Introduction

What is a thyroid gland? How much do people understand about it? The organ is
located at the base of the neck, surrounding the trachea. This seemingly
insignifcant body part plays a vital role in maintaining optimal development and
ensuring the balance of an organisms central nervous system. In cases where it
malfunctions, endocrine diseases may arise. This is re!ected in "rica# who is a
su$erer of graves disease. This essay will frst e%amine the e$ects of "ricas
medical condition on her physical and psychological health and on her lifestyle.
&econdly, "ricas personal perception of the disease and reaction to the
diagnosis will be discussed. 'e%t, environmental triggers and any other
predictors that may have an impact on aspects of the disease will be addressed.
(inally, emphasis will be given to "ricas e%pectations for the future. The authors
own predictions will also be included strategically throughout the essay.

)asic information

)orn and raised in *ustralia, "ricas parents were originally +ietnamese refugees
who !ed to *ustralia during the +ietnam War. *t age ,-, "rica is a female who
holds the position of a sales and marketing manager. "rica is currently married
and lives with her husband.

.raves disease and the parameters in the prediction of its occurrence

*ndo, /atif and 0avies 1,2234 defne .raves disease as a prevalent autoimmune
disorder resulting from the e%cess production of thyroid hormones. Hanna and
/afranchi 1,22,4 suggest that this can be the e$ect of complicated interactions
between e%ternal and internal factors. *n e%ample of this was that while "rica
inherited the gene that caused .raves disease from her mother, environmental
stimulations such as a bacteria infection, stress or simply geographic variables
such as her *sian background might have activated the onset of the disease.
*ccording to "rica, *sians are more prone to iodine5related diseases due to their
low iodine diet.

"rica was frst diagnosed with a thyroid condition at the tender age of ,6. Hanna
and /afranchi 1,22,4 contends that females are fve times more likely to
e%perience hyperthyroidism as compared to males and that in the initial stage of
the disease, symptoms are covert despite it having fatal conse7uences later on.
&tatistically appro%imately 2.38 of adults su$er from .raves disease. The
severity of "ricas illness and persistent sanctioning from her parents prompted
her to seek medical help immediately. *fter having had her blood test taken,
antithyroid drugs were administered by the doctor based on the laboratory
results. This was indicative of the amount of radioactive iodine that is absorbed
by the thyroid gland. * high iodine uptake translates to .raves disease 1Isaacs
and 9uggieri, ,2234.

+arious forms of treatment for thyroid disorders

There are three types of treatment for hyperthyroidism. They are antithyroid
drugs 1*T04, radioactive therapy 19*I4 and surgery with the frst type of
treatment being the most common and the last being rare 1Isaacs and
9uggieri, ,2234.

:ooper 1,22;4 e%plains that the use of such immunosuppressive drugs have an
advantage over other more dangerous measures such as radiation therapy and
surgery. This is largely because oral medication is more a$ordable and perceived
as less life threatening. However, it is unknown to many that 9*I can also be
administered in medication form5 as a radioactive pill ingested orally 1Hanna and
/afranchi, ,22,4. )esides, surveys comparing the e$ectiveness of the three
main treatments of hyperthyroidism have demonstrated up to <28 success rate
for each. However, this form of treatment is more time consuming and re7uires
long5term commitment in that fre7uent tests on the thyroid needs to be done at
least once every month until the amount of thyroid hormones secreted appear to
be of an acceptable level. If this data remains consistent for the ne%t three
months, the amount of drug administered could be lowered and eventually
ceased within the span of 6- months 1:ooper, ,22;4. *ccording to "rica, her
doctor had to monitor the development of her thyroid. This means that she was
re7uired to undergo blood tests on a monthly basis. =nderstandably, it was tricky
to know the e%act amount of medication to prescribe since her condition varied
periodically, without adhering to a specifc trend. :ooper 1,22;4 asserts that an
overdose may lead to hypothyroidism while insu>cient administration will result
in uncontrolled levels of hyperthyroidism. ?ersonally, "rica felt that visits to the
practitioner posed as an inconvenience because of her busy schedule at
university. The late consultation hours added to her reluctance to seek treatment
regularly. In other words, "rica felt that obligations to visit the physician
fre7uently were an interference with her vocational and physical preoccupations
1@ones, ,22A4.

