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BLOG: The other butterfly
On my way to the office following a second-year medical students’ problem-based learning (PBL) class at the MSU Radiology Building, I was stopped by a spectacular scene; one of those typical situations, where one is compelled to pull out his or her cell phone to take some pictures.
It was late October, while we were still enjoying some residual warmth in Michigan, before bracing ourselves for the cold season that was around the corner. Climate experts had been warning of a winter that would be a bitter one: At the time of writing this blog, around mid-December, we were prepared for an arctic vortex front with temperatures to plummet to below zero (in some places).
I was alerted to the scene by a woman who had just finished taking pictures of some small bushes. The woman then explained herself to me, as I slowed down with curiosity, wondering what she was taking pictures of:
“A butterfly,” she said, smiled and then moved on.
A pretty, brown butterfly was almost standing on the bush (Figure 1). So, it was my turn to stop by and take pictures. The butterfly stood there motionless for several seconds; not moving at all! So, I took the still picture, and when the butterfly began to move her wings, flying locally but still staying within few inches of the same area, I took a short video, which I thought would be spectacular to watch, but for technical reasons cannot be displayed.
Obviously, a few days later, the weather cooled off, gradually, and no more butterflies would be seen in the MSU Radiology Building Gardens until the spring. These gardens are spectacular, including both indoor and outdoor sections. The Radiology Building houses, in addition to all diagnostic equipment (MRI, CT scans, etc), a teaching floor in the basement. Second year medical students of MSU College of Human Medicine have their PBL classes in this section.
I have some passion for butterflies, and I Google butterfly pictures now and then and I also tremendously enjoyed my visit to the Butterfly (mini-zoo) at Mackinac Island, Michigan. Figure 2 depicts a picture that I took during my recent visit to the island in the summer of 2014. This butterfly is also brownish in color, but the decoration is quite different from the Radiology Garden’s butterfly. Butterflies come in numerous shapes, colors and decorations. Let me share with you what I have learned from a recent Google search for the purpose of this blog (but to the respected readers who are experts on butterflies, I apologize in advance if the website I will cite is not that accurate, or if I misunderstood what I had read). The website I visited is: Enchanted Learning (12/17/2016), at: http://www.enchantedlearning.com/subjects/butterfly/allabout/index.shtml.
Butterflies belong to the arthropods “group,” Phylum Arthropoda and the Order, Lepidoptera. Most of these, sometimes funny, names, which are assigned to tens of thousands of various species, are derivations from either Greek or Roman or both. In this case, Lepidoptera comes from two Greek words, the first meaning scales and the second meaning wings, according to the website. I also learned that there are 120,000 species of butterflies.
The website describes the butterfly with the following anatomical description:
“Butterflies are beautiful, flying insects with large scaly wings. Like all insects, they have six jointed legs, three body parts, a pair of antenna, compound eyes, and an exoskeleton. The three body parts are the head, thorax (the chest) and abdomen (the tail end).
The butterfly’s body is covered by tiny sensory hairs. The four wings and the six legs of the butterfly are attached to the thorax. The thorax contains the muscles that make the legs and wings move.”
This was all about the real butterfly. So, what is the “other butterfly?” I do not mean the kind of butterflies that I once saw in the laboratory.
“What butterflies and what laboratory,” you ask?
One day, last year, I was sitting in the phlebotomy room, for a blood draw at the Sparrow Laboratory branch at our clinic. While the phlebotomist was prepping my arm for the blood draw, I was focused on a bulletin board on the wall: Two very beautiful and colorful butterflies were standing still on the wall. The pair of butterflies were motionless, and the scene, with colors and beauty, was reminiscent of the brown butterfly on the bushes at the Radiology Gardens. They were plastic butterflies but they were so well made that they looked like real butterflies from a distance.
I asked the phlebotomist about them, “Are those butterflies yours?”
