Talking to an endocrinologist

I had never been to an endocrinologist before. I arrived at the office and walked in to the waiting room of mostly elderly people. I thought--"OK, I am the young guy here." I am the one who is going to leave smiling, after the doctor tells me I am too young to have anything wrong with me.

I waited for the doctor in one of the treatment rooms for a few minutes, reading a few brochures about hyperthyroidism and diabetes. Dr. Wotten (sounds like Cotton) walked in an sat in a chair about 10 feet from me. He did not have to come closer. "You need to have that removed" is all he needed to say. I replied "So, it is big, huh". "Yes", he said. "Have you ever been exposed to radiation?", he asked.

Great. I have known this guy for 10 seconds and he is so astonished by the size of my thyroid that he thinks I was exposed to a nuclear blast or something. This is not a good sign. I had gotten used to my big thyroid slowly growing over the years, so much so that I must have forgotten what I looked liked when it was the normal size. I replied to him "Nope. Never exposed to radiation." "Well, that's one of the biggest ones I have seen. It will continue to grow and it needs to be taken out".

Before the appointment, I had been on the Internet and read about the thyroid. Normally, it cannot be seen from the outside of your body. It is usually the size of a a shot-glass, shaped like a butterfly, lying beneath the Adam's apple. The thyroid produces a hormone called Thyroxin, the helps regulate bodily functions like heart rate, metabolism, and body temperature. People with too much thyroxin generally can be overactive, high-paced, and maybe underweight because of their increased metabolism. People with too little thyroxin might be the reverse. In fact, a lot of people with weight control problems would often blame the thyroid for their weight gain. Dr. Wotten said the first thing he wanted to do was to test my blood to see how much thyroxin hormone my thyroid was producing. I would either bee euthroid (normal), hyperthyroid (too much) or hypothyroid (too low). He said that in many cases, the thyroid can be huge, but still produce the correct amount of thyroxin. He went on to explain that the thyroid is told how much to produce by another gland in the brain, called the pituitary. The pituitary gland detects the amount of thyroxin in the blood and creates a hormone called thyroid stimulating hormone (TSH) that tells the thyroid when to turn on or turn off, as my body needs more thyroxin. The bottom line is my thyroid can be giant, like it is, but I would still have the right amount of thyroxine hormone.

I had a few questions:

1. Why would the thyroid be so big?
2. If it is producing the right amount of thyroxin, why take it out?
3. Do I have to remove the thyroid now (versus a year from now)?
4. What is involved in the surgery?
5. What is involved with replacing the thyroid hormone, assuming I had no thyroid anymore.


Dr. Wotten explained that the thyroid could have grown because of exposure to radiation, the lack of iodine in my diet (which is virtuallly impossible in the US, but is common in underdeveloped countries), genetic factors (I have no family members with this problem) or because of cancer. Cancer? Not what I wanted to hear. But then, cancer was rare. Thyroid cancer is one of the rarest out there. Plus, I had no family history of thyroid cancer, or cancer in general. It would be very unlikely that I would have thyroid cancer.

He said that the growing thyroid would not stop growing and it could eventually make it difficult to talk, swallow or even breathe. Well, I had already experienced the difficult to breathe problem. And, after thinking about it, my voice would often be hoarse at different times of the day, especially after exercising. I now realized that my giant thyroid was probably the root of these problems.

As far as the surgery, it said it was "outpatient". Can you believe that? Remove an organ and go home the same day? That made me feel good. Anything that could be done on an outpatient basis could not be too bad. Think about it--you arrive at 11:00 and are on your way home at 3:00. This was good to hear.

We spent a few minutes talking about replacement thyroxin. My thyroid would be gone, and I would just take a pill to replace the hormone. Simple. I just hate the fact that I would be dependent on taking a drug every day for the rest of my life. What would happen if there was a war? What happened if the world fell apart and I could not get my medicine? Those thoughts were truly what I was thinking. "So, doc. What happens if I don't take my pill"?, I asked. " You will be hypothyroid and start slowing down, and gain weight.", he replied. "No, I mean really stop taking it--I just don't take it again.". "Oh", he looked a little confused. "Well, after about three months, you die". Got it. (I went home that night, looked online and found a year supply for about $800. Note to self: In event of nuclear war, immediately place order for 10 years of thyroxin. Before they nuke the manufacturer. )



The blood was drawn by a nurse and Dr. Wotten came back in with one more comment. "Steve, before you leave, we want to do an ultrasound. Your thyroid is very big and we want to take a look and see how invasive the growth is and to get a better look at the size." OK. We can do the ultrasound. Dr. Wooten had said it was most likely benign--it turns out that thyroid cancer is rare, so, no problem if they wanted to take a look inside, from the outside--go for it.

That's when things started to get interesting....