Sunday, October 2, 2011

That Crazy Little Thing Called . . .

I have written before about how I believe it really is the small things in life that are the most important.   I am not talking necessarily about things that we might take for granted, but more about things we just don’t think about on a daily basis - like your thyroid gland.  How many of you have thought about your thyroid gland today?  This week?  This month? This year? I hadn’t either until about a month or so ago.
When I had my physical last month the doctor said that everything was great but he did notice that I had a goiter on the right side of my thyroid.  Goiter?  An enlargement, swelling, a lump.  In this day and age anything that is described as a lump strikes fear in our hearts and minds.  So I began the journey to get to know this goiter, this enlargement, this lump a little better.  I started by learning about “its relatives” on the Internet.  This is never really a good thing.  There is much conflicting and even more just plain wrong information out there.  I remembered from writing research papers in high school that if you find the same information in three sources it is assumed to be common knowledge.  I went with that.  If I read the same thing on three or more different websites I deemed it reputable.
Then, at the request of my primary care doctor, I sought information from the specialists.
First I had a radioactive scan.  This cut into two of my days.  On day one I had to go swallow a radioactive iodine pill.  It didn’t take long; it was simply an inconvenience.  The good part was that I got to go out for breakfast with a friend afterwards, something I don’t normally get to do during the school week.
The next day I went back for the actual scan.  I wasn’t too worried about the procedure until they had me lay down on a table and then started sliding me into one of those machines whose entire persona is a big, black claustrophobic hole.  Sensing my panic, the tech told me to relax, that it was not entirely closed in.  She also told me not to turn my head.  Well, the part that I could see was closed in.  The part on the sides of my head, where I was instructed not to look was open.  With a few mind games I was able to survive without embarrassing myself or my friend who went with me.  And, for being a pretty good girl, I got to go out for breakfast again on a school day!
A healthy functioning thyroid absorbs iodine.  By swallowing a radioactive iodine pill, the doctor was able to see how my thyroid was functioning.  The scan revealed that I have a “cold nodule” on the right side of my thyroid.  Though my general thyroid hormone levels are normal, this cold nodule means that a portion of my thyroid is not functioning.  A “hot nodule” is one where the thyroid is overactive.  Hot nodules are almost always benign.  Cold nodules can be cancerous.  Armed with my cold nodule in the right side of my thyroid, I went next to see an endocrinologist.
As an aside, I had this procedure done right around the tenth anniversary of 9/11.  We were watching a television special about the various commemorative activities being held in New York City and the security measures surrounding them.  One of the segments talked about how they had technology that could spot radioactivity - including people who had had any time of medical procedure using radioactive materials during the past two weeks.  Fortunately we weren’t going to New York City.
The endocrinologist looked at the scan results and told me that it was great that I had the scan, but that we were still at square one because what we really needed to know was whether or not the nodule was cancerous and there is no way to tell that from a radioactive scan.
He then said that he wanted to do a sonogram to determine the actual size of the nodule, another piece of information that seemingly was not shown by the first scan.  Nodules of one centimeter or less are rarely cancerous and do not require any further attention unless they grow larger.  Those nodules that are larger than a centimeter require more “getting to know you.”  Mine is 3.2 centimeters, which the doctor classified as “kind of big.”  Surprisingly, I hadn’t felt it.  Thyroid nodules can interfere with breathing, swallowing and can cause hoarseness, none of which have I incurred.  I am a visual person so I had to find something that was 3.2 centimeters.  The end joint of my own thumb is about that size.  It is hard for me to believe that I have something the size of almost half of my thumb in my throat and I didn’t even know it was there.  Sometimes now I think I can feel it but that just may be like that tiny spot on your shirt  - once you are made aware of it that is all you can see or, in this case, feel.
After assessing the nodule’s size the doctor said that he would need to do a needle biopsy.  He stuck a needle into the goiter, the enlargement, the lump, the nodule - four samples he took.  It didn’t hurt but it was a very strange sensation.  This was the first time that I actually felt like there was something in my throat.  As the needle penetrated the nodule, it pushed against my trachea and esophagus.   Like I said, this was a very weird sensation.  The entire procedure took only about ten minutes.  He then told me that it would take a week before he had any results.
How is it that nearly everything in this world seems to take only seconds and this was going to take a week?  I can order almost anything I want from and have it tomorrow.  And Amazon seems to have a hand in just about everything.  Can’t they branch out into medical testing?
The doctor told me that though thyroid cancer is out there, only about 5-10% of all nodules are cancerous.  He also said that thyroid cancer is treatable.  (Both of these things I knew from my research on the Internet but it was nice to hear them from a medical professional.)
As it turned out, it took only six days to get the biopsy results and they showed that the nodule is benign.  So for the time being it and I will remain constant companions.  The whole relationship will be re-examined in a few months.  If the nodule becomes too needy with regard to space, he will be surgically evicted: we’ll have to wait and see if such harsh measures are warranted.
In conclusion, in the past month I have learned a lot about that little thing called the thyroid gland.  Here are a few more facts (collected from my conversations with the doctor, not from my own travels on the Internet).

  • About 50% of the adult population has thyroid nodules.  Most people have no idea that they have them.
  • Modules in general are more common in women but cancerous nodules are more common in men.
  • Only 5-10% of all thyroid nodules are malignant.
  • Most thyroid cancer is curable.
  • This little gland has a big job.  Its primary function is to regulate metabolism
This may be more information than you wanted to know about the thyroid, but if you are ever told that you have a goiter, an enlarged thyroid, a lump, or a nodule you will know exactly what that means.