By Keith Roach, M.D.
DEAR DR. ROACH: I am writing with concern about my 50-year-old daughter, who, to me, shows signs of Graves' disease. She is taking thyroid medication, but I don't know if she is following up with her primary doctor. She seems to be in good health, without the symptoms associated with the disease. I can't say anything to her, as I might be completely wrong with my diagnosis, but her lovely eyes show a slight bulging. Should she see an endocrinologist for advice? I don't want to do the wrong thing, not knowing what I am talking about.
We have an acquaintance who has Graves' disease, and it's really a terrible thing to happen to anyone. Is there a medication for this problem? Any advice you can offer would be helpful. -- E.G.
ANSWER: Graves' disease (named after Dr. Robert Graves: it is NOT a "grave" disease) is an autoimmune disease in which antibodies attach to the thyroid and stimulate the thyroid to produce more thyroid hormone. Excess thyroid hormone causes many symptoms, especially changes to energy level (often too much energy, but occasionally too little), skin, intestines, nervous system -- almost every tissue in the body can be affected. Graves' disease can be treated with oral medication to reduce thyroid levels, by radioactive iodine or by surgery. I suspect your daughter is taking medication to reduce the thyroid activity.
The bulging of the eyes is a very important sign of Graves' disease. It is not caused by excess thyroid hormone, but rather the antibodies of Graves' disease cause the fat pad inside the eye to get larger, pushing the eyeball forward in its socket. This occasionally can be a big problem, requiring a specialist in ophthalmology, and sometimes surgery. Since the bulging is caused by the antibodies and not the thyroid hormone, it doesn't get better even if the Graves' disease is under control. So there is no reason to suspect that your daughter isn't being treated properly.
Both primary-care doctors and endocrinologists treat Graves' disease with medication, but usually only endocrinologists use radioactive iodine, and they tend to be more familiar with the ophthalmologic problem. I usually have my patients with Graves' disease consult an endocrinologist at least once.
DEAR DR. ROACH: My mother was diagnosed with rapidly progressive dementia (likely Alzheimer's disease) at 75 years of age. She was a moderate drinker throughout much of her adult life, consuming two drinks per night. Do you feel her alcohol consumption contributed to her diagnosis? Would you suggest I abstain from alcohol? I have had conflicting opinions from health care professionals. I am a social drinker, but I sometimes wonder if I am taking an unnecessary risk. -- L.R.
ANSWER: Alzheimer's disease usually is a slowly progressive form of dementia -- rapid progression is not common with Alzheimer's. Excess alcohol use is certainly is a cause of dementia, and it is possible that the two combined to cause a more rapid progression. But how much is too much? For women, more than one drink a day is not healthy, and a mixed drink can contain a lot of alcohol, depending on who is mixing it. I recommend for all women to keep to no more than one drink per day (two for men). That level is very unlikely to cause any adverse effects on the brain long term.
- Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters or mail questions to P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.
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