By Allan R. Handysides and Peter N. Landless
Overactive thyroid is a family problem. My mom and an aunt have it. I was diagnosed last month with hyperthyroidism, or Graves’ disease. My mom had radioactive iodine, and she now takes thyroid replacement. She was very happy with the treatment. My doctor has put me on antithyroid drugs, but I would prefer the iodine. I’m 51 years old and understand the small risk with the radioactive iodine. How would you recommend I be treated?
Graves’ disease, or hyperthyroidism, probably results from disturbances in the immune system—likely from autoreactive lymphocytes. These cells make antibodies that stimulate receptors leading to overactivity of the thyroid. The thyroid produces a hormone called thyroxine, which in turn stimulates metabolism in all other cells. The raised metabolic rate gives signs such as rapid heart rate, warm skin, and weight loss. The patient may feel palpitations, irritability, nervousness, changes in sleep patterns and appetite, and hand tremors.
One of the more medically interesting but unpleasant effects is on the eye. Patients with Graves’ disease—in about 50 percent of cases—have eye problems; in about 30 percent, bulging of the eyes is noticeable. In about 3 percent, there can be a vision-threatening condition.
The problem is a buildup of fibro-?fatty tissue in the orbit, plus enlargement of the muscles that move the eyeball. Computer tomography (CT) shows these changes. The eye may bulge to a point that the lids won’t close properly. Movement of the eyes may be hindered, leading to double vision. Some patients get a gritty feeling in their eyes and make more tears.
It’s this set of eye complications that may have led your doctor to choose antithyroid medication over radioactive iodine. Fifteen percent of patients seem to develop a progression of eye changes. Cigarette smoking may also make these eye changes worse. Antithyroid medications do not alter normal progress of the eye changes, so some doctors try them first. The addition of prednisone to the radioactive iodine treatment protocol seems to avoid this progression.
Radioactive iodine may increase the risk of thyroid cancer some 25 to 30 years down the road; this can be a consideration for younger patients.
Once the thyroid has been killed with radioactive iodine, replacement hormone, or thyroxine, becomes necessary.
If left untreated, Graves’ disease can cause a very miserable life and even lead to death. The treatments are able to bring a normal life to the individual, albeit at the expense of popping a pill each day.
I’ve been diagnosed with Parkinson’s disease. I’m 64 years old and am very concerned. Could you advise me?
You need ongoing care with a neurologist, who will be abreast of the latest and newest developments. The disorder is undergoing intensive investigation and, hopefully, newer and more effective remedies will become available.
We don’t know the cause of Parkinson’s disease. It’s a degenerative disease of the central nervous system that shows itself in a resting tremor, rigidity, slowed movement, and decreased dexterity. Individuals with Parkinson’s tend to walk with a flexed stance and to shuffle. Their handwriting may become very small, and—over a prolonged period—they may suffer some loss of mental alertness.
Parkinson’s begins at a mean age of 57 years and affects about 1 to 2 percent of the population over age 60. It ranges in severity from very mild to minimal discomfort to marked disability.
The lesions appear in the mid-brain nerve cells of the pigmented cells of the substantia nigra pars compacta. These cells die off in Parkinson’s disease. They have a function of producing a substance called dopamine. It’s been found that a synthetic chemical called “levadope” replaces some of the missing neurotransmitters with improvement in symptoms in many patients.
Studies continue, and hope for this condition is certainly realistic. The progress of your condition may be very slow, and you likely will enjoy many more years of productive life.
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Send your questions to Ask the Doctors, Adventist Review, 12501 Old Columbia Pike, Silver Spring, MD 20904. Or e-mail them to [email protected].
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Allan R. Handysides, M.B., CH.B., FRCPC, FRCSC, FACOG, is director of the General Conference Health Ministries Department.
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Peter N. Landless, M.B., B.CH., M. MED., F.C.P. (SA), F.A.C.C., is ICPA executive director and an associate director of the General Conference Health Ministries Department. This article was published October 28, 2010.
