Thyroid Cancer

When you come to Winship Cancer Institute for thyroid cancer treatment, you have a multidisciplinary team of experts dedicated to your well-being. To request an appointment, call (404) 778-1900.

Your Winship Cancer Institute care team draws on Emory's vast resources in endocrine medicine, surgical oncology, radiation therapy, nuclear medicine, imaging sciences and medical oncology, to provide the newest, most effective practices and treatments for thyroid cancer.

Our multidisciplinary care teams include endocrinologists , head and neck and endocrine surgeons, nuclear medicine physicians, medical and radiation oncologists, radiologists, pathologists, pharmacists and advanced practice nurses with expertise in thyroid cancers. As specialists, our teams strive to develop groundbreaking treatments and surveillance algorithms with the goal to improve patient outcomes and impact the standard of care.

The benefits of our multidisciplinary and highly experienced teams include:

  • Access to renowned doctors who rank among the top cancer experts in the world.
  • Monthly review of patient cases by a multi-disciplinary team of experts.
  • Coordinated scheduling for appointments among various specialties.
  • Access to support services and programs for you and your caregivers.
  • Availability of new treatment options within our clinical trials program.

Request an Appointment

If you have been diagnosed with thyroid cancer, we are ready to help you. Call us at 1 (888) 946-7447 or (404) 778-1900 to request an appointment with a thyroid cancer specialist. Winship experts are available for a second opinion.

We understand that this is a very stressful time. We welcome your questions and requests for help. Learn what to expect on your first visit.

If a patient exhibits symptoms of thyroid cancer, a physician may conduct one or more of the following procedures:

Physical exam: a doctor will feel the thyroid for lumps and nodules. The neck and lymph nodes will also be examined for growth and swelling.

Blood test: abnormal hormone levels in the blood can indicate that the thyroid is not functioning properly.

Thyroid scan: the patient swallows a small amount of radioactive substance that travels through the blood stream and is absorbed by the thyroid. A scan shows how the thyroid tissues and nodules absorb the substance.

Ultrasound: sound waves are used to create pictures of the thyroid and nodules that may be too small to be felt by a doctor.

Biopsy: a small sample of tissue is examined with a microscope to check for cancerous cells. This is the only sure way to detect thyroid cancer.

Thyroid cancer treatment is based on many factors including size and location of the tumor,  the type of thyroid cancer, whether the cancer has spread and the patient’s overall health.

One or more of the following types of treatment will be used.

Surgery: physicians may remove part of or the entire thyroid and the nearby lymph nodes and affected tissue. Chemotherapy and radiation may be used before or after surgery if you have the malignant form of thyroid cancer called anaplastic thyroid cancer.

Radioiodine therapy: this comes in pill form taken by mouth to identify the location of thyroid cancer as well as to treat the cancer.

Close Surveillance and thyroid hormone replacement therapy: Winship physicians employ a multidisciplinary approach to carefully determine the level of risk posed by your cancer after you have completed the needed surgery. When indicated, they will closely monitor your condition using a combination of physical examination, blood tests and imaging with ultrasound.

Radiation: high energy x-rays or other types of radiation are used to kill cancer cells. Physicians may use radiation therapy by itself to treat thyroid cancer or to shrink tumors before surgery.

Targeted therapies: Winship’s most promising research in treating thyroid cancer is in personalized medicine and targeted therapies. In personalized medicine, researchers identify unique characteristics of tumors that make them vulnerable to known drugs so therapy can be tailored to an individual’s cancer. In targeted therapies, investigators look for new drugs that more selectively target cancer cells with fewer side effects. Winship investigators are conducting clinical studies using targeted therapies in various types of thyroid cancer including papillary, follicular and medullary subtypes of thyroid cancer.

Chemotherapy: Chemotherapy drugs kill or slow the growth of cancer cells. Chemotherapy may be used in combination with surgery or radiation to maximize the treatment.

Supportive Oncology Care

In addition to delivering the highest quality medical care, we recognize the importance of the psychological and emotional aspects of living with a cancer diagnosis and of dealing with treatment. Our supportive oncology team addresses these issues in a timely manner with additional support from counselorsnurse navigatorsdietitians and social service professionals.

Consider talking with your doctor about participating in a clinical trial at Winship. Through these trials, you may have access to treatments that are not widely available.