“Oh, no, those belong to Sue,” a co-worker of hers in the lab who was off that day. Sue has the hobby of collecting butterflies. Fake butterflies, that is! Later, I would have some wonderful discussions with Sue about butterflies whenever I have a blood draw at the lab. The other day, I stopped by the laboratory to discuss a glitch encountered after implementing a new electronic health record at our clinics, I mentioned this Butterflies’ blog to Sue. She was so thrilled with the draft, and she consented to have her name mentioned in the blog. She also consented to have her plastic butterflies’ picture published (Figure 3).
Now, let me disclose the other butterfly I have been alluding to from the outset of this blog: The thyroid!
The thyroid gland is described as a butterfly in the literature (See the website sponsored by the American Association of Clinical Endocrinologists: http://www.thyroidawareness.com/).
And this thyroid talk is timely: January is Thyroid Awareness Month.
The analogy of the thyroid to a butterfly, anatomically speaking, is obviously based on similarity in shape, solely.
The thyroid is a tiny organ, a gland, which is partially wrapped around the lower part of the trachea in the neck, before the trachea enters into the chest cavity. The thyroid is perhaps the most popular gland in our endocrine subspecialty. Probably a lot of people are also familiar with other glands, especially the pancreas in view of the routine talk about diabetes. But no other gland is better-known to the internet and the public than the thyroid.
From the standpoint of simple physiology, the thyroid gland is the principal “headquarters” for energy mechanics and metabolism, regulated intricately by the thyroid hormones, thyroxine and triiodothyronine. Hyperthyroidism (over-function) may be associated with heart racing and palpitations, weight loss, diarrhea, heat intolerance, etc. Hypothyroidism (under-function) may be associated with slow heart rate, weight gain, constipation, cold intolerance, fatigue, etc.
Back to the “butterfly description,” the only relation between the thyroid and a butterfly is the shape! Figure 4 shows the cartoon we use for thyroid biopsy at our practice. The drawing depicts the anatomy of the thyroid in various planes (longitudinal, transverse and frontal). The frontal plane depicts the gland in an H-shaped structure, though the crossing bar is located closer to the lower ends of the vertical bars.
This H-shape appearance gives the gland its’ “butterfly” description. In my presentations, I also use the “H-shape” description. Using this analogy, the thyroid gland has two vertically located lobes, one on each side, connected by a bridge, the isthmus. It is usually not visible in the neck, nor easily palpable, when normal in size.
For an endocrinologist, about 50% of his or her patients are referred for thyroid problems: hypothyroidism, hyperthyroidism and thyroid nodules.
Patients with hypothyroidism are often told that their illness was caused by Hashimoto’s thyroiditis, which denotes the most common autoimmune disease in humans. The disease was described by the Japanese physician, Dr. Hakaru Hashimoto in 1912.
On the other hand, the commonest cause of hyperthyroidism is caused by Graves’ disease. Some patients are scared by the word, “Graves” when first told about the diagnosis. But again, the endocrinologist would rush to reassure them that the word denotes the name of the physician who described the disease in the nineteenth century, an Irish physician, Dr. Robert Graves.
While Graves’ disease has a strong genetic vulnerability, and it runs in families — blood-related families, that is — both former U.S. President George H.W. Bush and his wife, Barbara Bush, had Graves’ disease, at about the same time, in the early 1990s. The President had atrial fibrillation, and Mrs. Bush had infiltrative eye disease, both complications well-related to Graves’ disease. However, these different complications are caused by different mechanisms related to Graves’ disease — the former due the hormonal hyperthyroid state and the latter due to the extra-thyroidal autoimmune manifestation of the disease.
As to the thyroid nodules, these are common abnormalities of the thyroid, with a very high prevalence in the population. The literature cites a prevalence of up to 60% to 70% as detected by ultrasound according to some studies. Luckily, the majority of nodules are benign — little above 5% of thyroid nodules are cancerous.
That was the story of the “other butterfly.” Is it just the shape similarity, or is it also that as butterflies are the most fascinating insects, the thyroid is the most fascinating gland? Or maybe it is just me!