November 25, 2005
Mary Shomon did not set out to become an expert on thyroid disease. She was just minding her own business, when, in 1997, she suddenly became a thyroid patient. Finding the treatment of thyroid disease to be anything but straightforward, and the American medical profession to be something less than completely informed and open-minded on the therapeutic options, Mary set out to learn what she needed to learn about thyroid disease in order to get her life back to normal. She did not find this to be an easy process, because doctors managing thyroid disease are often incompletely informed, dogmatic, unsympathetic, and close-minded. But Mary diligently dug out the information she needed, weighed the options, and, with the assistance of doctors not intimidated by self-empowered patients, got herself healthy again.
Then, having finally helped herself to live a normal life with thyroid disease, she dedicated herself to helping others with thyroid disorders. In the intervening years she has forged herself into the nation's foremost advocate and educator for patients with thyroid disease. She publishes two websites - thyroid-info.comand thyroid.about.com- publishes several newsletters on thyroid disease (available from her websites,) gives seminars, often appears on national media, has written several books, and has been a New York Times best-selling author. All this activity is dedicated to helping patients who, like her, are coping with thyroid disorders.
Her latest book, Living Well With Grave's Disease and Hyperthyroidism (HarperCollins, 2005,) is up to her usual high standards.
Hyperthyroidism (elevated thyroid function) is a fairly common disorder in the U.S. Several varieties of thyroid disease can produce hyperthyroidism, the most common being Grave's disease, an autoimmune disorder. The symptoms of hyperthyroidism - palpitations, sweating, exercise intolerance, shortness of breath, gastrointestinal disturbances, and many others - can be very blatant, or very subtle. And the thyroid blood tests that are used to diagnose this condition, while occasionally very straightforward, are actually often misinterpreted by doctors - or worse, not measured at all.
Mary's book covers it all. She reviews the causes of hyperthyroidism, the symptoms it can cause, and explains very clearly what to look for in the blood tests. Why does she take pains to cover all this? Because somebodyhas to know about it, and patients who think they might have a thyroid disorder will often, unfortunately, have to take the lead in getting their doctors to either make the diagnosis or rule it out. This is some fairly complex material, but Mary (as usual) presents it in a logical, straightforward, highly readible fashion, and makes it readily understandable.
The best part of the book talks about treatment options. Most American doctors have a very simplistic approach to treating hyperthyroidism - first, you ablate the thyroid gland altogether by giving radioactive iodine. Then you replace thyroid hormone by giving a prescription for oral T4. (T4 is one of the two major thyroid hormones, the other being T3.) This treatment plan has the advantage of being very simple, which is one of the main reasons doctors like it. They like it so much that many (if not most) will never even consider any other options. Even many thyroid specialists have this tunnel vision regarding the treatment of hyperthyroidism.
Unfortunately, it is often not the best treatment for many patients. Instead of ablating the gland with radioactive iodine, drugs can be used instead to suppress thyroid function. With drug therapy - using either Tapazole or PTU -often the activity of the thyroid gland can be "titrated" back into the normal range without ablating the gland altogether. And when you take this approach, when the underlying disorder is Grave's disease, a substantial proportion of the time the thyroid function will eventually revert back to normal, on its own.
