The Thing About Thyroids

It looks like a mutant moth which is trying to mate with your windpipe. Or a fleshy bowtie which is too small for your shirt collar and has slid halfway up to your chin.

It is the thyroid gland and I had half of mine removed on Monday.

The thyroid produces a hormone which regulates the body’s metabolism – not too fast, not too slow, but juuust right. The metabolism affects the health of all that is you: brain, heart, muscles, bones and digestive tract; skin, hair and nails.

It’s a lot of responsibility for such a small citizen, so it partners with the pituitary gland to maintain proper balances. The pituitary is located in the brain and looks as much like testicles as anything outside of the scrotum. Must be one reason why men think about sex so often (don’t act so shocked).

Here’s how they work: The pituitary gland monitors the amount of thyroid hormone in the blood. Depending on the level, the pituitary sends TSH (thyroid stimulating hormone) through the bloodstream to the thyroid. This lets the thyroid know it is time to cook up another pot of hormone and dish it out to your other organs.

There are several reasons why the thyroid can misfire. Hypothyroidism (produces too little hormone); Hyperthyroidism (too much hormone); Graves disease; nodules; goiter and - sometimes - it doesn’t malfunction at all, it just sends out teasing little whispers that lead the doctors and patient on a merry chase.

My thyroid was one of the mischievous little teases. It led me on a convoluted journey which began with my primary care physician, led to the endocrinologist, on to ultrasound monitoring and then into surgery. It all started with a low sodium count and ended with a lobectomy, a two-and-half year dance across meadow and stream.

Nodules, which were the mitigating factors in my procedure, do not have the decency to grow on the outside of the thyroid. They are resident within the thyroid and monitored by ultrasound imaging. As such, when they need to be removed, they cannot be stripped away like a wart. The thyroid itself must be removed in part or in whole, depending on the nature of the nodule – benign or malignant.

So how do we determine the benign or malignant intent of the nodule? Fine Needle Aspiration (FNA) provides us with the answers. The physician, guided by ultrasound imaging, penetrates the nodule with the needles and removes cells for a biopsy. And the needles, while small enough to do the job efficiently, are not so small that your family member seated across the room cannot see them administered and hide behind a newspaper.

The results of the biopsy on my nodules revealed cell structures which eventually become cancer in 15% to 20% of the cases, especially in men. The surgeon, who performed the biopsy, consulted with the primary care physician and the endocrinologist and all agreed that removing part or all of the thyroid was the best option. Why, they counseled, take a chance on developing cancer, when the solution was a simple and routine surgical procedure? The only tradeoff is a lifetime of popping tiny purple pills, which have turned out to be surprisingly inexpensive (the patent expired). My wife and I agreed with their recommendation and surgery was scheduled – outpatient.

Two things of note concerning the surgery: 1) the wait is much longer for the family than the patient; 2) the anesthesia used for the surgery does not leave the same goofy euphoria as the drugs used in a colonoscopy.

The patient interacts with many staff members throughout the visit, beginning with paperwork and ending with the wheelchair ride to the front door. My hands-on caregivers were: Dr. Friedman, anesthesiologist; Cathy-with-a-C the surgery nurse; Kathy-with-a-K the nurse anesthetist; Dr. Williams, the surgeon; and Mark, Pippa and Jenny in recovery. There were others, but anesthesia has robbed me of their names. All were excellent and most appreciated.

But my most important care partner was my wife – from the first meeting with the surgeon to driving me home following the procedure, she was a trooper.

There is much more to know, such as the parathyroids and their effect on blood calcium, the importance of taking thyroid medicine, natural vs. synthetic thyroid medicine, etc. You may do self-study if you wish (I recommend The Thyroid Book from KRAMES Patient Education). But the important thing to know is that there are many of us ‘Thyrandroids’ out here. We all do fine with our little purple pills, and you may one day walk as one of our own – MWAA-HA-HA-HAA!

(Illustrations ©2008 TheStayWell Company)

Cattle Call Update

On Saturday morning, July 10, 2010, the orchestrators of the second Cattle Call I attended were soundly spanked by The Tennessean newspaper. Front page. Above the fold.

This particularly egregious Post Secondary Education Career Institute, unnamed in the earlier post, is High Tech Institute, a subsidiary of the Anthem Education group.

According to The Tennessean:

Nicholas Cutcher came home from the war, eager to train for his peacetime career.


What he got, after nine months of study and $15,000 worth of tuition, was a degree from High-Tech Institute of Nashville that he says was worse than useless. Months after he earned his degree as a limited-scope X-ray technician, he still hasn't found work...

…"Why did I pay $15,000 a year for a job that's going to pay me $12 an hour?" said Cutcher, who served as a medic in Iraq and returned home with a Purple Heart. The federal G.I. Bill, and by extension American taxpayers, picked up the tab for his education.

Seems like the industry requires an Associates Degree, rather than a certificate, to even think of employing an allied healthcare worker. Crutcher says his qualifications were laughable when he worked at unpaid intern positions following his graduation. He had not been instructed in many of the fundamentals, such as properly positioning a patient preparatory to taking an X-ray.

