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Thyroid function: Hypothyroidism – What happens to the body? What happens to the body when Thyroid function declines? Thyroid hormones are produced by a fleshy gland in the neck, just in front of the voice box/Adam’s apple, called the thyroid gland. Virtually every cell in the body needs thyroid hormone to function. While it is not exactly a fuel for cells, like sugar or fat, thyroid hormone sets the metabolic speed for the cell. In hypothyroidism, where the circulating levels of...
Thyroid function: Hypothyroidism – What happens to the body?
What happens to the body when Thyroid function declines?
Thyroid hormones are produced by a fleshy gland in the neck, just in front of the voice box/Adam’s apple, called the thyroid gland. Virtually every cell in the body needs thyroid hormone to function. While it is not exactly a fuel for cells, like sugar or fat, thyroid hormone sets the metabolic speed for the cell. In hypothyroidism, where the circulating levels of thyroid hormone are too low, the metabolic activity of cells slows down. In fact, metabolism slows down over almost the entire body, which causes a number of physical signs and symptoms.
Common symptoms of hypothyroidism
People are affected differently by having too little thyroid hormone circulating through the body. The most classic symptoms that occur from hypothyroidism are:
The inability to tolerate cold temperatures
Shortness of breath during even mild exercise.
All of these factors can be attributed to slow metabolism. Fatigue, weight gain, and shortness of breath during exertion are signs that the body is not using energy properly. Likewise, constipation reflects a slowing of the gastrointestinal tract.
Hypothyroidism may cause muscle aches, joint aches, dry skin, a hoarse voice, and swelling in the hands and feet.
Thyroid hormone is also important for nerve cell function. People with hypothyroidism may complain of experiencing abnormal sensations, such as “pins and needles” (i.e., paresthesias). Neurons (i.e., nerve cells) are very sensitive to the effects of thyroid hormone. Conversely, too little thyroid hormone can interfere with the neurons ability to function properly. In severe cases of hypothyroidism, people may experience altered mental status and cognitive dysfunction because low thyroid hormone levels can affect nerve cells in the brain.
Signs of hypothyroidism
Symptoms are abnormal things that a patient experiences while signs are abnormal things that a physician is looking for during a physical examination (physical findings). People with hypothyroidism may be able to detect some of the signs of hypothyroidism.
Puffy face. One of the most disconcerting group of signs caused by too little thyroid hormone are those that affect the face. People with hypothyroidism (usually moderate or severe disease) have puffy faces with swelling around the eyes. The hair of the eyebrows thins, and hair on the head may be come coarse, brittle, thin, and may fall out.
Speech problems may be due to tongue enlargement or from a general slowness in speech and movement which occurs because of hypothyroidism’s effect on the brain.
Mental ability. Severe hypothyroidism can cause a profound decrease in mental ability called myxedema coma. Physicians are able to detect several abnormalities in the heart from hypothyroidism.
The heart rate may be abnormally slow, a condition called bradycardia. Despite a slow heart rate, blood pressure might be increased. Fluid may accumulate in the space between heart and the tough, fibrous sheath around the heart called the pericardial sac. Fluid may also accumulate in the lungs (pleural edema/effusion) and in the abdomen (ascites).
Congenital hypothyroidism (Cretinism)
Congenital hypothyroidism is a severe form of hypothyroidism that occurs in infants and children. It occurs in geographic regions that have little iodine in the soil and in populations that do not supplement their salt with iodine. Every thyroid hormone molecule contains iodine.
When people are iodine-deficient, they cannot produce normal amounts of functional thyroid hormone. Thyroid hormone is particularly important in infants and children during development. If children do not maintain adequate levels of thyroid hormone, they can develop severe and long-lasting effects. Most notably, hypothyroidism in infants can cause mental retardation. Moreover, children will not grow properly and have short stature throughout life. Hypothyroidism also delays the onset of puberty and sexual maturation. The historic term for congenital hypothyroidism (now considered pejorative and no longer used) is cretinism.
What do thyroid blood tests mean?
Physicians measure certain substances in the blood to determine whether someone is hypothyroid, hyperthyroid (too much thyroid hormone), or euthyroid (normal).
The two main substances are thyroid stimulating hormone (TSH) and free T4, which is the active form of thyroid hormone. The results of these tests provide a snapshot of the current level of thyroid hormone, and also suggest a possible cause.
