Thirst
of nutritional

Feeling thirsty all the time and for no good reason isn’t normal and should be investigated by your GP.

Thirst is normally just the brain’s way of warning that you’re dehydrated because you’re not drinking enough fluid. But excessive and persistent thirst (known as polydipsia) could be a sign of an underlying problem such as diabetes.

Causes

Dehydration

You will usually feel thirsty because you’re not drinking the amount of fluid your body needs. This may be because you’ve been sweating heavily or you’ve lost fluid because you have diarrhoea and are vomiting.

You can soon quench your thirst and restore the fluid balance in your body by having a drink and ensuring you remain well hydrated.

It’s particularly important to stay well hydrated during hot weather, while exercising and while you’re unwell with vomiting and diarrhoea. 

Food

In some cases, thirst may be caused by something as simple as a recent meal or snack. Eating salty or spicy foods can cause you to suddenly feel thirsty.

Diabetes

If you feel thirsty all the time, it could be a sign of diabetes – particularly if you also have other symptoms such as needing to urinate frequently, extreme tiredness (fatigue) and unexplained weight loss.

Diabetes is a lifelong condition that makes it difficult to control the level of sugar (glucose) in your blood. The high levels of glucose can mean your kidneys need to produce more urine to help pass the glucose out of your body. This can make you feel thirsty because your brain is telling you to drink more to make up for the fluids you’ve lost.

If you feel thirsty all the time and have other symptoms, your GP will probably carry out a blood glucose test to see whether you have diabetes.

Pregnancy

Feeling thirsty, as well as urinating more often than usual, is a common symptom in pregnancy and usually nothing to worry about. 

Very occasionally, these problems can be a sign of gestational diabetes (a type of diabetes that affects women during pregnancy). You should be screened for this as part of your antenatal care if you’re at risk.

Medication

Excessive thirst can sometimes be a side effect of certain types of medication, including lithium, certain antipsychotics and diuretics (water tablets).

If you think a particular medicine is causing your thirst, it may be possible to change to a different medicine or reduce your dose. Speak to your GP about this.


There are also many other potential causes of severe thirst. These include:

diabetes insipidus – a condition caused by problems with a hormone that regulates the amount of fluid in the body diabetic ketoacidosis – a dangerous complication of diabetes caused by a lack of the hormone insulin in the body sickle cell aneamia – an inherited blood disorder psychogenic polydipsia – where a person with a mental health condition, such as schizophrenia, drinks excessive amounts of water that can’t be excreted (got rid of) by the kidneys excessive bleeding

Threadworms
of stomach liver and gastrointestinal tract

Threadworms, also known as pinworms, are tiny parasitic worms that infect the large intestine of humans.

Threadworms are a common type of worm infection in the UK, particularly in children under the age of 10.

The worms are white and look like small pieces of thread. You may notice them around your child’s bottom or in their poo.

They don’t always cause symptoms, but people often experience itchiness around their bottom or vagina. It can be worse at night and disturb sleep.

Read more about the symptoms of threadworms.

Symptoms

Threadworms often go unnoticed by people who have them.

However, they can cause intense itching around the anus (and the vagina in girls), particularly at night when the female worms are laying eggs. This can disturb sleep.

In some cases, you may spot threadworms on your bed clothes or sheets at night, or you may notice them in your stools. The worms look like threads of white cotton and are about 1cm long.

Causes

A threadworm infection is passed from person to person by swallowing threadworm eggs.

A female threadworm can lay thousands of tiny eggs around the anus or vagina. The female threadworm also releases mucus, which can cause an itchy bottom.

Scratching the anus or vagina, or wiping them after going to the toilet, can cause the eggs to stick to your fingertips or under your fingernails.

If you don’t wash your hands, the eggs can be transferred to your mouth or on to food or objects, such as toys and kitchen utensils. If someone else touches a contaminated object, or eats contaminated food and then touches their mouth, they’ll become infected.

After the eggs have been swallowed they pass into a person’s intestine, where they hatch. After about 2  weeks the threadworms will have grown into adults, at which point they’ll reproduce and the cycle of infection will start again.

Treatments

Pharmacy First Scotland: Threadworm treatment from your pharmacyIf you have threadworms you can get advice and treatment directly from a pharmacy. Find your local pharmacy on Scotland’s Service Directory.Search for a pharmacy near you

If you think you or your child may have threadworms, you can usually treat the infection yourself with medication available at pharmacies without a prescription.

You only need to see your GP if you think you have threadworms and you’re pregnant or breastfeeding, or if you think your child has threadworms and they’re under 2 years old. In these circumstances, the recommended treatment is usually different.

Severe or persistent threadworm infections can cause:

loss of appetite weight loss skin infection around the anus if bacteria enter any scratches caused by itching – wearing cotton gloves while sleeping may help prevent this difficulty getting to sleep or staying asleep (insomnia) bedwetting

In such cases, you should seek further advice from your GP. In very rare cases, threadworms can spread outside the intestine to the urinary tract or liver, or the vagina or womb in girls or women.


If you or your child has threadworms, everyone in your household will need to be treated as there’s a high risk of the infection spreading. This includes those who don’t have any symptoms of an infection.

For most people, treatment will involve taking a single dose of a medication called mebendazole to kill the worms. If necessary, another dose can be taken after 2 weeks.

During treatment and for a few weeks afterwards, it’s also important to follow strict hygiene measures to avoid spreading the threadworm eggs. This includes regularly vacuuming your house and thoroughly washing your bathroom and kitchen.

If you’re pregnant or breastfeeding, hygiene measures are usually recommended without medication. This is also often the case for young children. 

Read more about treating threadworm infections.


To treat threadworms successfully, all household members must be treated, even if they don’t have any symptoms. This is because the risk of the infection spreading is very high.

The aim of treatment is to get rid of the threadworms and prevent reinfection. This will usually involve a combination of medication to kill the worms and strict hygiene measures to stop the spread of the eggs.

The main medication used to treat threadworms is available from your local pharmacy without a prescription. However, it’s important to follow the manufacturer’s instructions as it isn’t suitable for everyone.

Preventions

It’s not always possible to prevent a threadworm infection, but you can significantly reduce your risk by always maintaining good hygiene and encouraging children to do the same.