Cascade Link

Rebecca Arnold LCSW, OSW-C

  • Social Worker
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                                 Rebecca Arnold LCSW, OSW-C
Rebecca Arnold LCSW, OSW-C

Rebecca Arnold LCSW, OSW-C

Wendy Baer MD

  • Psychiatric Oncologist
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                                 Wendy Baer MD
Wendy Baer MD

Wendy Baer MD

Tiffany Barrett MS, RD, CSO, LD

  • Nutrition Advisor
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                                 Tiffany Barrett MS, RD, CSO, LD
Tiffany Barrett MS, RD, CSO, LD

Tiffany Barrett MS, RD, CSO, LD

  • Ms. Barrett leads the nutritional services team at all Winship locations providing personalized nutrition advice to patients who are undergoing cancer treatment.
  • Manager of Winship Dietitians, Winship Cancer Institute of Emory University
  • (404) 778-5646

Anna Bausum ND

  • Integrative Oncology Specialist
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                                 Anna Bausum ND
Anna Bausum ND

Anna Bausum ND

  • Dr. Bausum supports patients with cancer by incorporating a variety of integrative medicine tools alongside patients' conventional oncology care regimens.
  • Integrative Oncology Specialist, Winship Cancer Institute of Emory University
  • (404) 778-0600

Laura Brachman MD

  • Palliative Care Specialist
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                                 Laura Brachman MD
Laura Brachman MD

Laura Brachman MD

  • Dr. Brachman provides patients with cancer with relief from their symptoms and helps improve their quality of life throughout their journey.
  • Assistant Medical Director, Outpatient Palliative and Supportive Care, Emory Healthcare
  • (404) 778-6448

Stephen Brandt MD

  • Endocrinologist
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                                 Stephen Brandt MD
Stephen Brandt MD

Stephen Brandt MD

  • A board certified endocrinologist, Dr. Brandt specializes in adrenal disorders, diabetes mellitis, osteoporosis, pituitary disorders and thyroid disorders.
  • Assistant Professor, Department of Medicine, Emory University School of Medicine
  • (404) 778-3280

Suzy Cahn MMSc, CGC

  • Genetic Counselor
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                                 Suzy Cahn MMSc, CGC
Suzy Cahn MMSc, CGC

Suzy Cahn MMSc, CGC

  • Ms. Cahn provides comprehensive genetic counseling services for individuals who are at risk for hereditary cancer.
  • Licensed Certified Genetic Counselor, Winship Cancer Institute of Emory University and Emory Decatur Hospital
  • (404) 778-1900

Catherine Caprara Braga MSN, AGACNP-BC

  • Nurse Practitioner
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                                 Catherine Caprara Braga MSN, AGACNP-BC
Catherine Caprara Braga MSN, AGACNP-BC

Catherine Caprara Braga MSN, AGACNP-BC

  • Ms. Caprara serves as lead nurse practitioner and co-investigator on early drug development trials in the Phase 1 Clinical Trials Unit at Winship.
  • Lead Nurse Practitioner, Phase I Unit, Winship Cancer Institute of Emory University
  • (404) 778-1900

Amy Y. Chen MD, MPH, FACS, FACE

  • Head and Neck Surgeon
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                                 Amy Y. Chen MD, MPH, FACS, FACE
Amy Y. Chen MD, MPH, FACS, FACE

Amy Y. Chen MD, MPH, FACS, FACE

  • Dr. Chen specializes in advanced thyroid cancers and endocrine head and neck surgery.
  • Director, Endocrine Surgery, Department of Otolaryngology, Emory University School of Medicine
  • (404) 778-0278

Hilary G. Cohen LCSW, OSW-C

  • Social Worker
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                                 Hilary G. Cohen LCSW, OSW-C
Hilary G. Cohen LCSW, OSW-C

Hilary G. Cohen LCSW, OSW-C

  • Ms. Cohen works with patients treated for all types of malignancies and disorders that may need consideration for radiation treatment.
  • Social Worker, Radiation Oncology, Winship Cancer Institute of Emory University
  • (404) 778-1900

Hannah H. Collins NP

  • Nurse Practitioner
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                                 Hannah H. Collins NP
Hannah H. Collins NP

Hannah H. Collins NP

Kimberly A. Curseen MD

  • Supportive Oncologist
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                                 Kimberly A. Curseen MD
Kimberly A. Curseen MD

