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Article by: Lim Zhen Ping
The former US President George HW Bush and his wife, Barbara Bush both came down with mysterious health issues. In early 1989, Barbara began rapidly losing weight, and having problems with her eyesight. Two years later, George suffered sudden heart complications, doctors suspected that the two very different symptoms were caused by the same disease.
January 20th 1989 was the day where George Herbert Walker Bush became the President of the United States. George's 63-year-old wife, Barbara stood beside him with puffy and watery eyes which were hard to notice from the crowd. She figured it was makeup allergies. However, Barbara’s eyes weren’t getting better and after busy days, Barbara’s eyes were even achier and more swollen than they've been. Again, she figured it was from the long hours wearing eye makeup.
In March, people noticed her drastic weight loss since the inauguration. By mid-march, she lost 8kg. Her irritated eyes were also steadily getting worse. Apart from being itchy and watery, they became so swollen that they bulged out of her face. On top of that, she was having double, even triple vision.
After months of ignoring the problem, Barbara visited Walter Reed Hospital where doctors were able to link her unrelated symptoms. While Barbara was correct that stress can lead to weight loss, another common cause is hyperthyroidism. Several conditions may cause hyperthyroidism, but Barbara's eye problems pointed towards the most common cause, Graves’ disease.
Named by Dr Robert James Graves who first described it in 1835. The disease is an
autoimmune disorder. In Graves’ disease, the body sends antibodies
to attack the thyroid gland, signalling it to release more thyroid hormones and thus, speeding up the body's processes. The antibodies created by the disease also cause eye muscles and connecting tissues to swell up. The increased pressure behind the eyes causes them to push outward, creating a bug-eyed appearance and often causing vision problems.
After a few days of testing, the results quickly confirmed that it was Graves’ disease. The permanent treatment for Graves’ disease was to destroy the thyroid. Extreme as it sounds, it is fairly safe. Iodine is mainly absorbed by the thyroid. So, the radiation only affects that gland while leaving the rest of the body cells intact. On April 12 1989, Barbara underwent the treatment. The next few weeks, doctors monitored her hormone levels through regular blood tests. Once her thyroid had stopped functioning, she began her hormone replacement pills. Everything was on its way back to normal.
Since the condition was easily treatable, the Bushes went public with the news. Thanks to the journalists and experts explaining the first lady's condition, the relatively unknown Graves’ Disease entered the public consciousness. As Barbara recovered, it proved that the disease which according to the National Institutes of Health affects 1 in 200 people was not to be feared. Her symptoms were gone and after a few months of close monitoring, her hormone levels were stable again.
In May of 1991, 66-year-old president George HW Bush was exercising when suddenly, a
pain gripped George's chest. After a check up with his physician, it appeared that his heart chambers were pumping blood at different rates, causing an irregular heartbeat known as atrial fibrillation. Atrial fibrillation can be a sign of heart attacks, but it can also be caused by conditions like high blood pressure, too much caffeine or physical stress, like exercising too hard. George Bush opted not to panic. But when his heartbeat hadn't gone back to normal after a while, the president was convinced to visit the hospital.
At Bethesda Naval Hospital, tests were carried out. It was clear he wasn't having a heart attack and initial tests ruled out the possibility of heart diseases which was good news. Meanwhile, Bush reported that he lost 4kg in the past two months. Not an alarming loss, but it was unusual as he had a slow metabolism and always had difficulties losing weight. This could be due to stress, but doctors took a blood sample to test for thyroid problems just in case.
On May 6th, Bush went back to work. Stress wasn't the trigger for the fibrillation as his heart remained normal all day and night. The next day, the blood test results came in. George Bush was suffering from a hyperactive thyroid. The most likely cause? Graves’ disease.
Bush went back to the hospital where his doctors had zeroed in on the cause of his atrial
fibrillation. His thyroid was over active. The thyroid controls the body's metabolism including the heart rate. Too much thyroid hormone in the bloodstream can cause rapid and irregular heartbeats. This explains Bush’s sudden fatigue and weight loss. The cause of the hyperthyroidism still needed to be determined. So, doctors tested his thyroids iodine absorption, the same as they did with Barbara two years earlier. As expected, the iodine uptake of George’s thyroid was unusually high. There was no evidence of an enlarged thyroid or tumours which left one possible diagnosis.
Graves’ disease was not considered in the first place as George wasn't showing many of the common symptoms like the eye irritation that had affected Barbara. But in patients over 60, the symptoms often appear differently. In many cases, only one organ is affected, in this case, his heart.
From here, George's treatment would proceed much in the same way as his wife's. After the radioactive iodine treatment was finished, Bush was also given a daily pill to bring his thyroid hormones back to the proper level. Another crisis averted for the Bush family and for America.
These two, high-profile cases brought Graves’ disease into the spotlight. There’s currently no answer for what causes Graves’ disease. As science advances, there's hope that this mystery might be solved, but for now, doctors and patients are grateful that even if we don't know what causes Graves’ disease, we at least know how to treat it.
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