By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

FRIEND'S THYROID CONDITION NEEDS TREATMENT, OR IT COULD BE FATAL

Question:  My friend has been told that she has Grave's Disease.  She has no health insurance and doesn't want to go back to the doctor to get this treated.  What should I tell her?  Is it OK to wait until she has insurance to get treatment?

Answer:  First, what is Grave's disease?  Grave's disease is the most common type of hyperthyroidism.  Hyperthyroidism is overactivity of the thyroid gland, which is a large gland that is found in the lower front portion of your neck.  It controls your metabolism, body temperature and muscle tone.

In the case of Grave's disease, the thyroid gland produces too much thyroid hormone, which leads to many problems throughout the body.  It is believed that Grave's disease is an autoimmune disease, where the body tries to "fight itself" and produces antibodies against its own tissue. 

Many of the symptoms of Grave's disease are nervousness, anxiety, and irritability.  Increased circulating levels of thyroid hormone can also cause rapid heart rate and palpitations.  Muscle weakness and tremors are common as well.  Weight loss, diarrhea and heat intolerance can also occur. A physician may look for physical changes that go along with Grave's disease such as warm, moist velvety skin, and redness of the palms.  The patient may also have fine, silky hair.  Nervousness, rapid speech and tremors may also be noted.

Hyperthyroidism causes proliferation of the tissue behind the eyes, making the eyes bulge out, a condition called exophthalmos.  The person with this condition also may experience staring, infrequent blinking and swelling around the eyes.  The cardiovascular system can also be drastically affected.  Blood pressure may rise to critical levels, and the heart may develop a rapid rate, leading to atrial fibrillation, a serious heart dysrhythmia.

As you can see, there are plenty of reasons your friend should get medical attention promptly.  Out of control thyroid levels can be fatal if left untreated.

The treatment for Grave's Disease depends on what symptoms and conditions have resulted from the elevated thyroid hormone levels, and how high the levels are.  Medications can be used to destroy the thyroid gland as well as to control the person's symptoms.  If the hormone levels are not controlled with medical management, radioactive iodine can be given to destroy -- or "ablate" in doctor lingo -- thyroid tissue.  Occasionally, part of the thyroid gland has to be surgically removed. 

After the gland is ablated, people may need thyroid hormone supplementation, if the entire gland is no longer functioning.  Once you have thyroid disease, it is a lifelong ailment and needs continual monitoring.  Encourage your friend to go back to her doctor as soon as possible.  Perhaps, you or some of her other friends could help her out a little with the expenses. Unfortunately, leaving this condition untreated could have tragic results.

"Family Medicine" is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701.  Past columns are available online at http://www.FamilyMedicineNews.org.