While thyroid blood test results can be complex, we will focus on tests that are of concern to someone with hypothyroidism. Someone who has hypothyroidism will have low levels of free T4 and high levels of TSH. This is because the body is trying to generate more thyroid hormone by increasing the level of TSH that is produced (but it is failing to have the intended effect on thyroid hormone levels).
Occasionally, a person may have subclinical hypothyroidism, which means that their blood levels are abnormal but they may not display any signs or symptoms of hypothyroidism. In this case, TSH levels will be abnormally high but free T4 levels may be normal or slightly lower. Because of this, physicians usually follow TSH levels rather than thyroid hormone levels to get a more accurate picture of a person’s hypothyroidism. In fact, once the diagnosis of hypothyroidism is made, physicians may simply track TSH levels without measuring thyroid hormone levels.
Most people with hypothyroidism are treated with artificial thyroid hormone. People who are treated for hypothyroidism will usually see their TSH and free T4 levels return to normal. If they happen to receive too much artificial thyroid hormone, free T4 levels may be abnormally high and TSH levels could be abnormally low. Hypothyroidism treatment is aimed at achieving normal levels of both of these blood markers.
Other blood tests that may be abnormal in hypothyroidism
Cholesterol metabolism may be slowed, which can lead to high blood cholesterol. Homocysteine levels can be abnormally increased as well. Over the long-term, these changes can increase the risk of heart disease and stroke. People with hypothyroidism may be anemic, that is, having too few red blood cells. They may also be at increased risk for abnormal blood clots in their veins.1 Serum creatinine may be increased in as many as 90% of people with hypothyroidism.2 Elevated creatinine levels indicate reduced kidney function. The amount of sodium in the blood may be abnormally low as well, a condition called hyponatremia. Severe hyponatremia can cause any number of effects, some of which mimic the signs and symptoms of hypothyroidism.
What are the side effects of thyroid removal? The thyroid gland is a very important endocrine gland located just in front of the trachea, it majorly controls the metabolic functions in the body. This metabolic function has to do with how energy is released and consumed in the body. The gland absorbs the iodine in food substances and converts it to thyroxine and triiodothyronine. These are the primary hormones it uses to control the body’s metabolic activities. However, this very important...
What are the side effects of thyroid removal?
The thyroid gland is a very important endocrine gland located just in front of the trachea, it majorly controls the metabolic functions in the body. This metabolic function has to do with how energy is released and consumed in the body. The gland absorbs the iodine in food substances and converts it to thyroxine and triiodothyronine. These are the primary hormones it uses to control the body’s metabolic activities.
However, this very important gland in the body may end up being surgically removed. There are a couple of factors or reasons to remove one’s thyroid gland, these reasons include; thyroid cancer, goiter, Hashimoto’s disease, etc. Removing the thyroid gland has been observed to have a number of side effects.
Patients who had their thyroid glands surgically removed end up living the rest of their lives with certain side effects which sometimes depend on the individual. They are also placed on one or more hormonal medications like synthroid, Levoxyl, Levothyroxine, Armour, etc. the side effects can be both psychological and physiological, some of which include:
It’s been observed that people, who once lived happily before the surgery, end up struggling with depression and anger. It isn’t clear as to what may be the exact cause of this. Some attribute it to the nature of the medication, or an imbalance in the hormonal levels within the body. It is also observed that after the thyroid gland has been removed, the chemical production in the brain is altered. Therefore, this psychological effect may be due to one or more factors, and is seen to drastically affect the quality of life, the mental and emotional health negatively.
One of the functions of the thyroid gland is managing the energy production and consumption in the body. It’s been observed that some patients experience a rapid weight gain after the surgery. And it sometimes comes with some joint pains; your bones appear to become suddenly too heavy to carry. Patients are usually required to consume a relatively large amount of vitamin D regularly.
Reduced Libido and Other Problems
The sex drive is seen to die completely. This can have a very bad effect on your relationship. Some very thriving relationships have hit the rock due to this.Lack of EnergyThe patients begin to experience weakness, and become less as energetic as they used to be. Some begin to experience an unusually high amount of sleeping time. This could also lead to inactivity, drowsiness and frustration.
