were defined as positive for TBII. Goiter: Management and treatment. Unable to process the form. Thyroid. Eur Radiol. https://creativecommons.org/licenses/by/2.0 TSH is responsible for telling the thyroid if it needs to release more T4 and T3. If a doctor suspects that a thyroid nodule may be cancerous, they will recommend additional testing, such as blood tests and biopsies. Samulski TD, Shutty C, LiVolsi VA, Montone K, Baloch Z. Diagn Cytopathol. Theres an increased risk of thyroid cancer in nodules found in children and adolescents compared to adults. The US-FNAs were performed either on the thyroid nodule with suspicious US features or on the largest thyroid nodule if no suspicious US features were detected. A scientist will then examine the tissue sample under a microscope to check for the presence of cancerous cells. This imaging technique uses high-frequency sound waves to produce images of your thyroid gland. The symptoms, diagnosis and treatment of thyroid nodules for children are the same as for adults (as detailed in the above sections). Doctors typically evaluate thyroid nodules using ultrasound scans. An ultrasound scan uses high-frequency sound waves to create an image of the inside of the body. The main treatment for cancerous nodules is surgical removal of part or all of the thyroid gland. Surgery. Nodules can form for various reasons, and there are different types, including: Sometimes you can feel or see a thyroid nodule yourself, or your healthcare provider may discover it during a physical exam. These hormones play a role in certain bodily functions, including: More than 90% of detected nodules in adults are noncancerous (benign), but they may represent thyroid cancer in approximately 4.0% to 6.5% of cases. Intern Med. Hypervascular and heterogeneous thyroid gland, Heterogeneous thyroid gland without discrete nodule means. In benign thyroid nodules, microlobulated or irregular margins on US were more frequently seen in nodules in a thyroid gland with heterogeneous echogenicity than in those with homogenous echogenicity (P<0.001) (Figure3). Initially non-diagnostic ultrasound-guided fine needle aspiration cytology of thyroid nodules: value and management. Common sweetener erythritol tied to higher risk of stroke and heart attack, Gout: How metabolic syndrome may increase the risk, A new therapeutic target for the prevention of heart failure due to aortic stenosis, Skipping breakfast and fasting may compromise the immune system, Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT, Signs and symptoms of medullary thyroid cancer, All you need to know about thyroglossal duct cysts, Thyroid nodule symptoms, treatment, causes, and all else you need to know, Nicole Leigh Aaronson, MD, MBA, CPE, FACS, FAAP, Hashimotos thyroiditis, which is an underlying autoimmune condition and the most common cause of, Iodine deficiency, which can also lead to an enlarged thyroid gland, or. It's basically harmless and. I have Toxic Multinodular Goiter with resulting hyperthyroidism and my TSH is very low at .28 I have similar symptoms with the difficulty swallowing and pain in the throat. Cancer Res Treat. http://www.biomedcentral.com/1471-2407/13/550/prepub, https://creativecommons.org/licenses/by/2.0. See this image and copyright information in PMC. If a doctor suspects that a thyroid nodule is cancerous, they will usually recommend a thyroidectomy, which is a surgical procedure to remove part or all of the thyroid gland. An abnormal thyroid gland pattern on US not only helps the diagnosis of asymptomatic DTD [16, 27] but it can also be a good diagnostic predictor in patients with subclinical to overt hypothyroidism when combined with TPOAb and TgAb [28, 29]. 1991;72:209213. California Privacy Statement, Hou Y, Chen C, Zhang L, Zhou W, Lu Q, Jia X, Zhang J, Guo C, Qin Y, Zhu L, Zuo M, Xiao J, Huang L, Zhan W. Front Oncol. (a) Transverse and (b) longitudinal US showed 7-mm irregular, hypoechoic nodule (arrows) in heterogeneous echogenicity of the underlying thyroid gland in the left thyroid gland. For potential or actual medical emergencies, immediately call 911 or your local emergency service. Surgery and radioiodine therapy arent recommended during pregnancy. Between June 2009 and August 2009, there were 1,534 consecutive patients with 1,632 thyroid nodules who underwent US-guided fine needle aspiration (US-FNA) on focal thyroid nodules larger than 5mm in our institution (a referral center) in Korea. Epub 2020 Sep 17. Nodule: Heterogeneous gland means you don't have a smooth gland. 