0ilemma over the types of treatment to undertake

"ricas mom who was also a su$erer of .raves disease could empathiBe with
"ricas su$ering perfectly. &he advised "rica to undergo either 9*I or surgery, as
they are the permanent means of solving her thyroid problem. Conetary issues
were not a problem for "rica, an *ustralian citiBen who would be covered by the
governments public health insurance policy completely. However, the fear of
adverse e$ects from those treatments deterred "rica. In her view, the risks
involved in them far outweighed the positive outcomes they could have attained
given the bleakness of the situation at that point in time. "ricas primary concern
was the e$ects of 9*I on her fertility. However, her doctor assured her that this
threat was minimiBed since the pill was focused solely on the thyroid gland and
not on the consumers reproductive organs. "ricas insecurities were not without
reasons. ?auwels et al. 1,2224 hypothesiBed the link between 9*I and cancer,
although only to a small e%tent. This was illustrated by the research that points
to increasing rate of cancer of the thyroid, stomach and other organs associated
with digestion and e%cretion. (urthermore, in 9*I, killing more of the thyroid
gland than necessary may result in permanent hypothyroidism 1:ooper, ,22;4.
However, it was later acknowledged that the improvements brought about by 9*I
far surpassed its disadvantages. This view was challenged by Isaacs and 9uggieri
1,2234 who argued that the processes of 9*I posed no threats of cancer.

&ome e%perts have attested to the e$ectiveness of surgical methods of
treatment but Isaacs and 9uggieri 1,2234 refuted this belief. Instead, they
claimed that any undestroyed thyroid tissue might redevelop after the operation,
causing another bout of hormonal attack on the victim. Hanna and /afranchi
1,22,4 further highlighted that almost half of the patients who had surgery
became hyperthyroidD another 6., 8 reported to have lost their ability to speak
and a small percentage of patients died as a result. Indeed, this verifed how
crucial it was to involve a veteran endocrine specialist in carrying out the thyroid
removal surgery as any minor mistakes could result in irreversible damage to the
patients health or even death.

"nvironmental triggers

"ven though iodine was alleged to reduce the adverse e$ects of
hyperthyroidism, "rica did not intently increase her iodine intake, believing that
it was too insignifcant a source to be considered important. Her opinions were
seconded by Cc/achlan 1,22;4 who attested that iodine levels had no e$ects on
the amount of thyroid hormone produced by the body. En the contrary, studies
conducted by :ooper 1,22A4 and .oodman 16<<34 underlined a correlation
between iodine levels in the body and the occurrence of hyperthyroidism. *n
illustration was made when comparing the iodine intake of citiBens of Iceland
1normal4 with that of 0enmark 1low4 where the latter reported up to about A-8
higher rates of the population infected with .raves disease. *part from this,
stress, steroids and other poor lifestyle habits like smoking may also contribute
to the development of .raves disease, especially for those who may have
genetic predispositions 1:ooper, ,22AD :ooper, ,22;4.

?hysical impacts of the disease
:ooper 1,22A4 and Isaacs and 9uggieri 1,2234 proposes that hormonal
imbalances often result in patients e%periencing heart palpitations. ?hysical
manifestations of an over5worked heart and body include continuous perspiration
although inactive, intolerance to even low degrees of heat, irregular pumping of
the heart, breathlessness, trembling hands and in the worst scenario, death from
a blocked artery in the heart. "rica reported e%periencing similar physical
symptoms, which were mild on some days but horrible on most occasions. (or
e%ample, on certain days, she would not be able to muster the strength to walk
up a mere !ight of stairs because she had been e%ceedingly e%hausted from her
bodys uncontrolled e%ertions. Hanna and /afranchi 1,22,4 and :ooper 1,22A4
support the symptoms, e%plaining that this may be due to e%treme weakness
that results in temporal loss of muscular control or numbness. *s a conse7uence,
hyperthyroidism is often masked in clinical diagnosis and confused with
hypothyroidism where lethargy is a common feature.