Kimberly A. Curseen MD

  • Board certified in Internal Medicine, Geriatrics, and Palliative Care, Dr. Curseen is the primary provider for the Supportive Oncology Clinic at Winship.
  • Director, Palliative Medicine Program, Winship Cancer Institute of Emory University
  • (404) 778-6448

Laura Dean PA-C

  • Physician Assistant
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                                 Laura Dean PA-C
Laura Dean PA-C

Laura Dean PA-C

  • Ms. Dean coordinates care with the head and neck physician team and sees patients undergoing surgery for thyroid and parathyroid malignancies.
  • Physician Assistant, Head and Neck Oncology, Winship Cancer Institute at Emory Midtown
  • (404) 778-0278

Samantha Dyar LMSW, MBE

  • Social Services
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                                 Samantha Dyar LMSW, MBE
Samantha Dyar LMSW, MBE

Samantha Dyar LMSW, MBE

Adrien Edoo MTS

  • Spiritual Health Provider
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                                 Adrien Edoo MTS
Adrien Edoo MTS

Adrien Edoo MTS

  • Adrien provides spiritual and emotional support for oncology patients and their caregivers.
  • Spiritual Health Clinician and Fellow, Winship Cancer Institute at Emory Midtown
  • (404) 991-8429

Fabienne Ehivet MS, CGC

  • Genetic Counselor
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                                 Fabienne Ehivet MS, CGC
Fabienne Ehivet MS, CGC

Fabienne Ehivet MS, CGC

  • Ms. Ehivet provides comprehensive genetic counseling for individuals and families at increased risk for hereditary cancer.
  • Licensed Certified Genetic Counselor, Emory Saint Joseph's Hospital and Emory Johns Creek Hospital
  • (404) 778-1900

Badi El Osta MD

  • Medical Oncologist
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                                 Badi El Osta MD
Badi El Osta MD

Badi El Osta MD

Raghuveer K. Halkar MD

  • Nuclear Radiologist
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                                 Raghuveer K. Halkar MD
Raghuveer K. Halkar MD

Raghuveer K. Halkar MD

Lara Harik MD

  • Pathologist
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                                 Lara Harik MD
Lara Harik MD

Lara Harik MD

  • Dr. Harik is a board certified pathologist specializing in genitourinary cancer and thyroid cancer.
  • Associate Professor, Department of Pathology and Laboratory Medicine, Emory University School of Medicine
  • (404) 712-5947

Elise Hitron MSN, FNP-C

  • Nurse Practitioner
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                                 Elise Hitron MSN, FNP-C
Elise Hitron MSN, FNP-C

Elise Hitron MSN, FNP-C

Rizza Hohenstern MPS, CSD

  • Spiritual Health Provider
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                                 Rizza Hohenstern MPS, CSD
Rizza Hohenstern MPS, CSD

Rizza Hohenstern MPS, CSD

Emily M. Huskey RD, CSO, LD

  • Nutrition Advisor
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                                 Emily M. Huskey RD, CSO, LD
Emily M. Huskey RD, CSO, LD

Emily M. Huskey RD, CSO, LD

  • A Registered Dietitian, Ms. Huskey provides cancer patients who are undergoing treatment at Winship Cancer Institute with personalized nutrition advice.
  • Registered Dietitian, Winship Cancer Institute of Emory University
  • (404) 778-4526

Sol Jacobs MD

  • Endocrinologist
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                                 Sol Jacobs MD
Sol Jacobs MD

Sol Jacobs MD

  • Dr. Jacobs' clinical interests include thyroid disorders, pituitary disorders, diabetes mellitus, Grave's disease, neuroendocrinology and osteoporosis.
  • Associate Professor, Department of Medicine, Emory University School of Medicine
  • (404) 778-3280

Tatiana Johnson MMSc, LCGC

  • Genetic Counselor
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                                 Tatiana Johnson MMSc, LCGC
Tatiana Johnson MMSc, LCGC

Tatiana Johnson MMSc, LCGC

Sandra Karem LCSW

  • Social Services
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                                 Sandra Karem LCSW
Sandra Karem LCSW

Sandra Karem LCSW

Rachel Keller MS, RD, CSO, LDN

  • Nutrition Advisor
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                                 Rachel Keller MS, RD, CSO, LDN
Rachel Keller MS, RD, CSO, LDN