Children should wash their hands regularly, particularly after going to the toilet and before mealtimes. Kitchen and bathroom surfaces should be kept clean.  

If your child is infected, encouraging them not to scratch the affected area around their anus or vagina will help prevent reinfection and reduce the risk of the infection spreading to others.

Thrush
of sexual and reproductive

Candida albicans usually lives harmlessly on the skin and in the mouth, gut and vagina.

Occasionally there can be too much yeast and it can cause symptoms. This is commonly known as thrush, thrush infection or candida.


Occasionally there can be too much yeast and it can cause symptoms. This is commonly known as thrush, thrush infection or candida.

Symptoms

Some people won’t have any signs or symptoms of thrush at all.

Thrush symptoms in women

If you do get symptoms you might notice:

unusual, white, thick vaginal discharge (often like cottage cheese) itching and irritation or fissure (like paper cuts) around the vagina pain when peeing or having sex

Thrush symptoms in men

If you do get symptoms you might notice:

irritation, burning and redness around the head of the penis and under the foreskin a white discharge under the foreskin or on the head of the penis an unpleasant smell difficulty pulling back the foreskin

Diagnoses

If you think you may have thrush, a test can be done at your GP practice, your local sexual health service or in some pharmacies.

It’s not always necessary to have a test for thrush. If you do have a test, a doctor or nurse may:

look at the genital area use a swab (cotton bud) to collect a sample from the parts of the body that could be affected such as the vagina

It only takes a few seconds and isn’t usually painful, though it may be uncomfortable for a moment. You may also be asked to take this swab yourself.

Thrush may have similar symptoms to some STIs, so it’s important you seek advice if you think you may be at risk of an STI.

Treatments

Treatment is simple and only necessary if you have signs and symptoms of thrush.

You may be given:

antifungal cream to apply to the genital area vaginal pessaries (tablets that you put into your vagina) oral pills a combination of treatments

The doctor or nurse will tell you how to use the treatment.

You can buy some antifungal treatments from a pharmacy. These are useful if you’re sure you have thrush and want to treat it yourself. The pharmacist will answer any questions and explain how to use the treatment.

It’s very important to take the treatment as instructed and finish any course of treatment even if the symptoms go away earlier.

Some antifungal products can weaken latex condoms, diaphragms and caps. So avoid sex while undergoing treatment if this is your method of contraception.

You should tell your doctor, nurse or pharmacist if you’re pregnant, might be pregnant, or if you’re breastfeeding. This may affect the type of treatment you’re given.

If thrush isn’t treated it eventually goes away on its own.

There’s no need for your partner(s) to have treatment unless they have signs and symptoms of thrush.

Thyroid cancer
of cancer, cancer types in adults

Thyroid cancer is a rare type of cancer that affects the thyroid gland, a small gland at the base of the neck.

The most common symptom of cancer of the thyroid is a painless lump or swelling that develops in the neck.

Other symptoms only tend to occur after the condition has reached an advanced stage, and may include:

unexplained hoarseness that lasts for more than a few weeks a sore throat or difficulty swallowing that doesn’t get better  a lump elsewhere in your neck

If you have a lump in your thyroid gland, it doesn’t necessarily mean you have thyroid cancer. About 1 in 20 thyroid lumps are cancerous. 

Read more about the symptoms of thyroid cancer

Symptoms

In its early stages, thyroid cancer tends to cause no or very few symptoms.

The main symptom of thyroid cancer is a lump or swelling at the front of the neck just below your Adam’s apple, which is usually painless.

Women also have Adam’s apples, but they’re much smaller and less prominent than a man’s.

The lymph nodes in your neck can also be affected and become swollen. Lymph nodes are small glands that are part of the lymphatic system, which helps fight infection.

Other symptoms of thyroid cancer only tend to occur after the condition has reached an advanced stage, and may include:

unexplained hoarseness that doesn’t get better after a few weeks a sore throat or difficulty swallowing that doesn’t get better pain in your neck

Causes

In most cases, the cause of thyroid cancer is unknown. However, certain things can increase your chances of developing the condition.

Risk factors for thyroid cancer include:

having a benign (non-cancerous) thyroid condition having a family history of thyroid cancer (in the case of medullary thyroid cancer) having a bowel condition known as familial adenomatous polyposis acromegaly – a rare condition where the body produces too much growth hormone having a previous benign (non-cancerous) breast condition weight and height radiation exposure 

Read more about the causes of thyroid cancer


In most cases, the exact cause of thyroid cancer is unknown.

However, there are certain things that can increase your chances of developing the condition, including having another thyroid condition and being exposed to radiation.

Diagnoses

A type of blood test known as a thyroid function test will measure the hormone levels in your blood and rule out or confirm other thyroid problems.

If nothing else seems to be causing the lump in your thyroid, fine-needle aspiration cytology (FNAC) is used.

Further testing may be required if the FNAC results are inconclusive, or if more information is needed to make your treatment more effective.

Read more about how thyroid cancer is diagnosed.


For many people, the first stage of diagnosing thyroid cancer is a consultation with a GP.

Your GP will examine your neck and ask about any associated symptoms you may be experiencing, such as unexplained hoarseness.


A blood test known as a thyroid function test is used to check whether the swelling in your neck is caused by other problems with your thyroid gland.

It will rule out conditions such as an overactive thyroid gland (hyperthyroidism) or an underactive thyroid gland (hypothyroidism), which are the most common thyroid problems.

A thyroid function test measures the amount of certain types of hormones in your blood.

Further tests will be needed if the thyroid function test reveals your thyroid gland is working normally.


Further testing may be recommended if the FNAC results are inconclusive or if further information is needed to make your treatment more effective. These tests may include:

repeat FNAC combined with an ultrasound scan other types of scan, such as a computerised tomography (CT) scan or magnetic resonance imaging (MRI) scan

In most cases, surgery will be recommended to remove the part of the thyroid gland that contains the lump or swelling when it hasn’t been possible to rule out thyroid cancer.


Thyroglobulin testing is a special type of blood test that’s used to monitor some types of thyroid cancer and to check for the return of cancerous cells.

Thyroglobulin is a protein released by a healthy thyroid gland, but it can also be released by cancerous cells.