Constipation Thyroxine and triiodo thyronine both play very important roles in digestion. They also affect the rate at which digestion occurs. A hormonal imbalance developed due to the removal of the thyroid gland has been observed to cause constipation due to irregular bowel movement.There some other issues that may be attributed to be one of the side effects of removing the thyroid gland, some of which include: Infertility in males, hair and nails become brittle, tremendous muscle pain, sometimes you become unnecessarily tired and weak, you have problems with thinking and problem solving, etc.
Where is my thyroid gland? The thyroid gland is located at the front of the neck just below the Adam’s apple (larynx). It is butterfly-shaped and consists of two lobes located either side of the windpipe (trachea). A normal thyroid gland is not usually outwardly visible or able to be felt if finger pressure is applied to the neck. Diagram showing the location of the thyroid gland in the neck. It has two lobes and sits in front of the windpipe (trachea). The voice box (larynx) sits just...
Where is my thyroid gland?
The thyroid gland is located at the front of the neck just below the Adam’s apple (larynx). It is butterfly-shaped and consists of two lobes located either side of the windpipe (trachea). A normal thyroid gland is not usually outwardly visible or able to be felt if finger pressure is applied to the neck.
Diagram showing the location of the thyroid gland in the neck. It has two lobes and sits in front of the windpipe (trachea). The voice box (larynx) sits just above the thyroid.
Diagram showing the location of the thyroid gland in the neck. It has two lobes and sits in front of the windpipe (trachea). The voice box (larynx) sits just above the thyroid.
What does my thyroid gland do?
The thyroid gland produces hormones that regulate the body’s metabolic rate as well as heart and digestive function, muscle control, brain development, mood and bone maintenance. Its correct functioning depends on having a good supply of iodine from the diet.
The release of thyroid hormones from the thyroid gland is controlled by thyrotrophin-releasing hormone from the hypothalamus in the brain and by thyroid stimulating hormone produced by the pituitary gland. This forms part of a feedback loop called the hypothalamic–pituitary–thyroid axis.
Thyroid stimulating hormone and free thyroid hormones are used to monitor thyroid function in a patient. Typically, modest changes in free thyroid hormones result in large changes in thyroid stimulating hormone.
What hormones does my thyroid gland produce?
The thyroid gland produces thyroxine, which is a relatively inactive prohormone and lower amounts of the active hormone, triiodothyronine. Collectively, thyroxine and triiodothyronine are referred to as the thyroid hormones. Twenty percent of the body’s triiodothyronine is made by the thyroid gland; the other 80% comes from thyroxine converted by organs such as the liver or kidneys.
The thyroid gland also produces calcitonin from cells called C-cells. Calcitonin is understood to play a role in regulating calcium levels in the body, but its exact function in humans remains unclear.
What could go wrong with my thyroid gland?
The thyroid gland can become overactive (hyperthyroidism) or underactive (hypothyroidism). This may, rarely, occur from birth, or develop later on in life. Hypothyroidism is often accompanied by an enlargement of the thyroid gland known as goitre.
Thyrotoxicosis is the term given when there is too much thyroid hormone in the bloodstream. It may be a result of overactivity of the thyroid gland (hyperthyroidism) as in Graves’ disease, inflammation of the thyroid or a benign thyroid tumour. Symptoms of thyrotoxicosis include intolerance to heat, weight loss, increased appetite, increased bowel movements, irregular menstrual cycle, rapid and irregular heartbeat, palpitations, tiredness, irritability, tremor, hair loss and retraction of the eyelids resulting in a ‘staring’ appearance.
Hypothyroidism is the term given when low levels of thyroid hormones are produced by the thyroid gland. It may result from autoimmune diseases (when the person’s immune system starts to attack the body’s own organs), poor iodine intake or be brought on by use of certain drugs. Since thyroid hormones are essential for physical and mental development, hypothyroidism during development (that is, before birth and during childhood) can result in learning difficulties and reduced physical growth. Hypothyroidism in adults results in decreased metabolic rate. This causes symptoms that include fatigue, intolerance of cold temperatures, low heart rate, weight gain, reduced appetite, poor memory, depression, stiffness of muscles and infertility.
Hyperthyroidism is another name for an overactive thyroid. It’s when the butterfly-shaped gland in your neck produces too much thyroid hormone. This can happen for many different reasons. You’re more likely to develop it if you’re a woman, if you’ve had other thyroid problems, or if you’re over the age of 60. It’s important to work with your doctor to find the cause because it can affect your treatment. What Your Thyroid Does Two major hormones that affect how your body works...
