The Thyroid in Rhyme

The thyroid in Rhyme

Nearly twenty five grams of endocrine tissue,

Could result in a small or big issue,

Has an ‘isthmus’ overlying third and fourth tracheal rings,

Oh what havoc the two  lobes and this brings !

Developmentally starts at the foramen cecum,

Descends down but in some,

Prefers the tongue over pre-tracheal position

Confusing the physician in forming a decision.

Elaborates hormones abbreviated T3 and T4,

As if two are not enough there is one more,

Calcitonin from the parafollicular or  ‘C’ cells,

Opposite to parathormone is where its function dwells.

What a role these Thyroxines play!

Its level high or low and treatment you delay,

Cold intolerant thick skinned   sluggish victim you see,

Or thin sweating exopthalmic cardiac wreck as the care may be.

‘Goitre’ the general term for thyroid swellings all,

To iodine deficiency, inflammatory, or neoplastic the reasons fall,

Clinical examinations, FNAC’s blood tests and uptake studies,

Categorize patients as ‘medical’ or ‘surgical; after share of fees!

Simple goiter may be nodular of diffuse,

For diffuse type , Iodine as treatment has been in use,

For ‘nodular ‘variety the knife you need,

Always with the blade you do a better deed !

Solitary nodule an enigma to say the least,

Could make the difference between beauty and beast,

Uptake differentiates as ‘warm’  ‘hot’ or cold’

‘Cold’ it is neoplasm we are told.

Thyroid neoplasia a world of its own,

Papillary cancer prefers lymph nodes for seeds to be sown,

Whereas follicular cancer metastases to bone,

‘Anaplastic’ feared most, infiltrates to make trachea groan.!

Medullary cancer has a tale of its own,

Prefers company as ‘MEN II’ as its incidence is known,

Whatever the histology, surgery is the answer,

May be followed by adjuvant treatment like any other cancer

During surgery, it is any surgeon’s fear,

Those recurrent laryngeal nerves  which are so near,

Injury or insult , and a patients hoarse voice you hear,

May necessitate trachostomy or cost a life so dear.

Surgery in toxic goiter, at ease one can never be,

Though uncontrolled and of toxicity patient be free,

The unwelcome ‘storm’ sets in without any notice,

Where is the surgeon’s ease when the patients’s life is on lease?

The thyroid has more potential for rhyme,

If only I have the time,

My prayer is that all patients euthyroid be,

And be free  of other problems one may see

Author

@ copyright Dr Cherian Koshy