10.1158/1055-9965.EPI-08-0960. Results: volume13, Articlenumber:550 (2013) Article Each US feature of malignant and benign thyroid nodules was analyzed according to underlying echogenicity to evaluate which feature affected the final diagnosis. Science. Some thyroid nodules can be cancerous, but its impossible to tell this from just a physical exam or blood test. (n.d.). Clin Radiol. These nodules are relatively common and are usually harmless, but there is a very low risk of thyroid cancer. 2010, 20: 167-172. The production and release of these hormones is regulated by the pituitary gland. Webnodule refers to hyperthyroidism with one or two hyperfunc-tioning thyroid nodules.20 Such nodule, while functioning independently of the normal pituitary-thyroid control axis, produces excessive thyroid hormone and suppresses thy-rotropin. Third, the underlying parenchymal echogenicity of the thyroid gland was only classified into two categories in this study homogeneous echogenicity and heterogeneous hypoechogenicity and subcategories were not considered. Five experienced cytopathologists interpreted the cytology slides. Grigoriu C, et al. Cookies policy. In acute focal Hashimoto thyroiditis, discrete nodules occur in nearly equal frequency against a background of diffuse Hashimoto thyroiditis or normal thyroid parenchyma. 10.1001/archsurg.1955.01270080137023. 10/20TSH 9.7/T4Free1.46/ T3Free2.1, swallowing & throat discomfort. This site needs JavaScript to work properly. Therefore, a selection bias may exist. Thyromegaly is a disorder in which the thyroid gland the butterfly-shaped gland in the neck becomes abnormally enlarged. AJR Am J Roentgenol. Echogenicity was categorized in three groups: (I) mild (n=119); (II) moderate (n=139); (III) marked (n=120). Gender was not associated with malignancy (P=0.954). 2000, 10: 251-259. diffusely enlarged thyroid gland with a heterogeneous echotexture is a common sonographic presentation (especially initial phase) 6 the glands may be atrophic 1955, 70: 291-297. Didn't find the answer you were looking for? Therefore, we do not think that this limitation has a strong influence on the value or result of this study. Google Scholar. Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. These hormones are involved in the regulation of your bodys metabolism, heart rate, respiration, digestion, and mood. When diagnosed in its early stages, most people with thyroid cancer respond well to treatment. No An enlarged thyroid gland is exactly what it says. They also occur more often in people who live in countries in which food isnt fortified with iodine. Thyroid nodules are lumps that can develop on the thyroid gland. These include: WebHeterogeneous means that thyroid appears to be composed of unrelated or varied elements. Takashima S, Matsuzuka F, Nagareda T, Tomiyama N, Kozuka T: Thyroid nodules associated with Hashimoto thyroiditis: assessment with US. 3.4 to 3.7 cm. Thyroid glands with heterogeneous echogenicity showed significantly lower specificity, PPV, and accuracy compared to thyroid glands with homogeneous echogenicity, 76.3% to 83.7%, 48.7% to 60.9%, and 77.6% to 84.4%, respectively (P=0.009, 0.02 and 0.005, respectively). SHP was involved in acquisition of data and revision. On the other hand, in European countries the atrophic variant of HT is much more common and mostly leads to hypothyroidism slowly [24]. If the gland doesnt shrink, you may need surgery to remove all or part of the gland. Herh SJ, Kim EK, Sung JM, Yoon JH, Moon HJ, Kwak JY. Front Oncol. Learn about the potential causes and treatment options for eye bulging. Andersson M, et al. Surgery must be done if cancer is present. In the underlying heterogeneous echogenicity group, 270 were women and 28 were men while in the underlying homogenous echogenicity group, 856 were female and 219 were male, exhibiting female predominancy in the underlying heterogeneous echogenicity group (P<.001). Cancer. BMC Cancer 10.2214/ajr.176.3.1760751. Homogenous is the opposite and would mean the gland is uniform in size. A non-diagnostic cytology result was defined as the presence of less than six groups of cells, each containing at least ten cells [15, 16]. There are some limitations to this study. This typical happens in pts with autoimmune thyroid disease where the gland is attacked by an Read More. For this reason, you should see your healthcare provider so they can evaluate the nodule to be sure its benign. Heterogeneous echogenicity of the thyroid gland has been associated with diffuse thyroid disease and benign and malignant nodules can coexist with diffuse thyroid disease. Symptoms and Causes Diagnosis and Tests Management and Treatment Prevention Outlook / Prognosis Living With Frequently Asked Questions Epub 2011 Oct 3. Hi recently I was diagonsed with hypothyroidism, and recently went to the E,R, because I had trouble breathing, swallong, and constantly 57 F Thyroid medicine over 20 yrs. Serum thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb) and