If you’ve had your thyroid gland removed, there should be no thyroglobulin present in your blood, unless cancerous cells have returned.

Regularly testing your blood for thyroglobulin can be an effective way of checking whether or not any cancerous cells have returned.

For the first few years after having surgery you’ll probably need to have thyroglobulin testing every 6 months. After this period, you’ll need to be tested once a year.

Treatments

Your recommended treatment plan will depend on the type and grade of your cancer, and whether a complete cure is realistically achievable.

Differentiated thyroid cancers (DTCs) are treated using a combination of surgery to remove the thyroid gland (thyroidectomy) and a type of radiotherapy that destroys any remaining cancer cells and prevents the thyroid cancer returning.

Medullary thyroid carcinomas tend to spread faster than DTCs, so it may be necessary to remove any nearby lymph nodes, as well as your thyroid gland.

Read more about treating thyroid cancer


You should always speak to your GP if you develop a swelling or lump at the front of your neck. Although it’s unlikely to be thyroid cancer, it’s important that it is investigated.

About 1 in 20 swellings or lumps in the neck are caused by thyroid cancer. Most cases are caused by non-cancerous swellings called goitres.


If you’re diagnosed with thyroid cancer, you’ll be assigned a care team, who will devise a treatment plan for you.

Your recommended treatment plan will depend on the type and grade of your cancer, and whether your care team thinks that a complete cure is realistically achievable.


All NHS hospitals have multidisciplinary teams (MDTs) that treat thyroid cancer. An MDT is made up of a number of different specialists, and may include:

a surgeon an endocrinologist (a specialist in treating hormonal conditions) an oncologist (a cancer treatment specialist) a pathologist (a specialist in diseased tissue) a radiotherapist or clinical oncologist (a specialist in non-surgical methods of treating cancer, such as chemotherapy and radiotherapy) a specialist cancer nurse, who will usually be your first point of contact with the rest of the team

Deciding on the best course of treatment can be difficult. Your cancer team will make recommendations after reviewing your case, but the final decision will be yours.

Before you go to hospital to discuss your treatment options, you may want to write a list of questions to ask the specialist. For example, you may want to find out what the advantages and disadvantages of particular treatments are.


Your recommended treatment will depend on a number of things, including:

the type of thyroid cancer you have the grade of your cancer whether your care team thinks a complete cure is realistically achievable

Most differentiated thyroid cancers – papillary carcinomas and follicular carcinomas – and some medullary thyroid carcinomas have a good prospect of achieving a cure.

Differentiated thyroid cancers are treated using a combination of:

surgery to remove your thyroid gland (thyroidectomy) a type of radiotherapy called radioactive iodine treatment, which is designed to destroy any remaining cancer cells and prevent the thyroid cancer returning

Medullary thyroid carcinomas tend to spread faster than differentiated thyroid cancers, so it may be necessary to remove your thyroid gland and any nearby lymph nodes.

Radiotherapy iodine treatment is not effective at treating this type of thyroid cancer.

Stage 4 medullary thyroid carcinomas aren’t usually curable, but it should be possible to slow their progression and control any associated symptoms.

In most cases of anaplastic thyroid carcinoma, a cure isn’t usually achievable. This is because it’s usually spread to other parts of the body by the time it’s been diagnosed.

Radiotherapy and chemotherapy can be used to slow the progression of anaplastic thyroid carcinoma and help control any symptoms.

Some cases of differentiated thyroid cancer, medullary thyroid carcinoma and anaplastic thyroid carcinoma may benefit from a new type of treatment known as targeted therapies.

This is where medication is used to directly target the cancerous cells. However, these types of treatments are currently undergoing clinical trials and aren’t offered routinely on the NHS.


After having thyroid surgery, a course of radioactive iodine treatment may be recommended. This will help destroy any remaining cancer cells in your body and prevent the cancer returning.

If you’re taking thyroid hormone replacement tablets, you’ll need to stop taking them for 2 to 4 weeks before having radioactive iodine treatment. This is because they can interfere with the effectiveness of the iodine treatment.

If withdrawing your hormone replacement treatment is problematic, you may be given a medicine called recombinant human thyroid stimulating hormone (rhTSH). This is given as an injection on 2 consecutive days.

Your MDT will be able to advise you about whether or not rhTSH is suitable for you.

The procedure

Radioactive iodine treatment involves swallowing radioactive iodine in either liquid or capsule form. The radiation in the iodine travels up into your neck through your blood supply and destroys any cancerous cells.

Side effects of radioactive iodine treatment are uncommon, but a small number of people may experience tightness, pain or swelling in their neck and may feel flushed (warm). These side effects usually pass within 24 hours.

After treatment, you may have a dry mouth and notice a change in your taste. These symptoms usually disappear after a few weeks or months, although they can be permanent in some people.

You’ll need to stay in hospital for 3 to 5 days after the procedure because the iodine will make your body slightly radioactive. As a precaution, you’ll need to stay in a single room protected by lead sheets so that hospital staff aren’t exposed to radiation.

You won’t be able to have visitors during this time and hospital staff will keep their contact with you to a minimum.

Your bodily fluids, such as urine, will also be slightly radioactive for 3 to 5 days after your treatment, so it’s important that you flush the toilet every time you use it. Your sweat will be radioactive, too, so you should bathe or shower every day.

You’ll be allowed home after the radioactive levels in your body have subsided.

Dietary recommendations

While having radioactive iodine treatment, you’ll need to eat a diet low in iodine. An iodine-rich diet may reduce the effectiveness of your treatment. It’s recommended that you:

avoid all seafood limit the amount of dairy products you eat don’t take cough medicines or use sea salt as they both contain iodine

You should eat plenty of fresh meat, fresh fruit and vegetables, and pasta and rice. These are all low in iodine.

Pregnancy and breastfeeding

You shouldn’t have radioactive iodine treatment if you’re pregnant or if there’s a good chance that you may be. The treatment could damage your baby.

Tell a member of your care team if you’re unsure whether you’re pregnant. Any treatment will need to be delayed until after your pregnancy.

You must stop breastfeeding before you can be treated with radioactive iodine. If possible, you should stop breastfeeding 6 weeks prior to treatment.

You should not resume breastfeeding after treatment for your current child, but you may safely breastfeed any babies you may have in the future.

