As I sat in the waiting area of the Tony Thwaites Wing at the University Hospital, I reflected on a rather stressful week.
I was praying to God, while contemplating giving consultant psychiatrist Dr Wendel Abel a visit. You see, as I sat there, the scalpel of Dr Hal Shaw, ear, nose and throat specialist (my hero), was walking carefully through the throat of my dearest relative as he performed surgery to her thyroid gland.
The thyroid gland is extremely vital and controls the working of every cell in the body. It makes the hormone, thyroxine, which controls the speed at which the body's cells and organs work and the gland needs iodine from our diet to make thyroxine.
What can go wrong?
Problems with the thyroid gland often involve over-production or under-production of thyroxine. The possibility exists for four different types of cancer of the thyroid, especially in people who have received radiation to the head, neck or chest.
Lumps or nodules in the gland are possible, which may or may not be cancerous. Then there are various forms of inflammation of the gland (thyroiditis). In all of these conditions, the thyroid size, functioning and levels of thyroxine produced must be monitored regularly with blood tests, X-rays, ultrasound or fine-needle biopsy.
Underproduction of hormone
In some countries, where the soil and, therefore the food, severely lack iodine, insufficient iodine is consumed for the body to produce thyroxine. So, the thyroid gland tries to compensate by growing large to form a goitre, a growth in the front part of the neck. Other causes of goitre include defects associated with the person's immune system, which lead to destruction of the gland (thyroiditis), and use of drugs like lithium carbonate to treat manic depression. Although some people with goitre produce normal amounts of thyroxine, others may eventually develop an underactive thyroid gland (hypothyroidism).
Interestingly, a common cause of hypothyroidism is the treatment (radiation or surgery) for the overproduction of thyroxine (hyperthyroidism). Symptoms of under-production of thyroxine include weight gain, sensitivity to cold temperatures, tiredness, depression and husky, slurred speech.
So, my loved one who had a goitre and hypothyroidism for about 25 years, and was now in surgery to remove the gland, used to complain for years about being cold, when everybody else thought that the temperature was fairly mild. Plus, her goitre was becoming so large that it was resting on her voice box, giving her a husky voice, and resting on her wind pipe causing shortness of breath. The gland was now growing out of control into her chest.
Treatment for underactive thyroid gland (hypothyroidism) involves replacing thyroxine in an oral form (Eltroxin tablet) and it is taken once daily before breakfast for the rest of the person's life.
Overproduction of hormone
In this case, the thyroid gland is overactive and produces too much thyroxine. The thyroid gland is stimulated, in most cases, to produce too much thyroxine and to increase the size of the thyroid gland (goitre). The condition is called hyperthyroidism or Graves disease. The body's functions speed up, the heart pounds and palpitations may develop. Blood pressure is likely to increase. Most of us have seen people with Graves disease, who have bulging, prominent eyes with bags underneath and with other symptoms such as weight loss, heat intolerance and sweating, irritability and breathlessness. Treatment involves:
Drugs - Carbimazole (Neomercazole) is taken either to prepare those with hyperthyroidism for surgery or just for daily maintenance therapy to interfere with the excessive production of thyroxine.
Surgery - If the goitre is causing problems, surgery to remove most of the gland (thyroidectomy) may become necessary. Thyroxine treatment usually becomes necessary afterwards since there is not enough gland left to produce the thyroxine that the body needs.
Radiation with iodine - In some cases, the size of the goitre may be reduced by radiation with radioactive iodine. The client will need to be isolated for about 36 hours in order to avoid contaminating others with the radioactivity.
The quality of life for my dearest relative has been better since the surgery and she is recuperating nicely. But, after the surgery, the gland is usually tested for cancer and in Jamaica the test result seems to take ages (like three weeks). And, so, we wait.
Dahlia McDaniel is a pharmacist and final year doctoral candidate in public health at the University of London; email: firstname.lastname@example.org.