Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [21]
The specialist’s office was not far from Patrick’s health club. After a short wait, he was ushered into an exam room. The doctor asked Patrick how he was feeling and then handed him a glass of water. He asked Patrick to sip and swallow several times as he stared intently at the front of Patrick’s neck. He then stood behind Patrick, placed his fingers around both sides of his neck, and again asked him to swallow. Taking his stethoscope from his pocket, he listened over Patrick’s neck. Finally, the doctor took out what looked like a metal ruler and measured the distance from the corner to the front of Patrick’s eyes. He put down the instrument and went back to his desk.
“You have Graves’ disease, a form of hyperthyroidism, an overactive thyroid gland.” The doctor swiveled his computer screen so that Patrick could see it. “Here, take a look at this scan of your thyroid,” the doctor said. The image looked like a huge stippled butterfly. “The best treatment for this condition is radioactive iodine. You swallow a radioactive pill, and it destroys the gland. Problem solved. You get it over with.” The doctor paused. “After that you’ll just need a daily thyroid pill. No big deal.”
But, Patrick told us, for him it was a “big deal.”
He asked the endocrinologist what alternatives there might be to radioactive iodine. “There are other options, but they’re not as good. This is clearly the best treatment.”
But Patrick persisted. “What are the other options?”
“There are medications that prevent the thyroid gland from making too much hormone,” the doctor said. “But these drugs sometimes have terrible side effects, damaging your liver or knocking down the white blood cell count so you could be open to life-threatening infections.” The doctor paused for a few moments, seeming to let that information sink in. “Or you could have surgery to remove the gland. But that also has real risks, with anesthesia, bleeding, and the possibility of damaging the other glands in the neck, the parathyroid glands, or even injuring the nerves to your vocal cords. This is really the best option.”
Patrick felt unsettled by the doctor’s words. “I don’t trust this idea of one-size-fits-all when it comes to medical problems,” he told us. His skepticism was the paradoxical gift of a previous illness, diabetes, diagnosed in his teens. Patrick was the oldest of five children, all born after his family had emigrated from Haiti and settled near relatives in Houston. As a teenager, already at six feet two inches, he weighed 260 pounds, and was a defensive lineman on the high school varsity football team. His mother, father, and grandparents all had diabetes. At age nineteen, when Patrick developed periods of intense thirst and frequent urination, classic signs of diabetes, his mother used one of her own test strips and found sugar in his urine. For several years he had taken oral medication and, at times, insulin injections to control his blood sugar.
Initially, Patrick said, his adherence to his prescribed diabetes therapy might well be described as “pretty poor.” Like many of his age, he often skipped his medication, so that his blood sugar swung widely. “My diet was terrible, chips and soda, because I wanted to be normal, like all the other kids,” he said. His doctors and his mother warned Patrick about the kidney failure and blindness