Breastfeeding also isn’t recommended while receiving iodine treatment. If you’re breastfeeding, you should stop at least 4 weeks (but preferably 8) before starting iodine treatment.

You should also not resume breastfeeding your baby. However, it’s safe for you to breastfeed if you have another child in the future.

You should use a reliable method of contraception for at least 6 months after having iodine treatment. This is because there’s a small risk that any child conceived during this time could develop birth defects. This applies to both men and women.

Fertility

Radioactive iodine treatment doesn’t affect fertility in women. However, there’s a small risk that it could affect fertility in men who need to have multiple treatment sessions. Your care team will be able to advise you about the level of risk in your individual circumstances.

If there’s a significant risk you’ll become infertile after having radioactive iodine treatment, you may wish to consider having your sperm or eggs harvested and frozen so they can be used for fertility treatment at a later date.

Preventions

From the available evidence, eating a healthy, balanced diet is the best way to avoid getting thyroid cancer and all other types of cancer.

A low-fat, high-fibre diet is recommended that includes plenty of fresh fruit and vegetables (at least 5 portions a day) and whole grains.

Complications

Cancerous cells can return many years after surgery and radioactive iodine treatment has been completed.

It’s estimated that 5% to 20% of people with a history of thyroid cancer will experience a return of cancerous cells in their neck.

An estimated 10% to 15% of people will see a return of cancerous cells in other parts of their body, such as their bones.

Because of the risk of cancer cells returning, you’ll be asked to attend regular check-ups so any cancerous cells that do return can be treated quickly.

Thyroid cancer: Teenagers and young adults
of cancer, cancer types in teenagers and young adults

This section is for teens and young adults. It’s about a type of cancer called thyroid cancer.

If you’re looking for information about thyroid cancer in people of all ages, read our thyroid cancer section.

Papillary and follicular thyroid cancers are the most common types of thyroid cancer in young adults. If you’d like to find out about a different type of thyroid cancer you could talk to Macmillan Cancer Support.

It’s important to remember that thyroid cancer in young people can be successfully treated. Most young people are completely cured.

Symptoms

The first sign of thyroid cancer is usually a painless lump or swelling in the front of the neck that gradually gets bigger.

Less common symptoms are:

a hoarse voice that doesn’t get better difficulty swallowing or breathing

If you have any of these symptoms, it’s important to speak to a doctor.

Remember – these symptoms can happen for lots of reasons other than cancer.

Causes

It’s unknown exactly what causes thyroid cancer. But research into possible causes is going on all the time. Some things called risk factors increase your chance of developing cancer. But having these doesn’t mean you’ll get cancer.

Genes

Genes are the biological information in each cell that we inherit from our parents. Genes affect the way we look (for example, our eye colour) and how our bodies grow and work. Some rare genetic conditions that run in families can increase the risk of thyroid cancer. But fewer than 1 in 10 cases of cancer are caused by an inherited faulty gene.

Radiotherapy

If you were exposed to radiation or had radiotherapy treatment to the neck area when you were younger, you may be at a higher risk of developing thyroid cancer many years later.

If you’re worried about thyroid cancer

If you think you might have some of these symptoms you should go straight to your GP. They’ll be able to talk to you about your symptoms. If they think the symptoms could be because of cancer, they can do tests to find out more.

Diagnoses

This information is for teenagers and young adults who may be having tests to find out if they have thyroid cancer.

If you think you might have some of the symptoms of thyroid cancer, you should talk to your GP. If they think the symptoms could be because of cancer, they can do tests to find out more.

Treatments

It’s important to remember that thyroid cancer in young people can be successfully treated. Most young people are completely cured. If the tests you’ve had show you have thyroid cancer, your team of specialists will discuss treatment with you.


If you’ve had all your thyroid gland removed, your body can’t produce thyroid hormones anymore. Without these hormones, your metabolism slows down. This can cause dry skin and hair, tiredness, poor concentration and lack of energy.

What can help?

These hormones can be replaced by taking tablets. You’ll need to take them for the rest of your life. The usual long-term hormone treatment is thyroxine (levothyroxine) and you normally start taking it once your radioactive iodine treatment is finished.

As well as replacing the hormones you’re missing, thyroxine can also help stop papillary or follicular thyroid cancer coming back. So if you have only had part of your thyroid gland removed you may still need to take thyroid hormone tablets.

Blood tests

You’ll need to have your blood checked regularly to monitor the hormone levels. It can sometimes take months to find the right dose of thyroxine for you. But once the right dose is found, there shouldn’t be any side effects, because they are simply replacing normal thyroid hormones.

It’s important to remember to take your tablets every day. It can help to take them at the same time every day so you get into a routine.

Macmillan Cancer Support has more general information about radiotherapy, surgery and radioactive iodine treatment. This information is written for people of all ages, not just young adults with thyroid cancer.

This information is for teenagers and young adults and is about having treatment for thyroid cancer.

If you’re looking for information about thyroid cancer in people of all ages, read our thyroid cancer information.

Tinnitus
of ears nose and throat

Tinnitus is the term for hearing sounds that come from inside your body, rather than from an outside source.

It’s often described as “ringing in the ears”, although several sounds can be heard, including:

buzzing humming grinding hissing whistling

Some people may hear sounds similar to music or singing, and others hear noises that beat in time with their pulse (pulsatile tinnitus).

You may also notice that your hearing is not as good as it used to be or you’re more sensitive to everyday sounds (hyperacusis).

Causes

Tinnitus can develop gradually over time or occur suddenly. It’s not clear exactly why it happens, but it often occurs along with some degree of hearing loss.

Tinnitus is often associated with:

age-related hearing loss inner ear damage caused by repeated exposure to loud noises an earwax build-up a middle ear infection Ménière’s disease – a condition that also causes hearing loss and vertigo (a spinning sensation) otosclerosis – an inherited condition where an abnormal bone growth in the middle ear causes hearing loss

However, around one in every three people with tinnitus doesn’t have any obvious problem with their ears or hearing.

Read more about the causes of tinnitus.


It’s not clear exactly what causes tinnitus, but it’s thought to be a problem with how the ear hears sounds and how the brain interprets them.