Hyperthyroidism is another name for an overactive thyroid. It’s when the butterfly-shaped gland in your neck produces too much thyroid hormone.
This can happen for many different reasons. You’re more likely to develop it if you’re a woman, if you’ve had other thyroid problems, or if you’re over the age of 60.
It’s important to work with your doctor to find the cause because it can affect your treatment.
What Your Thyroid Does
Two major hormones that affect how your body works are produced in your thyroid. These are called thyroxine (T-4) and triiodothyronine (T-3). Their job is to help keep your heart rate, body temperature, and other body functions working right. They do this by helping your body use carbohydrates and fats the way it’s supposed to.
Another important hormone your thyroid produces is called calcitonin, and this helps keep a healthy amount of calcium in your blood.
Why Your Body Might Make Too Much Thyroid Hormone
Most people with hyperthyroidism have a condition called Graves’ disease. This accounts for 70% of the cases.
Normally, the antibodies in your blood go after bacteria, but if you have Graves’ disease, the antibodies turn on your thyroid instead. This causes the gland to produce too much T-4 thyroid hormone.
Doctors aren’t sure why some people get Graves’ disease, but it tends to run in families. It’s also more common in young women.
Other conditions linked to hyperthyroidism include:
Plummer’s disease. This happens when one or more sections on your thyroid develop lumps that aren’t cancer. These lumps can make your thyroid grow bigger and produce too much T-4 hormone.
Plummer’s disease is more common in older people.
Thyroiditis. This can push your thyroid into overdrive for a short period of time. With this condition, your thyroid is swollen for unknown reasons. This swelling can force hormones out of your thyroid and into your bloodstream.
Thyroiditis can happen:
When you get a virus or another problem with your immune system
Overview Hyperthyroidism (overactive thyroid) is a condition in which your thyroid gland produces too much of the hormone thyroxine. Hyperthyroidism can accelerate your body’s metabolism significantly, causing sudden weight loss, a rapid or irregular heartbeat, sweating, and nervousness or irritability. Several treatment options are available if you have hyperthyroidism. Doctors use anti-thyroid medications and radioactive iodine to slow the production of thyroid hormones. Sometimes,...
Hyperthyroidism (overactive thyroid) is a condition in which your thyroid gland produces too much of the hormone thyroxine. Hyperthyroidism can accelerate your body’s metabolism significantly, causing sudden weight loss, a rapid or irregular heartbeat, sweating, and nervousness or irritability.
Several treatment options are available if you have hyperthyroidism. Doctors use anti-thyroid medications and radioactive iodine to slow the production of thyroid hormones. Sometimes, treatment of hyperthyroidism involves surgery to remove all or part of your thyroid gland. Although hyperthyroidism can be serious if you ignore it, most people respond well once hyperthyroidism is diagnosed and treated.
Hyperthyroidism can mimic other health problems, which may make it difficult for your doctor to diagnose. It can also cause a wide variety of signs and symptoms, including:
Sudden weight loss, even when your appetite and the amount and type of food you eat remain the same or even increase
Rapid heartbeat (tachycardia) — commonly more than 100 beats a minute — irregular heartbeat (arrhythmia) or pounding of your heart (palpitations)
Nervousness, anxiety and irritability
Tremor — usually a fine trembling in your hands and fingers
Changes in menstrual patterns
Increased sensitivity to heat
Changes in bowel patterns, especially more frequent bowel movements
An enlarged thyroid gland (goiter), which may appear as a swelling at the base of your neck
Fatigue, muscle weakness
Fine, brittle hair
Older adults are more likely to have either no signs or symptoms or subtle ones, such as an increased heart rate, heat intolerance and a tendency to become tired during ordinary activities. Medications called beta blockers, which are used to treat high blood pressure and other conditions, can mask many of the signs of hyperthyroidism.
Sometimes an uncommon problem called Graves’ ophthalmopathy may affect your eyes, especially if you smoke. In this disorder, your eyeballs protrude beyond their normal protective orbits when the tissues and muscles behind your eyes swell. This pushes the eyeballs forward so far that they actually bulge out of their orbits. This can cause the front surface of your eyeballs to become very dry. Eye problems often improve without treatment.
