“The President remains in excellent spirits, is in good health, without adverse symptoms of any kind,” said Dr. Burton Lee, Bush’s personal physician. He said that he and Bush’s other physicians have urged the President to relax his schedule temporarily. Lee said that Bush should not “be overly stressed in the next week” while he eases into the new therapy.
“(We) have been working . . . to try to give him a break over the next week,” Lee said. “He does not request this. Every time we try to give him a break, he tries to add things into his schedule. But he does listen to his . . . physicians, and he is going to be cutting back his schedule a bit over the next week.”
To that end, Bush canceled a Monday trip to Chicago and announced that Vice President Dan Quayle will take his place.
Bush’s condition was discovered when he underwent a diagnostic thyroid scan at Bethesda Naval Hospital Thursday morning. Graves is one of three general types of hyperthyroidism and is the same kind that First Lady Barbara Bush was found to have in 1989.
The President was immediately given a treatment dose of radioactive iodine, standard therapy for his condition.
“We anticipate that the President will be fully restored to his usual vigorous state of health very quickly,” said Dr. Kenneth Burman, an endocrinologist at Walter Reed Army Medical Center and a member of the President’s treatment team. Lee added that Bush “is carrying on all of his normal responsibilities . . . .”
The thyroid, a small organ in the neck, secretes a hormone called thyroxine, which regulates how fast tissues throughout the body burn sugar and produce energy. Graves’ disease results from an abnormality in the immune system in which the body manufactures antibodies that stimulate the thyroid gland to overproduce the hormone.
The doctors said that they will continue the drug regimen begun last weekend to stabilize Bush’s irregular heartbeat, a condition called atrial fibrillation that was caused by his overactive thyroid. Bush spent Saturday and Sunday nights at the naval hospital after complaining of shortness of breath when jogging at Camp David on Saturday afternoon. He returned to the White House Monday.
Bush has been taking the drugs digoxin and procainamide to treat the fibrillation, along with coumadin, an anticoagulant, to reduce the risk of stroke. Patients with atrial fibrillation have a slight risk of developing blood clots in the atria of the heart that can break free and travel to the brain, causing a stroke.
The physicians said that, when Bush’s normal thyroid hormone levels are reached–in about two to six weeks–the heart medicines will be tapered off until he no longer needs them. They said, however, that Bush may require long-term thyroid hormone replacement therapy, depending on the effect of the iodine treatment, which sometimes can damage or destroy the thyroid gland.
“Although radio iodine begins to exert its effect immediately, the full effect may not be noted for two to three months,” Burman said.
In the interim, he said, the President will take saturated solutions of iodine for about two weeks, which “will more rapidly restore the serum thyroid hormone levels to normal.”
With correction of the thyroid overactivity, he said, “the tendency toward atrial fibrillation will probably disappear.”
The physicians apparently decided against giving Bush one of two drugs, propylthiouracil or methimazole, which are often prescribed for a week to 10 days before radioactive iodine is administered. The drugs block production of thyroxine and help bring body functions back to normal more quickly.
But they pose the remote risk of a serious side effect. In some patients, the drugs can destroy bone marrow, leaving the individual vulnerable to infection.
“It’s extremely rare, but it can be devastating,” said Dr. James Ramey, an endocrinologist and associate clinical professor of medicine at George Washington University Medical Center, who is not connected to the case. “I’m sure they didn’t want to subject him to that risk.”
Ramey called the treatment chosen by Bush’s physicians “quite safe,” adding: “This will come under control. There is absolutely nothing to worry about.”
The doctors called it “unusual” for a husband and wife to suffer from the same disease. “It’s probably just a coincidence,” said Dr. Colum Gorman of the Mayo Clinic, who is part of the treatment team.
“There is no proven association with any . . . cause, including viruses or environment or exposure to radiation, or anything like that,” he added.