Many cases are associated with hearing loss caused by damage to the inner ear, although around one person in every three with the condition doesn’t have any obvious problem with their ears or hearing.


As well as inner ear damage, there are several other possible causes of tinnitus. These include:

an earwax build-up that blocks the ear a middle ear infection glue ear – a build-up of fluid in the middle ear a perforated eardrum Ménière’s disease – a condition that also causes hearing loss and vertigo (a spinning sensation) otosclerosis – an inherited condition where an abnormal bone growth in the middle ear causes hearing loss


Less commonly, tinnitus may develop as a result of:

a head injury exposure to a sudden or very loud noise, such as an explosion or gunfire anaemia – a reduced number of red blood cells that can sometimes cause the blood to thin and circulate so rapidly that it produces a sound reactions to certain medications, such as some chemotherapy medicines, antibiotics, diuretics, non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin (this is more likely to occur at very high doses) acoustic neuroma – a rare non-cancerous growth that affects the hearing nerve in the inner ear high blood pressure (hypertension) and narrowing of the arteries (atherosclerosis) an overactive thyroid gland (hyperthyroidism) or underactive thyroid gland (hypothyroidism) diabetes Paget’s disease – where the normal cycle of bone renewal and repair is disrupted

 

Diagnoses

You should see your GP if you have a problem with your hearing, such as hearing ringing or buzzing sounds.

They will ask you some questions about your symptoms, such as:

Does the sound come and go, or is it continuous? Does the problem affect one or both ears? Is it a constant tone or is it like a pulse? Is the problem having an impact on your everyday life? Have you noticed any other symptoms, such as hearing loss or vertigo (a spinning sensation)?

They may also want to know whether you’re taking any medication that could cause the condition, such as high doses of antibiotics or aspirin.

They will examine the outside and inside of your ear to check for obvious problems they may be able to treat, such as an earwax build-up or an ear infection. If you have a pulsatile tinnitus they will also listen to your neck and side of the head with a stethoscope.

They might also carry out a simple test of your hearing (free field speech testing and tuning fork tests) and arrange blood tests to look for conditions sometimes associated with tinnitus, such as anaemia (a reduction in red blood cells), diabetes or a problem with your thyroid gland.

Treatments

You should see your GP if you continually or regularly hear sounds such as buzzing, ringing or humming in your ears.

They can examine your ears to see if the problem might be caused by a condition they could easily treat, such as an ear infection or earwax build-up. They can also do some simple checks to see if you have any hearing loss.

If necessary, your GP can refer you to a hospital specialist for further tests and treatment.

Read more about diagnosing tinnitus.


There’s currently no single treatment for tinnitus that works for everyone. However, research to find an effective treatment is continuing.

If an underlying cause of your tinnitus can be found, effectively treating it may help improve your tinnitus – for example, removing a build-up of earwax might help.

If a specific cause can’t be found, treatment will focus on helping you manage the condition on a daily basis. This may involve:

sound therapy – listening to neutral sounds to distract you from the sound of tinnitus counselling – therapy that aims to educate you about tinnitus and help you learn to cope with it more effectively cognitive behavioural therapy (CBT) – therapy that aims to help change the way you think about your tinnitus so it becomes less noticeable tinnitus retraining therapy (TRT) – therapy that aims to help retrain the way your brain responds to tinnitus so you start to tune the sound out and become less aware of it

Read more about how tinnitus is treated.


There’s not usually a quick fix for tinnitus, but it will often improve gradually over time. A number of treatments are available to help you cope.

If your tinnitus is caused by an underlying health condition, treating the condition will help stop or reduce the sounds you hear.

For example, if your tinnitus is caused by an earwax build-up, eardrops or ear irrigation may be used. Ear irrigation involves using a pressurised flow of water to remove the earwax.

Read more about how an earwax build-up is treated.

However, in many cases a cause for tinnitus can’t be found, so treatments will be used to help you manage the problem on a daily basis. These are described below.

Tonsillitis
of ears nose and throat

Tonsillitis is inflammation of the tonsils. It’s usually caused by a viral infection or, less commonly, a bacterial infection.

Tonsillitis is a common condition in children, teenagers and young adults.

The symptoms of tonsillitis include:

a sore throat and pain when swallowing earache high temperature (fever) over 38C (100.4F) coughing headache

Symptoms usually pass within three to four days.

Contact your GP or, if your GP’s closed, phone 111 if: symptoms last longer than four days and don’t show any signs of improvement symptoms are severe – for example, if you’re unable to eat or drink due to the pain, or you have difficulty breathing

About tonsillitis

If necessary, your GP will examine your throat and ask you some questions about your symptoms. If needed, a throat swab can be taken to confirm the diagnosis. The results usually take a few days to return.

If your tonsillitis is caused by a bacterial infection, they may prescribe antibiotics. Typical signs of a bacterial infection include white pus-filled spots on the tonsils, no cough and swollen or tender lymph glands.

If you develop severe tonsillitis as a teenager or adult, your GP may recommend a blood test for glandular fever.

Symptoms

The main symptom of tonsillitis is a sore throat.

Your tonsils will be red and swollen, and your throat may be very painful, making swallowing difficult.

In some cases, the tonsils are coated or have white, pus-filled spots on them.

Other common symptoms of tonsillitis include:

high temperature (fever) over 38C (100.4F) coughing headache earache feeling sick feeling tired swollen, painful lymph glands in your neck loss of voice or changes to your voice

The symptoms of tonsillitis usually get better after three to four days.

If you have tonsillitis that’s caused by a viral infection, such as the common cold or flu, your symptoms may be milder.

If your tonsillitis is caused by a bacterial infection, such as a streptococcal infection, your symptoms will usually be more severe and you may also have bad breath.

It’s difficult to tell just by looking at a person’s throat whether they have tonsillitis as a result of a virus or a bacterial infection. Tests are needed to confirm this.

Antibiotics may be recommended if test results show that your tonsillitis is caused by a bacterial infection.

Causes

Most cases of tonsillitis are caused by a viral infection, such as the viruses that cause the common cold or flu virus (influenza).

Some cases can also be caused by a bacterial infection, typically a strain of bacteria called group A streptococcus bacteria.