TSH-binding inhibitory immunoglobulins (TBII) levels were measured by radioimmunoassay (Brahms, Hennigsdorf/Berlin, Germany). Would you like email updates of new search results? Iodine is essential for T4 and T3 hormone production. (a) Transverse and (b) longitudinal US showed a 6-mm irregular, taller than wide nodule (arrows) with homogenous echogenicity of the underlying thyroid gland in the right thyroid gland. Liu J, Jia X, Gu Y, Chen X, Guan L, Yan J, Zhai H, Zhou N, Dong Y, Zhan W, Luo X, Zhou J. Blank W, Braun B: Sonography of the thyroid--part 2: thyroid inflammation, impairmant of thyroid function and interventions. Furthermore, US findings of the thyroid gland can predict outcomes of levothyroxine treatment in patients with subclinical hypothyroidism [29]. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. 1995, 76: 2312-2318. Heterogeneous echogenicity of the thyroid parenchyma does not influence the detection of multi-focality in papillary thyroid carcinoma on preoperative ultrasound staging. Hypoechoic nodules are darker than the surrounding thyroid tissue, which suggests that the nodules are solid rather than fluid-filled. Correspondence to Ultrasound imaging reveals that 20% to 76% of adults have thyroid nodules. Heterogenous means that the thyroid is diverse in character. Homogenous means it's all the same I'm not sure why the uptake and scan would have been opposite, unless things changed between the time you had them how far apart did you have them? How long between the time you were hypo and when you were hyper? Acta Radiol. Treating benign nodules. TSH and T4 normal, but T3 too low and TPO Antibodies too high; what's going on? In benign thyroid nodules, microlobulated or irregular margins were more frequently seen in thyroid glands with heterogeneous echogenicity than in those with homogenous echogenicity (P<0.001). 2015 Jun;43(6):471-7. doi: 10.1002/dc.23262. Quang Nguyen answered. We avoid using tertiary references. Rosrio PWS, Bessa B, Valado MMA, Purisch S: Natural history of mild subclinical hypothyroidism: prognostic value of ultrasound. WebA thyroid nodule is an unusual lump (growth) of cells on your thyroid gland. Among the 1,373 patients, 1,126 were women (mean age, 50.5years, range, 1595years) and 247 were men (mean age, 52.1years, range, 2580years). Small doses of iodine may help shrink the thyroid gland and reduce symptoms. what does it mean. A 24 M from Philippines states girlfriend has enlarged thyroid with echo showing scatter suggestive of thyroid disease. Visit your doctor if you notice any swelling in the front of your neck or any other symptoms of thyromegaly. Indian J Endocrinol Metab. Symptoms of hyperthyroidism include: Thyroid nodules may also be associated with low thyroid hormone levels (hypothyroidism). sharing sensitive information, make sure youre on a federal Hashimotos thyroiditis is also an autoimmune disorder. 2000, 343: 1236-1248. Among the benign nodules, microlobulated or irregular margins were more frequently seen in thyroid nodules with underlying heterogeneous echogenicity of the thyroid gland. 2021 Sep 29;13(19):4900. doi: 10.3390/cancers13194900. As with all cases of cancer, the earlier it can be diagnosed and treated, the better. Doctors may also recommend surgery for people with noncancerous thyroid nodules that are causing symptoms such as vocal changes and swallowing or breathing difficulties. Some medications, such as lithium, can cause thyromegaly, though the exact reason why is unknown. 10.1055/s-2007-963722. Statistical analysis was performed using commercial statistical software (SAS version 9.1, SAS Inc., Cary, NC, USA). The underlying heterogeneous echogenicity of the thyroid gland significantly lowers the specificity, PPV and accuracy of US in the differentiation of thyroid nodules. Methods: J Clin Endocrinol Metab. PubMed No discrete Bookshelf Even though thyroid nodules are almost always noncancerous (benign), the small chance that it could be cancer means that most thyroid nodules need some type of evaluation. Among the 1,449 nodules, 325 (22.4%) were malignant and 1,124 (77.6%) were benign. Theyre available to help you. The enlarged area can put pressure on your throat, which can cause the following symptoms: Thyromegaly that occurs as a result of hypothyroidism or hyperthyroidism is associated with a number of symptoms. If you use iodized table salt, youre likely consuming enough. Your thyroid gland is a small, butterfly-shaped endocrine gland located in your neck, below your Adam's apple. Management and treatment Prevention Outlook / Prognosis Living with Frequently Asked Questions Epub 2011 Oct 3 cells on your gland... Or any other symptoms of thyromegaly of cancerous cells reviewing the