June 20, 2008

Radiation, Surgery or Medicines for Overactive Thyroid?

DEAR DR. DONOHUE: I recently read your answer to a person whose doctor suggested radioactive iodine for hyperthyroidism. I was disappointed that you did not mention antithyroid drugs. Two years ago, I was diagnosed with Graves disease. My endocrinologist wanted to do the radioactive iodine treatment. My thyroid was three times normal size. I decided to take antithyroid meds. My gland is almost normal size now, and my doctor said he never expected me to do so well. Please tell your readers that there are other options for an overactive thyroid. - J.B.

ANSWER: An overactive thyroid gland (Graves disease is the most common variety of such a gland) puts the body in overdrive and gives rise to a number of distinctive symptoms. The heart beats fast even when the person is quietly sitting. Weight drops in the face of increased calorie intake. Affected people feel warm when others are comfortably cool. Menstrual periods are disturbed. The gland usually enlarges - a goiter.

Three treatments are available for this condition. One is radioactive iodine. The iodine is attracted to the gland like it's a magnet. It kills thyroid gland tissue. It's like having surgery without any cutting. Radioactive iodine treatment is popular in North America.

In Europe, the most popular treatment is antithyroid drugs. They're used here too. The medicines are easy to take and control symptoms well. Some people relapse after the drugs are stopped, but these medicines are an accepted and effective way to end the problem of an overactive gland.

The third treatment is surgical removal of part of or the entire gland.

Which is the best treatment? That's hard to say. None is optimal for everyone. Much depends on the person's preferences and symptoms. It's good to hear the medical route did so well by you.

DEAR DR. DONOHUE: I have read many articles about the benefits of omega-3 fish oils. I have been taking it this past year to lower my cholesterol.

My wife is concerned that the capsules might contain mercury. I also read that omega-3 may be harmful. Please advise whether I should discontinue their use. - J.S.

ANSWER: Omega-3 fatty acids, found in fish oils, gained notoriety quite some time ago, when it was discovered that Eskimos, subsisting mainly on a fish diet, rarely suffered from heart disease. The protection was found to come from the omega-3 fatty acids in fish. Those oils appear to protect the heart from heart attacks. They lower blood triglycerides. They can decrease blood pressure. They keep arteries supple. They stop the generation of abnormal and possibly dangerous heartbeats. There is some evidence to support a claim that they offer protection against Alzheimer's disease. All in all, they have a stellar reputation. You don't need to stop using them.

No mercury leaches into the oil when it is extracted from fish, even from fish that contain mercury.

DEAR DR. DONOHUE: My 35-year-old daughter died of a dissection of the left anterior descending coronary artery. She lived in the Midwest. She was promoted and sent to Colorado. She arrived there on a Monday and died the following Thursday. Could the change in altitude have caused the dissection? - P.F.

ANSWER: Your daughter had a very rare condition of a major heart artery. Dissection is a splitting of the artery wall. A cleft appears in the artery, and blood flows into the cleft. This is something that happens more often to the aorta, the body's largest artery.

Altitude had nothing to do with it. High blood pressure might have.

It's a condition that is almost always undetectable until it happens, and then it is often fatal.

You have my sincerest sympathy on this terrible tragedy.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853- 6475. Readers may also order health newsletters from www.rbmamall.com

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