Medication causes problems for patient

Q: My 26-year-old daughter has been diagnosed with Graves disease. She went on some medication that caused a severe rash. She went to emergency for it and received a cocktail with prednisone in it. She finished the four day dose, now has severe joint pain, and can hardly walk. It’s in her feet, hips, shoulders and hands. I’m very concerned as to what to do. Do you have any advice?

A: There are a number of disorders that can result in hyperthyroidism, however Graves’ disease is the most common. Graves results from an overproduction of thyroid hormones that can affect anyone, however it is most common in women younger than 40. Symptoms can include eyes that bulge (Graves’ ophthalmopathy), an enlarged thyroid gland, irregular heart beat, fatigue, anxiety, hand and finger tremor, difficulty sleeping and a great deal more. Almost half of all individuals diagnosed with Graves’ will have Graves’ ophthalmopathy in which the tissues around the eyes are affected. Puffy eyelids, dry eyes, double vision, and the sensation of a fixed stare are common.

Risk factors for Graves’ include having a family history of the disorder, the smoking habit, pregnancy, and some other disorders of the immune system including rheumatoid arthritis and type I diabetes. When left untreated, cardiac arrhythmias can result, as can osteoporosis. Bone strength depends, in part, on the amount of calcium and other vital minerals they contain. An excess of thyroid hormone interferes with the body’s natural ability to provide calcium to bones.

Common treatment includes therapy with radioactive iodine and anti-thyroid drugs such as propylthiouracil and Tapazole. Side effects of the latter drugs can include joint pain, liver failure, rash, or a decrease in white blood cell count. Tapazole (methimazole) is not given to pregnant women because of a small risk of possible birth defects, making propylthiouracil the drug of choice for pregnant women. Beta blockers such as Corgard, Inderal and others block the effect hormones have on the body and may provide relief for some symptoms. When drug therapy fails to provide sufficient results, surgery in the form of a thyroidectomy may be appropriate. While problems rarely exist when the procedure is performed by a qualified surgeon, a disadvantage to surgery is potential damage to the parathyroid glands and to a person’s vocal cords.

My guess is she was given prescription corticosteroids because she had mild symptoms of Graves’ ophthalmopathy. This choice of treatment is common but steroids can cause fluid retention, weight gain, elevated blood pressure readings and higher than normal sugar levels. Or, from another perspective, she took the medication and subsequently developed a rash, suggesting the medication, not the Graves’ disease, caused the rash. If that was the case, she was likely prescribed the steroids for the allergic reaction and was left with joint pain, perhaps as a continuing reaction to the original medication.

Your daughter should return to her physician in follow up. In her case, the steroid was likely helpful and she may require a longer course of treatment. Graves’ patients may end up hyper-or-hypothyroid, while some may have no long-term adverse health consequences. However,they may suffer from weight gain and develop a goiter. Your daughter may have something serious going on to have this reaction. If it is medication related, she will likely be taken off the treatment and converted to other therapy such as radioiodine therapy as the next step.

Other readers who are interested in learning more can order Dr. Gott’s Health Report “Thyroid Disorders” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Peter H. Gott, MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.

Can it be Grave’s if the tests are normal?

DEAR DR. GOTT: I am desperate! I have all the symptoms of Grave’s disease, including a medium-sized multi-nodular goiter (which has been biopsied and the results were benign); but in spite of seeing numerous doctors, including three endocrinologists, they say I do NOT have it because my blood tests fall “within normal” range!! I am having a difficult time functioning in my day-to-day activities and am praying you can help me.

DEAR READER: Graves’ disease is hyperthyroidism, a disorder of the immune system that causes the overproduction of thyroid hormones. Normal thyroid function is regulated by a hormone released by the pituitary gland. The antibody associated with Graves’ disease, thyrotropin receptor antibody (more simply known as TRAb), has the ability to mimic the action of the pituitary hormone and essentially overrides normal regulation of the thyroid gland, [Read more…]

Double vision linked to Graves’ disease

DEAR DR. GOTT: Is Graves’ disease curable? I have hyperthyroidism and double vision I’m told is from the disease. What can I do?

DEAR READER: Graves’ disease is not curable, but it’s completely treatable. This type of hyperthyroidism occurs when the immune system mistakenly attacks the thyroid gland, causing it to produce an excess of a hormone known as thyroxine. The immune system cannot be prevented from attacking the thyroid gland, but fortunately there are several treatments available to lower the production of thyroxine and ease the symptoms.
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FMD may have caused stroke

DEAR DR. GOTT: I am an active 58-year-old female, 5 feet 6 inches and 119 pounds. I had Grave’s disease, for which medication was ineffective, so I was given radioactive iodine, which eliminated my thyroid. I now take Levoxyl as well as full-strength aspirin and a daily multivitamin. My father died at age 57 of a stroke. He also had asthma and high blood pressure. My mother passed away from cancer and had adult-onset diabetes.
Out of the blue, while driving with my husband to our daughter’s house three hours away, I suddenly had split vision. A horizontal black line appeared in the middle of my vision with a picture on top and one on the bottom. It was very disconcerting, and I knew something very bad had happened, although the incidence only lasted about two minutes.
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