Saturday, December 29, 2007

Thyroid Patient

Greetings Gentle Readers,

Yes, this is the same ole' Gizzard posting. I have a quick story to tell. I had a young student a few years ago attend one of my classes on abdominal ultrasound. We cover everything in the belly, then some. The "then some" involves discussions about small parts, thyroid, and testicular imaging (another post to come). In day five we cover superficial sonography to include masses , lymph nodes, muscular tumors, and thyroid sonography.

As usually happens, the students scan each other in the lab on the great machines we have, and damned, if I was looking over the shoulder of the neophyte when I spotted a heterogeneous lesion in a students thyroid gland. I say "no big deal"to the person on the gurney, and no big deal to all who gathered rapidly (my utterance rang like a monastery chime in a mountain retort in the Himalayas). DING DONG!!!!!


Medical Dilemma. It looked like the throngs of unwashed hanging about after a car bombing. But these people could hear! BONG BONG!

One word of advise to junior sonographers, never say OMG or WOW in front of a patient. They will look at you with the eyes of lasers (and my cat) and say "What did you find?". Many patients watch the eyes of a sonographer instead of the screen which they think looks like a snowstorm (1965 TV set on channel 2).
Gizz Note: did you know that it was once thought a tornadoe could be predicted by listening to the pattern of white noise on a TV set? Please look that one up for me folks.

I proceeded to tell the group about the mass seen on the screen with attention directed to it's grey-scale features, all the time smiling and tapping my toes lightly.

By the literature, the vast majority of lesions in the thyroid gland are benign processes, and should cause little concern. I preached this to the audience who gave me the "fish-eye". I counseled the student who's thyroid lesion was clearly presented on the screen not to worry, but consult her doctor when she returned home. I always say this when ever an abnormality is seen in the classroom setting. I told her I am not a doctor and that it is up to her physician to decide what to do.

Sure enough, I get an E-mail the next week from this student telling me she did visit her physician, and they DID perform a biopsy and it WAS cancer. Wow, if I had any schnapps at the office, I would have taken a sip. I told her to stay in touch and God Bless.

It does not end here. She showed up a year later to take another class, and I got big huggz when she strode into class. Alas I do not always remember names, but I do remember faces, so I accepted the bear hug she dealt me.

I asked her about the surgery, and she said they did a total thyroidectomy. "They removed it all and gave you radiation chemo?" I asked

"No, they did not give me any chemo...."


"My Doctor did not want me to have Iodine 131 therapy because I told him I wanted children."

Here I must say dear readers, that most thyroid cancers which are deemed virulent, or aggressive are followed by radiation treatment consisting of a couple pills of a very radioactive form of iodine. This treatment requires the patient to be cloistered for at least 2 days in isolation because of the high levels of radiation emitted by the iodine (mostly beta rays which do not penetrate far). Clothing, food, tissues, bandages, all personal effects must be tossed after this form of chemo.

The idea here is to treat any remaining cancer cells with radiation. Iodine is taken up specifically by thyroid cells, thus is the best chemo agent for the task as it will hunt out aberrant thyroid tissue like a blood hound seeks an escaped criminal.

Here the story resumes. I say to her "Would you like for me to scan your thyroid bed for any thing extra?"

Of course you have figured out I found another mass. It was removed, and she did have radiation chemotherapy, only after delivering her healthy baby son.
By the way, the image you see above is one of my feline buddies I inhabit the house with. She just got a shower, and she is not pleased. And Yes, I will post her to lolcats.


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