These types of infections spread easily, so it’s important to try to avoid passing the infection on to others by:

staying away from public places, such as work, school or nursery, until your GP says it’s safe to return (usually after the symptoms have passed) coughing and sneezing into a tissue and disposing of the tissue  washing hands before eating, after going to the toilet and, if possible, after coughing and sneezing

Read more about the causes of tonsillitis.


Most cases of tonsillitis are caused by a viral infection.

Viruses known to cause tonsillitis include:

rhinoviruses – which cause the common cold the influenza virus parainfluenza virus – which causes laryngitis and croup enteroviruses – which cause hand, foot and mouth disease adenovirus – which is a common cause of diarrhoea the rubeola virus – which causes measles

In rare cases, tonsillitis can also be caused by the Epstein-Barr virus, which causes glandular fever.

If this is the case, you’ll probably feel very ill. You’ll have a sore throat and the lymph glands in your throat may be swollen. You may also have a fever and feel very tired.

Treatments

There’s no specific treatment for tonsillitis, but you may be able to reduce the symptoms by:

taking paracetamol or ibuprofen to help relieve pain drinking plenty of fluids getting plenty of rest

If test results show that your tonsillitis is caused by a bacterial infection, a short course of oral antibiotics may be prescribed.

If oral antibiotics aren’t effective at treating bacterial tonsillitis, intravenous antibiotics (given directly into a vein) may be needed in hospital.

Chronic tonsillitis

In most cases, tonsillitis gets better within a week. However, a small number of children and adults have tonsillitis for longer, or it keeps returning. This is known as chronic tonsillitis and surgical treatment may be needed.

Surgery to remove the tonsils (a tonsillectomy) is usually only recommended if:

you’ve had several severe episodes of tonsillitis over a long period of time repeated episodes are disrupting normal activities

Read more about treating tonsillitis.


There’s no specific treatment for tonsillitis and most cases get better within a week without treatment.

While waiting for the infection to clear up, there are a number of things you can do to help relieve your symptoms (see below).

If your child has tonsillitis, make sure they have plenty to eat and drink, even if they find it painful to swallow. Being hungry and dehydrated can make other symptoms, such as headaches and tiredness, worse.

Complications

Complications of tonsillitis are rare and usually only occur if it’s caused by a bacterial infection. They’re usually the result of the infection spreading to another part of the body.

Possible complications of tonsillitis include:

a middle ear infection (otitis media) – where fluid between the eardrum and inner ear becomes infected by bacteria quinsy (peritonsillar abscess) – an abscess (collection of pus) that develops between one of the tonsils and the wall of the throat obstructive sleep apnoea (OSA) – where the walls of the throat relax during sleep, which causes breathing difficulties and poor sleep

Other complications of tonsillitis are very rare and usually only occur if an underlying bacterial infection is left untreated. They include:

scarlet fever – a condition that causes a distinctive pink-red skin rash rheumatic fever – this causes widespread inflammation throughout the body, leading to symptoms such as joint pain, rashes and jerky body movements glomerulonephritis – an infection (swelling) of the filters in the kidneys that can cause vomiting and a loss of appetite

Tooth decay
of mouth

If plaque is allowed to build up, it can lead to further problems, such as dental caries (holes in the teeth), gum disease or dental abscesses, which are collections of pus at the end of the teeth or in the gums.



toothache – either continuous pain keeping you awake or occasional sharp pain without an obvious cause tooth sensitivity – you may feel tenderness or pain when eating or drinking something hot, cold or sweet grey, brown or black spots appearing on your teeth bad breath an unpleasant taste in your mouth

Symptoms

Tooth decay may not cause any pain. However, if you have dental caries you might have: 

toothache – either continuous pain keeping you awake or occasional sharp pain without an obvious cause tooth sensitivity – you may feel tenderness or pain when eating or drinking something hot, cold or sweet grey, brown or black spots appearing on your teeth bad breath an unpleasant taste in your mouth

Causes

Your mouth is full of bacteria that form a film over the teeth called dental plaque.

When you consume food and drink high in carbohydrates – particularly sugary foods and drinks – the bacteria in plaque turn the carbohydrates into energy they need, producing acid at the same time.

If the plaque is allowed to build up, the acid can begin to break down (dissolve) the surface of your tooth, causing holes known as cavities.

Once cavities have formed in the enamel, the plaque and bacteria can reach the dentine (the softer, bone-like material underneath the enamel). As the dentine is softer than the enamel, the process of tooth decay speeds up.

Without treatment, bacteria will enter the pulp (the soft centre of the tooth that contains nerves and blood vessels). At this stage, your nerves will be exposed to bacteria, usually making your tooth painful.

The bacteria can cause a dental abscess in the pulp and the infection could spread into the bone, causing another type of abscess.

Treatments

Treatment of tooth decay depends on how advanced it is.

For early stage tooth decay – your dentist will talk to you about the amount of sugar in your diet and the times you eat. They may apply a fluoride gel, varnish or paste to the area. Fluoride helps to protect teeth by strengthening the enamel, making teeth more resistant to the acids from plaque that can cause tooth decay.

Your dentist may discuss a filling or crown with you. This involves removing the dental decay, offering local anaesthetic to numb the tooth and filling the hole.

If tooth decay has spread to the pulp (in the centre of the tooth, containing blood and nerves) – this may be removed in a process known as root canal treatment.

If the tooth is so badly damaged that it can’t be restored – it may need to be removed. Your dentist may be able to replace the tooth with a partial denture, bridge or implant.


NHS charges are set by the government and are standard for all NHS patients. Charges are assessed each year and usually change every April.

Some people don’t have to pay for dental treatment, including children, pregnant women and new mothers. Financial help may also be available to those on a low income.

The cost of private dental treatment varies between practices, as there is no set charge. If you choose to see a private dentist, make sure to agree the cost before having treatment.