Signs and symptoms of Graves’ ophthalmopathy include:
Red or swollen eyes
Excessive tearing or discomfort in one or both eyes
Light sensitivity, blurry or double vision, inflammation, or reduced eye movement
When to see a doctor
If you experience unexplained weight loss, a rapid heartbeat, unusual sweating, swelling at the base of your neck or other symptoms associated with hyperthyroidism, see your doctor. It’s important to completely describe the changes you’ve observed, because many signs and symptoms of hyperthyroidism may be associated with a number of other conditions.
If you’ve been treated for hyperthyroidism or currently are being treated, see your doctor regularly as advised so that he or she can monitor your condition.
A number of conditions, including Graves’ disease, toxic adenoma, Plummer’s disease (toxic multinodular goiter) and thyroiditis, can cause hyperthyroidism.
Your thyroid is a butterfly-shaped gland at the base of your neck, just below your Adam’s apple. Although it weighs less than an ounce, the thyroid gland has an enormous impact on your health. Every aspect of your metabolism is regulated by thyroid hormones.
Your thyroid gland produces two main hormones, thyroxine (T-4) and triiodothyronine (T-3), that influence every cell in your body. They maintain the rate at which your body uses fats and carbohydrates, help control your body temperature, influence your heart rate, and help regulate the production of protein. Your thyroid also produces calcitonin, a hormone that helps regulate the amount of calcium in your blood.
How it all works
The rate at which T-4 and T-3 are released is controlled by your pituitary gland and your hypothalamus — an area at the base of your brain that acts as a thermostat for your whole system. Here’s how the process works:
The hypothalamus signals your pituitary gland to make a hormone called thyroid-stimulating hormone (TSH). Your pituitary gland then releases TSH — the amount depends on how much T-4 and T-3 are in your blood. If you don’t have enough T-4 and T-3 in your blood, your TSH will rise; if you have too much, your TSH level will fall. Finally, your thyroid gland regulates its production of hormones based on the amount of TSH it receives. If the thyroid gland is diseased and is releasing too much thyroid hormone on its own, the TSH blood level will remain below normal; if the diseased thyroid gland cannot make enough thyroid hormone, the TSH blood level will remain high.
Reasons for too much thyroxine (T-4)
Normally, your thyroid releases the right amount of hormones, but sometimes it produces too much T-4. This may occur for a number of reasons, including:
Graves’ disease. Graves’ disease, an autoimmune disorder in which antibodies produced by your immune system stimulate your thyroid to produce too much T-4, is the most common cause of hyperthyroidism. Normally, your immune system uses antibodies to help protect against viruses, bacteria and other foreign substances that invade your body. In Graves’ disease, antibodies mistakenly attack your thyroid and occasionally attack the tissue behind your eyes (Graves’ ophthalmopathy) and the skin, often in your lower legs over the shins (Graves’ dermopathy). Scientists aren’t sure exactly what causes Graves’ disease, although several factors — including a genetic predisposition — are likely involved.
Hyperfunctioning thyroid nodules (toxic adenoma, toxic multinodular goiter, Plummer’s disease). This form of hyperthyroidism occurs when one or more adenomas of your thyroid produce too much T-4. An adenoma is a part of the gland that has walled itself off from the rest of the gland, forming noncancerous (benign) lumps that may cause an enlargement of the thyroid. Not all adenomas produce excess T-4, and doctors aren’t sure what causes some to begin producing too much hormone.
Thyroiditis. Sometimes your thyroid gland can become inflamed for unknown reasons. The inflammation can cause excess thyroid hormone stored in the gland to leak into your bloodstream. One rare type of thyroiditis, known as subacute granulomatous thyroiditis, causes pain in the thyroid gland. Other types are painless and may sometimes occur after pregnancy (postpartum thyroiditis).
Hyperthyroidism, particularly Graves’ disease, tends to run in families and is more common in women than in men. If another member of your family has a thyroid condition, talk with your doctor about what this may mean for your health and whether he or she has any recommendations for monitoring your thyroid function.
Hyperthyroidism can lead to a number of complications:
Heart problems. Some of the most serious complications of hyperthyroidism involve the heart. These include a rapid heart rate, a heart rhythm disorder called atrial fibrillation and congestive heart failure — a condition in which your heart can’t circulate enough blood to meet your body’s needs. These complications generally are reversible with appropriate treatment.