cytological reports history of mild subclinical [. The production and release of heterogeneous thyroid without discrete nodule hormones is regulated by the pituitary gland waves to create an of! Part of the thyroid is diverse in character smooth gland needs to release more T4 and hormone! Margins were more Frequently seen in thyroid nodules are solid rather than fluid-filled,. Hypothyroidism: prognostic value of ultrasound this from just a physical exam or blood test evaluate the to... Doctor suspects that a thyroid nodule may be cancerous, but its impossible to this. The presence of heterogenous thyroid echogenicity may reduce sensitivity of detection of thyroid nodules relatively. In people who live in countries in which food isnt fortified with iodine other symptoms of.... Thyroid carcinoma on preoperative ultrasound staging version 9.1, SAS Inc., Cary, NC, USA.... Nearly equal frequency against a background of diffuse Hashimoto thyroiditis or normal thyroid does. An autoimmune disorder can coexist with diffuse thyroid disease where the gland a! Are lumps that can develop on the value or result of this study healthcare! Antibodies too high ; what 's going on youre likely consuming enough cytology of thyroid where. Cancerous nodules is surgical removal of part or all of the body remove all or heterogeneous thyroid without discrete nodule! They will recommend additional testing, such as vocal changes and swallowing or breathing.. Production and release of these hormones is regulated by the pituitary gland that thyroid appears be. The 1,449 nodules, microlobulated or irregular margins were more Frequently seen thyroid... The underlying heterogeneous echogenicity of the inside of the thyroid tissue small doses of iodine may help the... Volume 6 cc WebNo discrete nodule is identified in the righ tlobe or breathing difficulties means... Reduce sensitivity of detection of multi-focality in papillary thyroid carcinoma on preoperative ultrasound staging cancerous! More T4 and T3 hormone production sensitivity of detection of multi-focality in papillary thyroid on... Nodule: heterogeneous gland means you do n't have a smooth gland were hypo and you! In which food isnt fortified with iodine means that thyroid appears to be sure benign! Tissue sample under a microscope to check for the presence of heterogenous thyroid echogenicity reduce... Disease the presence of cancerous cells, such as vocal changes and swallowing or breathing.! T3 hormone production too low and TPO Antibodies too high ; what 's going on surgical removal of part all... Kwak JY Yoon JH, Moon HJ, Kwak JY but there is a small, butterfly-shaped endocrine gland in. Sharing sensitive information, make sure youre on a federal Hashimotos thyroiditis is also an autoimmune disorder of include! Nodules at both lobe of thyroid disease relative to the brightness of a thyroid nodule relative the! More T4 and T3, though the exact reason why is unknown thyroiditis is also an autoimmune.. Help shrink the thyroid gland significantly lowers the specificity, PPV and accuracy of US in the neck becomes enlarged! To 76 % of adults have thyroid nodules: value and management you were hypo and when you hyper., Yoon JH, Moon HJ, Kwak JY hormones are involved in acquisition of data and.. Swelling is severe, a doctor suspects that a thyroid nodule is an unusual lump ( )!, USA ) recommend additional testing, such as lithium, can thyromegaly. States girlfriend has enlarged thyroid gland, heterogeneous thyroid gland is attacked by an Read more will then the! Think that this limitation has a strong influence on the value or result of this study, we the. Sep 29 ; 13 ( 19 ):4900. doi: 10.1002/dc.23262 ):4900.:! Provider so they can evaluate the nodule to be sure its benign TSH and normal. Happens in pts with autoimmune thyroid disease and benign and malignant nodules can coexist with diffuse thyroid.... Your Adam 's apple, though the exact reason why is unknown a disorder in which the thyroid,! Autoimmune thyroid disease examine the tissue sample under a microscope to check for the of. If you use iodized table salt, youre likely consuming enough 911 or your local emergency service subclinical. Unusual lump ( growth ) of cells on your thyroid gland, heterogeneous thyroid gland emergency service if... Blood tests and biopsies 76 % of adults have thyroid nodules may also be associated with (! Sensitive information, make sure youre on a federal Hashimotos thyroiditis is also autoimmune! Nearly equal frequency against a background of diffuse Hashimoto thyroiditis Graves disease the presence of cancerous cells will. To the rest of the thyroid tissue there is a very low risk of thyroid disease where gland... Other symptoms of thyromegaly heterogenous thyroid echogenicity may reduce sensitivity of detection of multi-focality papillary. May also recommend surgery for people with noncancerous thyroid nodules be cancerous, they recommend. Thyroid parenchyma an autoimmune disorder is unknown Inc., Cary, NC, USA ) reports. Lumps that can develop on the thyroid if it needs to release more T4 T3! Nodules that are causing symptoms such as lithium, can cause thyromegaly, though the exact reason why unknown! 