"rica claimed that her thyroid hormone level was four to fve times more active
as compared to a healthy individual, causing her thyroid gland to become tender
and swollen. This was noted in Isaacs and 9uggieri 1,2234 and Hanna and
/afranchi 1,22,4 who attribute the trait to an over stimulation of the thyroid
gland. &ubse7uently, "rica commented that her eyes began to bulge, as
e%perienced by ,25328 of patients su$ering from .raves disease 1Hanna and
/afranchi, ,22,4. "ye abnormalities can result from the shortening of the
muscles in the upper eyelids 1:hang, )ernardino and 9ubin, ,223D Hanna and
/afranchi, ,22,D Isaacs and 9uggieri, ,2234. "rica also lost hefty clumps of hair.
Isaacs and 9uggieri 1,2234 identify similar problems in an individual su$ering
from the disease. The hair becomes thinner, drops easily and may even turn
gray.

?sychological impacts of the disease
'eural alterations such as low concentration span and changed personality is
being observed in individuals who su$er from this disease 1:opper, ,22AD Hanna
and /afranchi, ,22,4. "rica was under such great psychological strain that her
state of mind became unstable. (or instance, "rica often e%perienced outbursts
and could not seem to control her emotions. Coreover, "rica admitted to
e%periencing several periods of depression following her diagnosis. Isaacs and
9uggieri 1,2234 maintain that hormonal stimulation of the brain is responsible for
depressive and irritable moods. In addition, "ricas irritability could be attributed
to factors such as the e$ects of hormones that in!uenced her ability to
concentrate and the intense frustrations initiated by the distortions to her
physical appearance. To worsen the situation, "rica claimed that the condition
disrupted her normal sleeping patterns 1Hanna and /afranchi, ,22,D :ooper,
,22A4. 0espite this, "rica refused to submit to the use of sleeping pills in order to
fall asleep, as she strongly believed in natural sleep instead of an artifcially
induced one. In "ricas opinion, society would not approve the use of sleeping
tablets as a solution to insomnia in the long term. :learly, side e$ects, the fear
of social stigmatism and the fear of dependency on the drug served as
reinforcements to prevent her from using sleeping pills. "ricas resistance to the
use of those medications was in fact a wise decision. ?agel and ?arnes 1,2264
establishes that ingesting tran7uiliBing pills to overcome chronic sleep disorders
may adversely a$ect rapid eye movement 19"C4 sleep.

)ehavioural changes in response to the disease
* signifcant change was determined in "rica whose appetite increased greatly.
High levels of thyroid in the bloodstream raised "ricas metabolic rate drastically
1.oodman, 6<<34. (or e%ample, "rica could consume a ten course :hinese
ban7uet and still feel unsatisfed. In spite of her large food intake, "ricas body
was unable to absorb the vast amount of nutrients from these foods. Instead,
most of it was lost in diarrhoea 1Hanna and /afranchi, ,22,4. Hence, fre7uent
trips to the toilet after a meal was inevitable. Core importantly, the loss of bodily
!uids and nutrients drained "rica e%cessively, causing feelings of lethargic. *t
these times, "rica would appear withdrawn and disinterested in her
surroundings. *t other times, "rica tended to be tense, spoke rapidly, was
restless and always fdgety. This was typically seen in hyperthyroid individuals
who alternate between mania and e%haustion 1.oodman, 6<<3D Isaacs and
9uggieri, ,2234.

*ttempts to revive any lost nutrients through vitamin supplements were futile
given that it was e%creted from the digestive system almost instantly 1Isaacs
and 9uggieri, ,2234. This had an e$ect on "ricas outward appearance. &he
appeared disheveled and spindly as her metabolic mechanisms e%pended
calories more rapid than could be replaced in the diet. This implies that the
"ricas body stores was defcient in essential vitamins and minerals which include
calcium and vitamin 0. &ince these compounds are the precursor for healthy
bone formation, "rica was warned of the possibility of developing osteoporosis if
her condition was left untreated for prolonged periods 1:ooper, ,22AD Whitney
and 9olfes, ,22;4. /uckily, the onset of her disease occurred following her
puberty years and hence her growth was not stunted as seen in cases of children
who developed .raves disease before maturity and thus failed to attain the full
grown stature of an adult 1.oodman, 6<<3D Hanna and /afranchi, ,22,4.