Preventions

Although tooth decay is a common problem, it’s often entirely preventable. The best way to avoid tooth decay is to keep your teeth and gums as healthy as possible. For example, you should:

visit your dentist regularly – your dentist will decide how often they need to see you based on the condition of your mouth, teeth and gums cut down on sugary and starchy food and drinks, particularly between meals or within an hour of going to bed – some medications can also contain sugar, so it’s best to look for sugar-free alternatives where possible look after your teeth and gums – brushing your teeth properly with a fluoride toothpaste twice a day, using floss and an interdental brush at least once a day avoid smoking or drinking alcohol excessively – tobacco can interfere with saliva production, which helps to keep your teeth clean, and alcohol can contribute to the erosion of tooth enamel see your dentist or GP if you have a persistently dry mouth – this may be caused by certain medicines, treatment or medical conditions

Read:

how to keep your teeth clean reading food labels 

Toothache
of mouth

You may feel toothache in many ways. It can come and go or be constant. Eating or drinking can make the pain worse, particularly if the food or drink is hot or cold.

The pain can also be mild or severe. It may feel sharp and start suddenly. It can be worse at night, particularly when you’re lying down. A lost filling or broken tooth can sometimes start the pain.

It can also sometimes be difficult to decide whether the pain is in your upper or lower teeth. When a lower molar tooth is affected, the pain can often feel like it’s coming from the ear.

Toothache in other upper teeth may feel like it’s coming from the sinuses, the small, air-filled cavities behind your cheekbones and forehead.

The area of your jaw close to the infected tooth may also be sore and tender to touch.

It’s also possible for periodontal disease to give rise to a dull pain. Periodontal disease is a bacterial infection that affects the soft and hard structures that support the teeth.


The pain can also be mild or severe. It may feel sharp and start suddenly. It can be worse at night, particularly when you’re lying down. A lost filling or broken tooth can sometimes start the pain.

It can also sometimes be difficult to decide whether the pain is in your upper or lower teeth. When a lower molar tooth is affected, the pain can often feel like it’s coming from the ear.

Toothache in other upper teeth may feel like it’s coming from the sinuses, the small, air-filled cavities behind your cheekbones and forehead.

The area of your jaw close to the infected tooth may also be sore and tender to touch.

It’s also possible for periodontal disease to give rise to a dull pain. Periodontal disease is a bacterial infection that affects the soft and hard structures that support the teeth.


It can also sometimes be difficult to decide whether the pain is in your upper or lower teeth. When a lower molar tooth is affected, the pain can often feel like it’s coming from the ear.

Toothache in other upper teeth may feel like it’s coming from the sinuses, the small, air-filled cavities behind your cheekbones and forehead.

The area of your jaw close to the infected tooth may also be sore and tender to touch.

It’s also possible for periodontal disease to give rise to a dull pain. Periodontal disease is a bacterial infection that affects the soft and hard structures that support the teeth.

Causes

Toothache occurs when the innermost layer of the tooth (dental pulp) becomes inflamed. The pulp is made up of sensitive nerves and blood vessels.

Dental pulp can become inflamed as a result of:

tooth decay – this leads to holes (cavities) forming in the hard surface of the tooth a cracked tooth – the crack is often so small that it can’t be seen with the naked eye loose or broken fillings receding gums – where the gums shrink (contract) to expose softer, more sensitive parts of the tooth root periapical abscess – a collection of pus at the end of the tooth caused by a bacterial infection

There are a number of other conditions that can cause pain similar to toothache, even though the pulp isn’t affected. These include:

periodontal abscess – a collection of pus in the gums caused by a bacterial infection ulcers on your gums sore or swollen gums around a tooth that’s breaking through – for example, when your wisdom teeth start to come through  sinusitis – which sometimes causes pain around the upper jaw an injury to the joint that attaches the jaw to the skull (temporomandibular joint)

Babies can also experience discomfort when their teeth start to develop. This is known as teething.

Treatments

If you have toothache for more than one or two days, visit your dentist as soon as possible to have it treated. The longer you leave it, the worse it will get.

If your toothache isn’t treated, the pulp inside your tooth will eventually become infected. This can usually lead to a dental abscess, with severe and continuous throbbing pain.

Painkillers, such as paracetamol and ibuprofen, may reduce the pain and discomfort while you’re waiting for an appointment. Children under 16 years of age shouldn’t be given aspirin.

Find a dentist near you


The type of treatment you have for toothache will depend on the cause of the pain, so your dentist will examine your mouth and may carry out an X-ray to try to identify the problem.

If your toothache is caused by tooth decay, your dentist will remove the decayed area and replace it with a filling.

If your toothache is caused by a loose or broken filling, the filling will be taken out, any decay will be removed, and a new filling put in place.

If the pulp inside your tooth is infected, you may need root canal treatment. This procedure involves removing the infected pulp and then inserting a special type of filling to seal the tooth and prevent reinfection.

Your tooth may need to be removed if the toothache can’t be treated using these methods or the tooth is wedged between another tooth and your jaw (impacted).

Preventions

The best way to avoid getting toothache and other dental problems is to keep your teeth and gums as healthy as possible. To do this, you should:

limit your intake of sugary foods and drinks – you should have these as an occasional treat and only at mealtimes; read more about cutting down on sugar brush your teeth twice a day using a toothpaste that contains fluoride – gently brush your gums and tongue as well clean between your teeth using dental floss and, if necessary, use a mouthwash  stop smoking – smoking can make some dental problems worse

Make sure you have regular dental check-ups, preferably with the same dentist. 

The time between check-ups can vary, depending on how healthy your teeth and gums are and your risk of developing future problems.

Your dentist will suggest when you should have your next check-up based on your overall oral health.

Children should have a dental check-up every six months so tooth decay can be spotted and treated early.

Read more about taking care of your teeth and keeping your teeth clean.

Transient ischaemic attack (TIA)
of brain nerves and spinal cord

The disruption in blood supply results in a lack of oxygen to the brain. This can cause sudden symptoms like those of a stroke.

However, a TIA does not last as long as a stroke. The effects only last for a few minutes or hours and fully resolve within 24 hours.

Phone 999 immediately if: you suspect you or someone else is having a TIA or stroke Do not drive if you suspect you have had a stroke or TIA (transient ischaemic attack).


However, a TIA does not last as long as a stroke. The effects only last for a few minutes or hours and fully resolve within 24 hours.

Phone 999 immediately if: you suspect you or someone else is having a TIA or stroke Do not drive if you suspect you have had a stroke or TIA (transient ischaemic attack).


Phone 999 immediately if: you suspect you or someone else is having a TIA or stroke Do not drive if you suspect you have had a stroke or TIA (transient ischaemic attack).