And, The Tennessean reports, there is more:

But Stratton Douthat, who spent four months last year working as an admissions recruiter for High-Tech Institute in Nashville, said his experience at the school was more like working for a high-pressure used-car dealership than an educational institution. Recruiters operated under strict quotas, made hundreds of calls a day to try to drum up new students and would go down to the unemployment office to try to entice the newly unemployed to enroll at the school, he said. "They're supposed to be changing lives," Douthat said. "They were after those student loans and Pell grants."

The Directors of Admission for Nashville and Atlanta must have hurried out the building before the hiring interviews concluded in order to cash the government checks. Priorities.

Eat or Be Eaten

“I don’t eat anything that had a face,” the young woman explained in describing her vegetarian diet. My ill-advised follow-up question, “What about potatoes? They have eyes.” ended the dialogue as she moved off to a less cretinous conversationalist.

How many of us, I have often wondered, would continue to eat the meat of face-bearing animals if it required killing the animal, field dressing it and processing the meat?

Using nature as our guide – and the human race is as much a part of nature as the tse tse fly and the sparrow – all is fair in the name of survival. The mantra is Eat or Be Eaten.

Nature has a way of illustrating the point to us, often with a ferocity that galls the tender of heart. My home is in the dead center of suburbia. We embrace nature on our acre of wildlife sanctuary, playing host to several clutches of bluebirds throughout the summer. One of our favorite times is when the fledgling bluebirds leave the bird house on their maiden flights. Tentative and clumsy, the fledglings are encouraged to leave the nest by their parents from nearby trees.

Having witnessed two of the young blues awkwardly leave the nest, we hit a dry spell where the remaining fledglings were resisting all encouragement to take flight. We took flight on an errand of our own and returned shortly. I spotted what I thought was a water stain running from the hole in the bird house to the hydrangeas underneath. Closer inspection revealed not a stain, but the ass end of a snake.

I pulled the snake out of the hole and flung it over the fence. The snake did not seem to have ingested anything, yet when I opened the bird house, I found two dead fledglings, eyes closed and no respiration. I removed the bodies to a shaded area up the hill, hoping that they were only suffering from a fear-induced shock. Snakes really piss me off.

Pondering on the event later, I had to admit that the snake was just doing what snakes do. It was not emotionally constrained by the fact that birds have faces. It was acting under a more rigid imperative - survival. Nature had equipped the snake to climb bushes, slither through holes and ingest face-bearing, feathered fowl. And come to think of it, nature had equipped the bluebirds with wings to evade snakes and pursue face-bearing insects (not all faces are attractive).

This has been a banner summer for finding mammal remains and entrails in our yard. The bird bath seems to be a popular place for feathered predators to leave the odd chipmunk leg or unidentifiable cartilage. A gathering of flies clued me to what – judging by the fur – was a puddle of rabbit entrails in the wooded area behind our house. I guessed that the remaining sweetmeats would be gone the next day, and indeed they were. Only a small tuft of fur remained to remind the world of the rabbit’s existence.

And that is not necessarily a bad thing. The rabbits have spent the past winter and spring procreating like – well, rabbits. They have proved to be a scourge to my wife’s garden, eating tender shoots and buds a’borning. They have no fear of humans. Only the well-aimed rock has moved them from their feasting, and then only by a few feet. This is the first year that I have cheered the coyote sightings, forgiving their transgressions against small pets. ‘Go get ‘em, boys!’ I cry and point to the closest warren.

And the deer. As bucolic a sentimentality as they portray when seen at dusk, grazing with their fawns in the neighbor’s yard, they have been worse than the rabbits at decimating the garden. While lilies may not have faces, they DO have throats, and the deer snapped off more than 100 helpless buds before they had the chance to bloom – taken before the flower of their youth. Had we a hunting rifle, my wife would have culled the herd, despite city ordinances against such activity in the ‘burbs.

Among the backyard atrocities we have witnessed we can include: a blue jay carrying off a cardinal chick from its nest; a hawk nailing a starling on the ground and spreading its wings over the victim as it delivered the coup de grace; a larger hawk snatching a squirrel from its repast and disappearing over the rooftops; a crow fending off attack as it attempted to abduct a mockingbird chick; and a neighborhood cat carrying a baby rabbit off to show to its homeowners (cats have no owners, only homes). All the victims had faces. So did the victors.

I also have no doubt that, were I to have an ‘episode’ in the back yard and lie dead or helpless, other face-bearing creatures would have no problem in feeding on me. The crows would come first, to feast on the sweet moistness of my eyes and any other fleshy portions readily accessible. The coyotes or neighborhood dogs would follow to rend flesh and open the body cavities to the gut and prized heart. Insects would follow quickly to feast and lay eggs, and the vultures – God’s recylcing experts – would remove remaining soft tissues and stink.

Back, then, to the earlier question. How many of us would continue to eat the meat of face-bearing animals if it required killing the animal, field dressing it and processing the meat? Probably more than we suspect, since that would indicate we were thrown back to a more agrarian way of life, where survival depended on taking advantage of every food source available throughout the seasons.

Plus, nature has equipped us with the tools to eat whatever we need – eyes to see, ears to hear, brains to track prey and fingers to pull triggers. We have incisors to cut through lettuce and cabbage; canines to rip flesh; and molars to crush nuts and grains. Eat or be eaten. I am nobody’s smorgasbord.