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Talk show host's diagnosis introduces Graves' disease to the public
In February, talk show host Wendy Williams announced she would take a 3-week break from her popular daytime TV show to rest and focus on managing her recently diagnosed Graves’ disease. Williams, who had fainted on the air in late October, was instructed by her physician to take the hiatus.
For many Americans, Williams’ announcement may have been the first time they had heard of Graves’ disease, an autoimmune disorder that causes the overproduction of thyroid hormones. Compared with thyroid conditions such as Hashimoto’s thyroiditis, Graves’ disease is relatively unknown to the general public.
“I think because Hashimoto’s thyroiditis is the most common cause of an underactive thyroid in the United States, it gets a lot of attention,” Barrie M. Weinstein, MD, assistant professor of endocrinology, diabetes and bone disease at the Icahn School of Medicine at Mount Sinai, told Endocrine Today. “An underactive thyroid is far more common than an overactive thyroid, therefore more people are familiar with it.
Weinstein spoke to Endocrine Today about the often-subtle symptoms of Graves’ disease, the diagnosis and treatment of the condition, and how a celebrity diagnosis such as Williams’ might raise awareness of this disease.
Do you think Wendy Williams’ diagnosis has the potential to increase public knowledge about Graves’ disease?
Weinstein: Yes. Whenever a celebrity gets diagnosed with a disease and starts talking about it, awareness comes to the forefront.
How did Williams find out she had Graves’ disease? What are some of the symptoms?
Weinstein: I am not her doctor but by report it seems she was experiencing a lot of the symptoms that are common in patients with Graves’ disease. It’s common for the diagnosis to be delayed — it’s common for patients to experience these symptoms for many months before they present to a doctor.
Some of these symptoms are just common symptoms that people might also have as a result of stress or other similar factors from everyday life. Symptoms of Grave’s disease include difficulty sleeping; anxiety, which people might attribute to stress from work or family; palpitations, which might be attributed to underlying anxiety or having too much caffeine. Weight loss is another one, and people are usually just happy they are losing weight. There might be loose stools or frequent bowel movements, and the patient might assume they just ate something bad or have developed an intolerance to a specific food.
Sometimes there is bulging of the eyes with associated excessive tearing, feeling of irritation in the eye or double vision — that’s more likely to get a person to the doctor.
What are some of the risk factors?
Weinstein: Anyone can develop Grave’s disease, but there are some risk factors which can increase the risk of developing it. Graves’ disease is more common in women than men, and more common in women who are pregnant or who recently had a baby. It’s more prevalent in people who have a family history or who already have another autoimmune disorder. There are studies that have found that it’s more common in black people, specifically black women. Stress and smoking can also place people at higher risk.
How is Graves’ disease diagnosed and treated?
Weinstein: In terms of diagnosis, the symptoms, combined with a simple blood test that measures thyroid hormone levels as well as antibodies, are what is needed to make the diagnosis. Sometimes, further workup is needed with a radioactive iodine uptake test.
Regarding treatment, there are three common treatments for Graves’ disease: anti-thyroid medication, radioiodine ablation, or total thyroidectomy. The treatment of choice for the definitive management of Grave’s disease is radioiodine ablation, but many people are first started on anti-thyroid medication, which often can help quickly ameliorate symptoms and reduce thyroid hormone levels before deciding what the next step will be.
The majority of people treated with anti-thyroid medications will relapse and will need another form of treatment. That, most commonly, is radioiodine ablation. Radioiodine ablation is very effective, and the majority of patients will be successfully treated. In a small percentage of patients, a second dose will be needed. Also, patients who are given radioiodine ablation need to understand that there’s a high likelihood they’ll go from having an overactive thyroid to an underactive thyroid, and end up needing thyroid hormone replacement for the rest of their life.
After radioiodine ablation, thyroid hormone levels are followed closely, and as soon as it seems as though the patient might become underactive, they are started on thyroid hormone replacement. Thyroid levels are then monitored for the rest of the patient’s life.
When might surgery be considered?
Weinstein: Surgery is commonly recommended in women who want to conceive immediately, who don’t have time to wait for the pills to work or for radioiodine ablation to take effect. The recommendation is to wait 6 to 12 months after having radioiodine ablation to conceive. So, for any woman who wants to start a family now, we’ll recommend surgery.
Surgery may also be the best option for people with large goiters or suspicious nodules or with Grave’s eye disease.
Any advice for someone concerned about Graves’ disease?
Weinstein: A lot of patients with Graves’ disease commonly have symptoms for many months before they come to the attention of a doctor. At that point, they’re really feeling unwell. Patients who start to have palpitations/rapid heartbeat and are losing weight should not assume it is due to underlying stress or anxiety. Instead, they should discuss with their doctor the need for a simple blood test to measure their thyroid level. They don’t need to go to an endocrinologist, either; they can go to their primary care doctor for that blood test. Patients might not know this. So, I think it will be beneficial to a lot of people that this is now being talked about. – by Jennifer Byrne
For more information:
Barrie Weinstein, MD can be reached at 5E 98th Street, 3rd fl, New York, NY 10029; email: renatt.brodsky@mountsinai.org.
Disclosure: Weinstein reports no relevant disclosures.