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.