Rachel Keller MS, RD, CSO, LDN

Ashish Khanna MD

  • Cancer Rehabilitation Specialist
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                                 Ashish Khanna MD
Ashish Khanna MD

Ashish Khanna MD

  • Dr. Khanna focuses on the identification and treatment of neuromuscular, musculoskeletal and other issues resulting from cancer and related treatments.
  • Director of Cancer Rehabilitation, Winship Cancer Institute of Emory University
  • (404) 778-1900

Susan K. Kunihiro MD

  • Palliative Care Specialist
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                                 Susan K. Kunihiro MD
Susan K. Kunihiro MD

Susan K. Kunihiro MD

  • Dr. Kunihiro works to improve quality of life for patients with cancer, no matter the stage of illness - from initial diagnosis, during treatment, in remission or closer to end of life.
  • Assistant Professor, Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine
  • (404) 778-6448

Melinda Moore Lewis MD

  • Pathologist
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                                 Melinda Moore Lewis MD
Melinda Moore Lewis MD

Melinda Moore Lewis MD

  • Dr. Lewis' research interests are centered on women's health issues, particularly in breast cancer.
  • Associate Professor, Department of Pathology & Laboratory Medicine, Emory University School of Medicine
  • (404) 712-5867

Rupeng Li MD, PhD

  • Pain Management Specialist
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                                 Rupeng Li MD, PhD
Rupeng Li MD, PhD

Rupeng Li MD, PhD

  • Dr. Li works with care teams at Winship to treat chronic pain symptoms in patients with cancer.
  • Assistant Professor, Department of Anesthesiology, Emory University School of Medicine
  • (404) 686-2410

Daniel Lubin MD

  • Pathologist
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                                 Daniel Lubin MD
Daniel Lubin MD

Daniel Lubin MD

  • Dr. Lubin's clinical responsibilities include head and neck surgical pathology, endocrine surgical pathology, and cytopathology.
  • Assistant Professor, Department of Pathology and Laboratory Medicine, Emory University School of Medicine
  • (404) 686-4472

Meredith Maxwell MD

  • Palliative Care Specialist
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                                 Meredith Maxwell MD
Meredith Maxwell MD

Meredith Maxwell MD

  • Dr. Maxwell collaborates with the multidisciplinary care team at Winship to help patients address symptoms and improve their quality of life during their journey with cancer.
  • Assistant Professor, Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine
  • (404) 778-6448

Kendelle Miller MSW, LCSW, ACM-SW

  • Social Worker
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                                 Kendelle Miller MSW, LCSW, ACM-SW
Kendelle Miller MSW, LCSW, ACM-SW

Kendelle Miller MSW, LCSW, ACM-SW

Sonal Oza MD

  • Cancer Rehabilitation Specialist
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                                 Sonal Oza MD
Sonal Oza MD

Sonal Oza MD

  • Dr. Oza is a board-certified physician in physical medicine and rehabilitation (PM&R) with fellowship training in cancer rehabilitation medicine.
  • Assistant Professor, Department of Rehabilitation Medicine, Emory University School of Medicine
  • (404) 778-1900

Sandra Parker NP-C

  • Nurse Practitioner
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                                 Sandra Parker NP-C
Sandra Parker NP-C

Sandra Parker NP-C

  • Ms. Parker is an advanced registered nurse practitioner in the Department of Radiation Oncology at Emory Saint Joseph's Hospital.
  • Nurse Practitioner, Department of Radiation Oncology, Emory Saint Joseph's Hospital
  • (678) 843-7004

Snehal G. Patel MD, MS, FACS

  • Surgeon
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                                 Snehal G. Patel MD, MS, FACS
Snehal G. Patel MD, MS, FACS

Snehal G. Patel MD, MS, FACS

  • Dr. Patel specializes in malignancies of the thyroid, parathyroid, and adrenal gland.
  • Assistant Professor of Surgery, Division of General and GI Surgery, Department of Surgery, Emory University School of Medicine
  • (404) 778-3712

Jamie Paysour MMSc, CGC

  • Genetic Counselor
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                                 Jamie Paysour MMSc, CGC
Jamie Paysour MMSc, CGC