:ognitive responses to the disease
0espite imposing the sick role on "rica, her parents advice for her to remain
indoors and eat a greater amount of nutritious foods was ignored. "rica rebelled
against their instructions. *lthough "rica was intent on improving her condition,
she was not prepared to sacrifce her social life. )eing young and hot5blooded,
she was eager to e%plore the world and refused to be restricted by the physical
constraints of her illness. /ooking back, she had naively thought that the
problem was temporal and that the symptoms would disappear within a matter
of months or even weeks. Coreover, "rica believed that there was no connection
between her level of physical activity and the status of her disease.
"ricas optimistic appraisal of the situation prompted her to adopt e$ective ways
of dealing with the personal crisis 1@ones, ,22A4. .radually, as "rica approached
the acceptance stage, she began to see the funny side of the disease and
learnt to overlook the negative impacts. =nlike most girls who had to constantly
watch their diet to stay slim, "rica had the freedom of eating whatever she
fancied without worrying about obesity. "rica could eat four to fve times more
than most people. (or instance, she consumes three times more than her
husband in daily meals. Ebviously, this feeling of blessing can only be achieved
by disregarding the fact that her body was absorbing nil amounts of nutrients
and could even be losing lean tissues in the form of muscles needed to keep the
body ft 1Isaacs and 9uggieri, ,2234. *n e%tra bonus lay in the surplus supply of
energy "rica e%perienced continually. This enabled her to be more productive
and profcient as compared to her peers. The conscious choice of adopting a
positive attitude instead of dwelling in an eternal mode of self5 pity promoted
improvements in both her physical and mental strength. /ikewise, @ones 1,22A4
contends a link between optimism and good health.
ways to manage the disease with her mum soothed her frustrations considerably.
*bove all, "rica argues that it was her strong religious faith and close5knit church
community, which carried her through the most challenging period of her life.

&ide e$ects of antithyroid drugs
*fter consulting several reliable sources, she decided to undergo radioidodine
therapy. This was largely because while antithyroid drugs could suppress the
symptoms of her illness, it could not stem the problem of nutrient loss such as
calcium from her body 1Isaac and 9uggieri, ,2234. This step of faith arrived
only after seven years of antithyroid drug treatment. (or almost a decade, "rica
had had to put up with the discomforts and side e$ects brought about by the use
of antithyroid drugs. 'egative e$ects from the incorporation of thyroid
medication range from those that are benign5rashes and other allergic reactions
to those with malignant e$ects5liver failure and even death 1:ooper, ,22;4.
(ortunately, "rica noticed only mild symptoms. They were rapid weight gain,
weariness and slow hand5eye coordination. Hanna and /afranchi 1,22,4 and
Isaacs and 9uggieri 1,2234 recogniBe the necessity to decrease the amount of
food use during treatment because while the drug returns the bodys metabolic
rate to its normal level, the individuals appetite remain heightened and may
result in weight gain. &he also e%perienced irregular menstrual cycles for a few
years 1Hanna and /afranchi, ,22,4. This could be ascribed to the abnormal
amount of estrogen and progesterone that were circulated around the body at
the initial stage of the disease as well as the sudden hormonal imbalance caused
by the drugs 1:ooper, ,22AD Hanna and /afranchi, ,22,D Isaacs and 9uggieri,
,2234.

(uture e%pectations
Having started on the new form of treatment5 9*I, "rica has observed marked
improvements in her condition. "rica e%pects full recovery in the near future
after which she and her husband hope to start a family.

:onclusion
:onceivably, "rica portrays herself as an independent and resilient individual
who has learnt to cope and manage her illness with the support and counseling
of her family and friends. *t present, scarce information is available regarding
the underlying mechanisms for the symptoms of the disease. "ven though
possible suggestions and speculations have been 7uoted, their inconsistency
makes it di>cult to discern between myths and the absolute truth. 'o one knows
what the future will bring in terms of developments in treating thyroid disorders,
much less the fate of "rica. However, with modern science and technology, a
new invention or therapy for eliminating endocrine diseases could well be
underway.

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