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)