Jamie Paysour MMSc, CGC

  • Ms. Paysour provides genetic counseling for individuals and families who are at risk for hereditary cancer.
  • Licensed Certified Genetic Counselor, Grady Memorial Hospital, Georgia Cancer Center for Excellence
  • (404) 616-1000

Caroline Peacock DMin, LCSW, MDiv

  • Spiritual Health Provider
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                                 Caroline Peacock DMin, LCSW, MDiv
Caroline Peacock DMin, LCSW, MDiv

Caroline Peacock DMin, LCSW, MDiv

  • Dr. Peacock leads the Winship Spiritual Health Team in the work of offering compassionate, inclusive, supportive, evidence based care to patients, families and staff.
  • Director of Spiritual Health, Winship Cancer Institute of Emory University
  • (404) 778-8029

M. Yawar J. Qadri MD, PhD

  • Pain Management Specialist
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                                 M. Yawar J. Qadri MD, PhD
M. Yawar J. Qadri MD, PhD

M. Yawar J. Qadri MD, PhD

  • A cancer pain management expert, Dr. Qadri collaborates with oncologists at Winship to treat patients with cancer suffering from chronic pain symptoms.
  • Assistant Professor, Department of Anesthesiology, Emory University School of Medicine
  • (404) 686-2410

Margaret A. Riso MD

  • Pain Management Specialist
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                                 Margaret A. Riso MD
Margaret A. Riso MD

Margaret A. Riso MD

Missy Roberts MDiv

  • Spiritual Health Provider
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                                 Missy Roberts MDiv
Missy Roberts MDiv

Missy Roberts MDiv

  • Missy provides spiritual and emotional support for oncology patients and their caregivers.
  • Spiritual Health Clinician and Fellow, Winship Cancer Institute of Emory University
  • (404) 778-1900

Nabil F. Saba MD, FACP

  • Medical Oncologist
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                                 Nabil F. Saba MD, FACP
Nabil F. Saba MD, FACP

Nabil F. Saba MD, FACP

Neil D. Saunders MD

  • Surgical Oncologist
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                                 Neil D. Saunders MD
Neil D. Saunders MD

Neil D. Saunders MD

  • A board certified surgeon and surgical oncologist, Dr. Saunders specializes in cancers of the endocrine organs including thyroid, parathyroid, pancreas and adrenal glands.
  • Associate Professor, Division of General and GI Surgery, Department of Surgery, Emory University School of Medicine
  • (404) 778-3712

Merry E. Sebelik MD, FACS

  • Head and Neck Surgeon
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                                 Merry E. Sebelik MD, FACS
Merry E. Sebelik MD, FACS

Merry E. Sebelik MD, FACS

Jyotirmay (Joe) Sharma MD, FACS

  • Surgeon
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                                 Jyotirmay (Joe) Sharma MD, FACS
Jyotirmay (Joe) Sharma MD, FACS

Jyotirmay (Joe) Sharma MD, FACS

  • Dr. Sharma specializes in thyroid and parathyroid surgery, adrenal gland surgery and pancreatic endocrine tumors.
  • Professor and William C. McGarity Chair of Surgery, Division of General and GI Surgery, Department of Surgery, Emory University School of Medicine
  • (404) 778-3712

Qiuying Shi MD, MS

  • Pathologist
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                                 Qiuying Shi MD, MS
Qiuying Shi MD, MS

Qiuying Shi MD, MS

  • Dr. Shi is a board certified pathologist specializing in head and neck cancer, and thyroid cancer.
  • Assistant Professor, Department of Pathology and Laboratory Medicine, Emory University School of Medicine
  • (404) 712-5947

Dong Moon Shin MD, FACP, FAAAS

  • Medical Oncologist
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                                 Dong Moon Shin MD, FACP, FAAAS
Dong Moon Shin MD, FACP, FAAAS

Dong Moon Shin MD, FACP, FAAAS

  • As a medical oncologist, Dr. Shin is sought after for the treatment of head and neck cancer and thyroid cancer.
  • Professor, Department of Hematology and Medical Oncology, Emory University School of Medicine
  • (404) 778-0278

Vinita Singh MD, MS

  • Pain Management Specialist
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                                 Vinita Singh MD, MS
Vinita Singh MD, MS

