Barbara Bush Home from the Hospital

Former First Lady Barbara Bush was discharged from a Houston hospital today. She was admitted 4 days ago for what was called “routine testing” after the First Lady claimed that she was not feeling well lately. Doctors believe that Mrs. Bush was having a mild relapse of her Graves Disease, a thyroid condition she was first treated for in1989. Treatment will only require an adjustment in her medications.

What is the Thyroid?

The thyroid is a butterfly-shaped gland in your neck, just above your collarbone. It makes hormones that regulate regulates heart rate, blood pressure, body temperature and weight. The thyroid gland contains mainly 2 types of cells — thyroid follicular cells and C cells (also called parafollicular cells).

The follicular cells use iodine from the blood to make thyroid hormone, which helps regulate a person’s metabolism. Too much thyroid hormone (a condition called hyperthyroidism) can cause a rapid or irregular heartbeat, trouble sleeping, nervousness, hunger, weight loss, and a feeling of being too warm. Too little hormone (called hypothyroidism) causes a person to slow down, feel tired, and gain weight.

Thyroid hormone production is regulated by another hormone called thyroid-stimulating hormone (TSH), which is made by the pituitary gland located in the brain.

What is Graves Disease?

Graves’ disease, also known as toxic diffuse goiter, is the most common cause of hyperthyroidism in the United States. Hyperthyroidism is a disorder that occurs when the thyroid gland makes more thyroid hormone than the body needs. About 1 percent of the U.S. population has hyperthyroidism, with women being much more likely to develop hyperthyroidism than men.

Graves’ disease is an autoimmune disorder, meaning the body’s immune system acts against its own healthy cells and tissues. In Graves’ disease, the immune system makes antibodies called thyroid-stimulating immunoglobulin (TSI) that attach to thyroid cells. TSI mimics the action of TSH and stimulates the thyroid to make too much thyroid hormone.

What are the symptoms of Graves Disease?

People with Graves’ disease may have some of the common symptoms of hyperthyroidism such as

  • nervousness or irritability
  • fatigue or muscle weakness
  • heat intolerance
  • trouble sleeping
  • hand tremors
  • rapid and irregular heartbeat
  • frequent bowel movements or diarrhea
  • weight loss
  • goiter, which is an enlarged thyroid that may cause the neck to look swollen
  • the eyes of people with Graves’ disease may appear enlarged because their eyelids are retracted and their eyes bulge out from the eye sockets. This condition is called Graves’ ophthalmopathy.

What is Graves Ophthalmopathy?

Grave’s ophthalmopathy (GO) occurs when cells from the immune system attack the muscles and other tissues around the eyes. The result is inflammation and a buildup in tissue and fat behind the eye socket, causing the eyeballs to bulge.

Other symptoms of GO include

  • dry, irritated eyes
  • puffy eyelids
  • double vision
  • light sensitivity
  • pressure or pain in the eyes
  • trouble moving the eyes

How is Graves’ disease treated?

Doctors may prescribe one or more of the three treatment options:

  • Radioiodine therapy: Radioiodine therapy is the most commonly used treatment for Graves’ disease in the United States. In radioiodine therapy, the patient takes radioactive iodine-131 by mouth. Because the thyroid gland collects iodine to make thyroid hormone, it will collect the radioactive iodine from the bloodstream in the same way. Iodine-13 gradually destroys the cells that make up the thyroid gland but will not affect other tissues in the body.
  • Antithyroid drugs : Two antithyroid drugs, methimazole and propylthiouracil (PTU), interfere with the way the thyroid gland uses iodine to make thyroid hormones.
  • Thyroid surgery: Surgery is the least-used option in treating Graves’ disease. However, doctors sometimes choose surgery to treat pregnant women who cannot tolerate antithyroid drugs, people in whom thyroid cancer is suspected, or those who fail other forms of treatment. Graves’ disease itself does not cause cancer.

Source: National Endocrine and Metabolic Diseases Information Service

For more information:

Graves Disease
Mark Boguski, M.D., Ph.D. is on the faculty of Harvard Medical School and is a member of the Society for Participatory Medicine, "a movement in which networked patients shift from being mere passengers to responsible drivers of their health" and in which professional health care providers encourage "empowered patients" and value them as full partners in managing their health and wellness.

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