Brittle bones. Untreated hyperthyroidism can also lead to weak, brittle bones (osteoporosis). The strength of your bones depends, in part, on the amount of calcium and other minerals they contain. Too much thyroid hormone interferes with your body’s ability to incorporate calcium into your bones.
Eye problems. People with Graves’ ophthalmopathy develop eye problems, including bulging, red or swollen eyes, sensitivity to light, and blurring or double vision. Untreated, severe eye problems can lead to vision loss.
Red, swollen skin. In rare cases, people with Graves’ disease develop Graves’ dermopathy, which affects the skin, causing redness and swelling, often on the shins and feet.
Thyrotoxic crisis. Hyperthyroidism also places you at risk of thyrotoxic crisis — a sudden intensification of your symptoms, leading to a fever, a rapid pulse and even delirium. If this occurs, seek immediate medical care.
What Is Thyroid Cancer? Your thyroid is shaped like a small butterfly, and is usually found inside the lower front of your neck. It’s a gland that controls your metabolism. It also releases hormones that direct many functions in your body, including how you use energy, how you produce heat, and how you consume oxygen. Thyroid cancer develops when cells genetically mutate or change. The abnormal cells begin multiplying in your thyroid and, once there are enough of them, they form a tumor. If...
What Is Thyroid Cancer?
Your thyroid is shaped like a small butterfly, and is usually found inside the lower front of your neck. It’s a gland that controls your metabolism. It also releases hormones that direct many functions in your body, including how you use energy, how you produce heat, and how you consume oxygen.
Thyroid cancer develops when cells genetically mutate or change. The abnormal cells begin multiplying in your thyroid and, once there are enough of them, they form a tumor.
If it’s caught early, thyroid cancer is one of the most treatable forms of cancer.
Types of Thyroid Cancer
Researchers have identified four main types:
Papillary thyroid cancer. If you have thyroid cancer, you probably have this type. It’s found in up to 80% of all thyroid cancer cases. It tends to grow slowly, but often spreads to the nymph nodes in your neck. Even so, you have a good chance for a full recovery.
Follicular thyroid cancer makes up between 10% and 15% of all thyroid cancers in the United States. It can spread into your lymph nodes and is also more likely to spread into your blood vessels.
Medullary cancer is found in about 10% of all thyroid cancer cases. This type is more likely to run in your family and is linked to problems with other glands. It’s also more likely to be found at an early stage because it produces a hormone called calcitonin, which doctors keep an eye out for in blood test results.
Anaplastic thyroid cancer can be the most severe type because it’s the most advanced and aggressive. It’s also the hardest to treat. But it’s also rare.
What Are the Symptoms?
If you have thyroid cancer, you probably didn’t notice any signs of it in the early stages. That’s because there are very few symptoms in the beginning.
But as it grows, you could notice any of the following problems:
Neck, throat pain
Swollen lymph nodes or enlarged thyroid gland
Lump in your neck
Vocal changes, hoarseness
What Causes It?
There is no clear reason why most people get thyroid cancer. There are certain things, though, that can raise your odds of getting it.
Inherited genetic syndromes. Some conditions, including cancer, come from the DNA you get from your parents. In eight out of 10 cases of medullary thyroid cancer, for example, the cancer is a result of an abnormal gene you’ve inherited.
Iodine deficiency. If you don’t get much of this chemical element in your diet, you could be at more risk for certain types of thyroid cancer. This is rare in the United States because iodine is added to salt and other foods.
Radiation exposure. If your head or neck is exposed to radiation as a child, or if you have too many X-rays, for example, you may have a higher chance of getting it.
Who Gets It?
Thyroid cancer is more common in women than men. Women tend to get thyroid cancer in their 40s and 50s, while men who get it are usually in their 60s or 70s.
Follicular thyroid cancer mostly happens to people who are over 50. Anaplastic thyroid cancer usually happens after 60.
You can still get thyroid cancer if you’re younger. Papillary thyroid cancer, for example, happens most often in people between ages 30 and 50.
Is It Treatable?
Thyroid cancer is usually very treatable, even if you have a more advanced stage of it. That’s because there are effective treatments that give you a great chance for a full recovery. And surgery, when it’s needed, can sometimes cure it.