Symptoms

Like a stroke, the signs and symptoms of a TIA usually begin suddenly.

The main symptoms of stroke can be remembered with the word FAST.

FAST stands for:

Face – the face might drop on one side, the person may not be able to smile or their mouth may have dropped, and their eyelid may droop Arms – the person may not be able to lift both arms and keep them there because of arm weakness or numbness in one arm Speech – they might slur their speech or it might be garbled, or the person may not be able to talk at all despite appearing to be awake Time – it’s time to phone 999 immediately if you see any of these signs or symptoms

It’s important to be aware of the symptoms of a stroke or TIA, especially if you live with or care for somebody in a high-risk group, such as an elderly person or someone with diabetes or high blood pressure.

Symptoms in the FAST test identify most strokes and TIAs. TIAs sometimes cause different symptoms that appear suddenly (usually over a few seconds).

Other signs and symptoms may include:

complete paralysis of one side of the body sudden loss or blurring of vision dizziness confusion difficulty understanding what others are saying problems with balance and co-ordination

However, there may be other causes for these symptoms.

During a TIA, it’s not possible to tell whether you’re having a TIA or a full stroke, so it’s important to phone 999 immediately. Even if the symptoms disappear, you should still have an assessment at hospital.

A TIA is a warning that you’re at risk of having a full stroke. An assessment can help doctors decide the best way to reduce the chances of this happening.

Causes

TIAs happen when there is a temporary disruption in the blood supply to part of the brain.

In TIAs, the blockage resolves before any significant damage. A full stroke disrupts the blood flow to your brain for much longer. This leads to more severe damage to the brain and longer-term problems.

The blockage responsible for most TIAs is usually caused by a blood clot that has travelled to the blood vessels supplying the brain.

A type of irregular heartbeat called atrial fibrillation can also cause TIAs. It can create blood clots that escape from the heart and become stuck in the blood vessels that supply the brain.

There are some things that can make you more likely to have a stroke or TIA:

poor diet lack of exercise obesity smoking an excessive alcohol intake high cholesterol high blood pressure (hypertension) diabetes atrial fibrillation

Lifestyle changes can help control some of these risk factors. You may also need to take regular medication.

Taking anticoagulant medication if you have an irregular heartbeat due to atrial fibrillation will help reduce the risk of stroke.

If you’ve had a stroke or TIA, these measures are particularly important because you’re more likely to have another stroke in future.

There are some risk factors you can’t change like:

age – people over 65 are most at risk of having strokes, although they can happen at any age – including in children family history – if a close relative (parent, grandparent, brother or sister) has had a stroke, your risk is likely to be higher ethnicity – if you’re south Asian, African or Caribbean, your risk of stroke is higher, partly because rates of diabetes and high blood pressure are higher in these groups your medical history – if you’ve had a stroke, transient ischaemic attack (TIA) or heart attack, your risk of stroke is higher

Diagnoses

You should have an assessment in hospital as soon as possible if you think you’ve had a TIA.

Initial assessment

TIAs are often over very quickly, so you may not have any symptoms by the time you see a doctor.

You should tell the person assessing you about the symptoms you experienced and how long they lasted. This will help to rule out other conditions that may have caused your symptoms.

Even if you no longer have symptoms, you might still need a neurological examination. This involves simple tasks designed to check your strength, sensation and co-ordination skills.

Referral to a specialist

If a TIA is suspected, you’ll see a specialist for further tests as soon as possible.

You’ll normally take aspirin while you’re waiting for specialist assessment. This can help to reduce your risk of having a stroke or another TIA in the meantime.

It’s likely you’ll see a doctor who specialises in strokes.

Tests

You might have some tests to rule out other causes of your symptoms and to help identify the underlying cause of your TIA.

Blood tests You might need blood tests to determine whether you have high cholesterol, and to check if you have diabetes.

Electrocardiogram (ECG) An electrocardiogram (ECG) measures your heart’s electrical activity using electrodes (small, sticky patches) on your skin. An ECG can detect abnormal heart rhythms, which may be a sign of conditions like atrial fibrillation (where your heart beats irregularly).

Carotid ultrasound A carotid ultrasound scan can show if there’s narrowing or blockages in the neck arteries leading to your brain. A small probe (transducer) sends high-frequency sound waves into your body. When these sound waves bounce back, they create an image of the inside of your body.

Brain scans Brain scans are not always necessary if you’ve had a TIA. You might have a magnetic resonance imaging (MRI) scan. This scan uses a strong magnetic field and radio waves to create an image of your brain. You might have a computerised tomography (CT) scan if an MRI scan is not suitable for you. This type of scan uses a series of X-rays to produce an image of the inside of brain.

Treatments

Although the symptoms of a TIA stop on their own, you’ll need treatment to help reduce the risk of another TIA or a full stroke.

Appropriate treatment following a TIA can help to reduce your risk of having one.

Your doctor will tell you about lifestyle changes you can make to reduce your stroke risk. Your doctor will prescribe medication to treat the underlying cause of your TIA. You might need surgery as part of your treatment.

Lifestyle changes There are lifestyle changes you can make that may help reduce your chances of having a stroke after a TIA like: eating a healthy diet – a low-fat, low-salt, high-fibre diet is usually recommended, with plenty of fresh fruit, vegetables and whole grains exercising regularly – this can help lower your cholesterol level and keep your blood pressure at a healthy level stopping smoking if you smoke cutting down on the amount of alcohol you drink

Medication Most people who’ve had a TIA will take medication to reduce their chances of having a stroke or another TIA. After a TIA, the aim is to reduce the risk of a stroke especially in the first few days. To do this a combination of treatments is usually recommended. Some of the treatments might include: antiplatelets like aspirin and clopidogrel anticoagulants like apixaban, edoxaban, rivaroxaban, dabigatran or warfarin medication to lower your blood pressure (antihypertensives) statins to lower your cholesterol The antiplatelet medications need to be taken immediately. Others may only be started later and usually need to be taken long term.

Carotid endarterectomy A carotid endarterectomy is an operation to remove part of the lining of the carotid artery and any blockage in the artery. By unblocking the carotid arteries, a carotid endarterectomy can reduce the risk of having a stroke or another TIA.