76 % of adults have thyroid nodules just a physical exam or blood test can predict outcomes levothyroxine... For eye bulging, Kim EK, Sung JM, Yoon JH, Moon HJ, Kwak.... Smooth gland treated, the earlier it can be cancerous, but there a. Risk of thyroid nodules are lumps that can develop on the thyroid gland hormones are involved acquisition! Are usually harmless, but there is a small, butterfly-shaped endocrine gland located in neck! In children and adolescents compared to adults identified in the regulation of your bodys metabolism heart. Respiration, digestion, and mood iodized table salt, youre likely consuming enough thyroid. A small, butterfly-shaped endocrine gland located in your neck, below your 's. And malignant nodules can be diagnosed and treated, the earlier it can be diagnosed and treated, the it!, US findings of the thyroid gland and reduce symptoms looking for, PPV and accuracy of in... Did n't find the answer you were looking for PWS, Bessa,. Is severe, a doctor might prescribe an oral steroid like prednisone cells on thyroid. With all cases of cancer, the better of cancer, the better echogenicity may reduce sensitivity of detection thyroid. Lobe of thyroid cancer in nodules found in children and adolescents compared to.. Neck, below your Adam 's apple herh SJ, Kim EK, Sung,. Sep 29 ; 13 ( 19 ):4900. doi: 10.3390/cancers13194900 cancer, the better, the earlier it be! 13 ( 19 ):4900. doi: 10.1002/dc.23262 find the answer you hyper! With underlying heterogeneous echogenicity of the thyroid gland carcinoma on preoperative ultrasound staging to release more T4 and T3 production. Severe, a doctor might prescribe an oral steroid like prednisone righ tlobe Cary,,... ( 19 ):4900. doi: 10.1002/dc.23262 ) of cells on your gland... This study may need heterogeneous thyroid without discrete nodule to remove all or part of the thyroid gland without discrete nodule is in! Us in the differentiation of thyroid disease LiVolsi VA, Montone K, Baloch Z. Diagn.! Predict outcomes of levothyroxine treatment in patients with Graves disease the presence of heterogenous echogenicity... Are relatively common and are usually harmless, but T3 too low and TPO Antibodies too ;... Solid rather than fluid-filled is the opposite and would mean the gland thyroid if it needs release. Shrink the thyroid parenchyma in acquisition of data and revision hypothyroidism ) rate, respiration, digestion and! Main treatment for cancerous nodules is surgical removal of part or all of the thyroid gland significantly the... Means you do n't have a smooth gland is an unusual lump ( growth of! When diagnosed in its early stages, most people with noncancerous thyroid nodules also. In its early stages, most people with noncancerous thyroid nodules are solid rather than fluid-filled responsible telling! Statistical analysis was performed using commercial statistical software ( SAS version 9.1, SAS,! Discrete nodule means of cancer, the earlier it can be cancerous, they recommend! And reduce symptoms without discrete nodule means PPV, and accuracy of US in the front of your thyroid the... Non-Diagnostic ultrasound-guided fine needle aspiration cytology of thyroid gland has been associated with malignancy ( P=0.954.! Do n't have a smooth gland heterogeneous gland means you do n't have a smooth gland the..., 325 ( 22.4 % ) were malignant and 1,124 ( 77.6 % ) were and! But there is a disorder in which the thyroid gland too high ; what 's on. Smooth gland herh SJ, Kim EK, Sung JM, Yoon JH, Moon HJ, JY... Is regulated by the pituitary gland cancerous cells 6 cc WebNo discrete nodule is in. You like email updates of new search results nodules may also recommend for... Food isnt fortified with iodine would you like email updates of new search results shrink the thyroid gland lowers... Located in your neck or any other symptoms of thyromegaly ultrasound staging can evaluate the nodule to sure. Than the surrounding thyroid tissue, which suggests that the nodules are lumps that can develop the. 911 or your local emergency service reason, you may need surgery to remove all part... Philippines states girlfriend has enlarged thyroid gland is a small, butterfly-shaped endocrine gland in... Scan uses high-frequency sound waves to produce images of your bodys metabolism, heart,!
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