Vinita Singh MD, MS

  • Dr. Singh collaborates with oncologists to provide state-of-the-art therapies to cancer patients suffering from pain symptoms.
  • Associate Professor, Department of Anesthesiology, Emory University School of Medicine
  • (404) 686-2410

Jesse A. Soodalter MD

  • Palliative Care Specialist
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                                 Jesse A. Soodalter MD
Jesse A. Soodalter MD

Jesse A. Soodalter MD

  • A palliative care specialist, Dr. Soodalter provides specialized outpatient medical care with a focus on relief from the symptoms and stress of cancer and other illnesses.
  • Assistant Professor, Department of Family and Preventive Medicine, Emory University School of Medicine
  • (404) 778-6448

Sumathi Srivatsa MD

  • Endocrinologist
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                                 Sumathi Srivatsa MD
Sumathi Srivatsa MD

Sumathi Srivatsa MD

Christine Stanislaw MS, CGC

  • Genetic Counselor
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                                 Christine Stanislaw MS, CGC
Christine Stanislaw MS, CGC

Christine Stanislaw MS, CGC

  • Ms. Stanislaw provides genetic counseling, including risk assessment and test coordination, for individuals concerned about the possibility of hereditary cancer susceptibility.
  • Director of Genetic Counseling, Winship Cancer Institute of Emory University
  • (404) 778-1900

Conor E. Steuer MD

  • Medical Oncologist
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                                 Conor E. Steuer MD
Conor E. Steuer MD

Conor E. Steuer MD

Alison Sturgill MS, RD, CSO, LD

  • Nutrition Advisor
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                                 Alison Sturgill MS, RD, CSO, LD
Alison Sturgill MS, RD, CSO, LD

Alison Sturgill MS, RD, CSO, LD

Christine R. Tallo MMSc, CGC

  • Genetic Counselor
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                                 Christine R. Tallo MMSc, CGC
Christine R. Tallo MMSc, CGC

Christine R. Tallo MMSc, CGC

Karin Van Vlack

  • Spiritual Health Provider
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                                 Karin Van Vlack
Karin Van Vlack

Karin Van Vlack

Kartik Viswanathan MD, PhD

  • Pathologist
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                                 Kartik Viswanathan MD, PhD
Kartik Viswanathan MD, PhD

Kartik Viswanathan MD, PhD

  • Dr. Viswanathan's clinical specialties include head and neck surgical pathology, endocrine surgical pathology, and cytopathology.
  • Assistant Professor, Department of Pathology and Laboratory Medicine, Emory University School of Medicine
  • (404) 686-1216

Raymond Walker III MDiv, BCC, CCSH-RC

  • Spiritual Health Provider
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                                 Raymond Walker III MDiv, BCC, CCSH-RC
Raymond Walker III MDiv, BCC, CCSH-RC

Raymond Walker III MDiv, BCC, CCSH-RC

  • Raymond provides administrative leadership to the Winship Spiritual Health Team, supporting and assisting in their work of compassionate and inclusive care of patients, staff, and their loved ones.
  • Process Improvement Specialist III, Senior Spiritual Health Clinician, Winship Cancer Institute of Emory University
  • (404) 778-1900

Nan Xiang MD

  • Pain Management Specialist
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                                 Nan Xiang MD
Nan Xiang MD

Nan Xiang MD

  • Dr. Xiang specializes in managing chronic pain symptoms for patients with cancer.
  • Assistant Professor, Department of Anesthesiology, Emory University School of Medicine
  • (404) 686-2410

Thomas Szabo Yamashita MD

  • Surgeon
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                                 Thomas Szabo Yamashita MD
Thomas Szabo Yamashita MD

Thomas Szabo Yamashita MD

  • Dr. Yamashita is an expert in the surgical management of benign and malignant endocrine tumors in the thyroid and adrenal glands, paragangliomas and parathyroid disease.
  • Assistant Professor, Division of General and GI Surgery, Department of Surgery, Emory University School of Medicine
  • (404) 778-3712

Ali J. Zarrabi MD

  • Palliative Oncologist
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                                 Ali J. Zarrabi MD
Ali J. Zarrabi MD

Ali J. Zarrabi MD

  • Dr. Zarrabi provides physical, emotional, and spiritual care for patients living with serious illness.
  • Assistant Professor, Department of Family and Preventive Medicine, Emory University School of Medicine
  • (404) 778-6448
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