Friday, March 12, 2010

Medical Opinion: Reyes' Thyroid Condition

The following article was written by Fonzie Forever contributor Hector Perez. Hector is a fourth year medical student and big-time Mets fan. We thank him for his awesome insight into this issue.[1]

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Jose Reyes is going to miss at least two to eight weeks for abnormal thyroid levels. Most readers are probably wondering why the long, variable recovery time and why Reyes needs to give up baseball entirely for the remainder of his recovery period. Some of the answers are contained within, but allow me to preface this article by saying that I have no knowledge of the intricacies of Reyes’ illness and, in particular, the clinical reasoning that went into the decisions passed down by the Mets team doctors. I have some clinical knowledge as a current Medical student, so I’m going to attempt to work backwards and try to evaluate best case and worst case scenarios for Reyes, using assumptions based upon the little we do know about the case.

Hyperthyroidism can manifest in patients in numerous different ways. Eye symptoms are sometimes the most obvious; extreme examples can include the eyeballs protruding from the socket in patients with severe hyperthyroidism. The heart rate can be increased with elevated oxygen requirements and systemic hypertension; rarely, it can lead to heart failure in severe cases. Increased fatigue and shortness of breath with exercise can also rarely occur in patients. Weight loss and intolerance to heat are among the most “classic” patient presentations, but symptoms of anxiety, depression, and even psychosis are associated with hyperthyroidism.

Jose Reyes’ thyroid dysfunction has been referred to as “inflammation,” and given the therapy of rest, it’s probably pretty likely that the doctors believe that his hyperthyroidism is transient. In other words, Reyes probably has thyroiditis, of which there are several subtypes. Chiefly, the major difference is pain in or around the thyroid gland, which is in the neck. According to most reports, Reyes appears to be asymptomatic, so we can assume he has a subtype of “painless” thyroiditis.

Probably the most likely diagnosis for Reyes is “silent thyroiditis” which is mainly a temporary disorder of the immune system, which attacks thyroid follicles. Some drugs can also cause painless thyroiditis including amiodarone (a heart drug), lithium (a drug used for patients with bipolar disorder), or interferon-alfa (a drug used for patients with Hepatitis C). Before the question emerges, there is no indication that any anabolic steroid, human growth hormone or any otherwise illegal substance can cause silent thyroiditis.

The natural course of this disease is transient. The immune system only temporarily attacks the thyroid follicles and then the body’s natural ability to inhibit production kicks in. It generally lasts about two to eight weeks before subsiding. The patient may have some or none of the typical symptoms of hyperthyroidism but it’s important to monitor them closely during this time, which is probably the major reason why Reyes has to sit out regular activity for the time being.

Perhaps most distressing, up to 10% of patients have recurrences of painless thyroiditis. Also, up to 50% of patients may develop permanent hypothyroidism. In other words, there is a good chance that Reyes’ thyroid may still cause him problems even after the current recovery period, which is a troubling thought for Mets fans waiting for him to play baseball again. The good news is that there is no reason to believe that Reyes’ current injury will extend past the maximum eight weeks.

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[1] The lawyer in me feels obligated to disclaim this a little bit. The above post should NOT be used in any kind of actual medical diagnosis or treatment. Hector has not graduated yet and, more importantly, is not your doctor. As he mentions above, he has no special personal knowledge of Reyes' condition. It's just a smart future doctor providing us a little extra insight into a strange and uncommon condition. If you have any questions, please leave them in the comments.

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