George H.W. Bush: Hyperthyroidism Diagnosed


Graves disease
 
Graves disease was diagnosed immediately after the occurrence of atrial fibrillation. Bush had been feeling increasingly tired over the preceding two weeks, had lost nine pounds in two months, and had seen his handwriting deteriorate. Physical examination disclosed a fine tremor of his hands and slight enlargement of his thyroid gland (goiter). Bush was hyperthyroid. 1 SEE BELOW

"President Bush and the team of physicians caring for him agreed that his hyperthyroidism should be treated in the safest, fastest, most definitive, and permanent way possible. Therefore, he took an oral dose of radioactive iodine a few days after being admitted to the hospital" 1. Two days later Bush began a ten day course of potassium iodide (SSKI), four drops three times a day, to prevent a rare complication of radio-iodine therapy called "thyroid storm" (extreme hyperthyroidism).

The treatment worked. "Within a few months" Bush's thyroid was no longer over-producing thyroid hormone. In fact, it was now producing too little (a common occurence after radiation treatment). Thus, Bush began taking, for the rest of his life, a pill containing synthetic thyroid hormone known as "Synthroid" 1.

Comment: For a few days, radio-iodine treatment generally makes the patient radioactive to a degree that can jeopardize others who come too close. For this reason, such treatments are generally given in the hospital. Lower levels of radiation persist longer, however. As far back as 1986 the White House contained radiation detectors 2. It would be interesting to know whether the detectors had to be turned off or re-calibrated after Bush had his radiation treatment. It would also be interesting to know how physical access to the President was controlled while he was radioactive.



conjugal Graves
 
Bush's wife, Barabara, had earlier been diagnosed with Graves disease. The odds of two people (not related by blood) developing Graves disease within a two years of each other are long (Doctor Zebra has seen a one-in-three-million number 1, but thinks this answers the wrong question.)

The Bush dog, Millie, came down with Graves disease, too 3, although there are reports Millie had a different auto-immune disease: lupus 1.

Because of the remarkable coincidence of three cases of auto-immune disease in one household, the Secret Service tested the water in the White House, at Camp David, at the Vice President's residence, and at Walker's Point (Bush's home in Maine) for lithium and iodine, two substances "known to cause thyroid problems" 4a. SEE BELOW.


More...
The following statements 4 were issued by the White House in the wake of Bush receiving a diagnosis of Graves disease.

(The number in square brackets after the date of each statement is the document number used by the Bush Presidential Library.)


Remarks Announcing the Resignation of William H. Webster as Director of the Central Intelligence Agency and a News Conference
May 8, 1991 [91050801]

[...]

Q. Mr. President, you were described yesterday as elated when you got the news that it was your thyroid, not your heart, that was out of kilter. Do you have any plans to adjust your schedule -- which we all know is rather grueling for anyone, let alone a 66-year-old?

The President. Almost 67. [Laughter] No. They've said that with the thyroid thing that I might not get into as active an athletic regime as I'd like to. And they told me that this morning when I did this test. But they're elated that they know what caused this fibrillation and that's it's curable and will be cured very soon. But they've asked me just for the next few days to check it a little bit in terms of athletics, not in terms of my schedule here.

Q. But beyond the next few days, will you be scaling back?

The President. No, I don't think so. That's the good news, is that once the thyroid is corrected, that means there's no problem on the heart -- thyroid connected to the heart bone, you know. And I think it's going to be all right, and they've assured me that it can be okay, yes.

[...]


Remarks to the Hispanic Alliance for Free Trade
May 9, 1991 [91050900]

... I just came back from Bethesda and really got a wonderful report. I won't go into the clinical assessment, but it's great. I just take something to do with the thyroid, and the heart is perfect. So, I'm very lucky, very, very lucky. ...


Question-and-Answer Session With Reporters
May 15, 1991 [91051502]

Q. How are you feeling?

The President. Fine. Very good report on the health today. And today's really, literally -- and I'm not just saying this -- the best I've felt since this onset of all this problem.

Q. You're not tired?

The President. Have been, but today I'm not. Yesterday I was dead tired. But they've got a report back now that I think the doctors will comment on later, but it was very good on getting this thyroid in balance. So, for some reason, I'm itching to get back into action here outside, get some -- --

Q. Miss your jogging?

The President. I miss my exercise. I really do. It's the longest I've been in my life, I think.

[...]

Q. Are you going to take a longer Memorial Day vacation?

The President. You got it.

Q. How many days more?

The President. I don't know.

[...]

Q. How about giving us a little bit more on your health report? What did they say about your thyroid? Is it destroyed?

The President. Well, I asked the doctor if he wanted -- I got this when Marlin was doing his briefing. I almost sent in a little note -- I was listening to your questions, wonderful questions, to Marlin about my property taxes. [Laughter] And I asked Burt, and he said he'd rather wait until he talks to the other doctors. But he came in with a very good report about the thyroid now being in balance.

Q. Is it gone?

The President. Well, I don't know. It's not gone. I'd better keep a little of it because you don't want to get those hormones out of shape, you know what I mean? [Laughter]

Q. No, I haven't the slightest idea. [Laughter]

Q. How much weight have you lost? Five pounds, more, eight?

The President. No, about 10.

Q. Ten pounds?

The President. Yes.

Q. Over how long a time?

Q. How long?

The President. Over about a 3-week period.

Q. Are you happy?

The President. Yes. Yes, I'd like to keep it off.

Q. What are you, 190 now, Mr. President?

The President. Help. Here she comes. [Laughter] No, 187 last night.

Q. That's the lowest you've been in how many years?

The President. Lowest I've been in 30 years.


The President's News Conference in Kennebunkport, Maine
May 28, 1991 [91052800]

Q. Mr. President, could we get your reaction -- --

Q. How about the water at the White House? Do you want to talk about that now?

The President. The water at the White House?

Q. Yes.

The President. What about it?

Q. They're apparently checking it.

Q. It's being checked to see if this is the thyroid problem.

Q. They're saying that possibly you and Mrs. Bush and the dog, having gotten these autoimmune problems, that perhaps it's something to do with the water.

The President. Maybe the air. I don't know -- --

Q. You didn't know about it?

The President. No.

Q. Did you know it was being checked?

The President. Not checked. I just heard something on the television. I could hardly believe it.

The odds against two people in the family having -- the doctor told me, the thyroid specialist, one of the classic thyroid men, Colonel Burman, known for his expertise, told me the odds are one in three million. But many people live in the same house together, one of whom has thyroid -- so I'm not going to lose confidence in the water at the White House until we know a little more about this.

Q. How about two people and the dog?

The President. I feel very comfortable in looking into it. Well, two people and the dog, that's about one in 20 million. [Laughter]

Q. How are you feeling today?

The President. Good. Feel good.

Q. How about the water at the Vice Presidential mansion?

The President. Well, it tasted good to me, but I don't have any reason to believe that had anything to do with my thyroid. But let them look into it.

Q. Have you been gaining weight up here, sir?

The President. Yes, darn it. [Laughter]

Q. How much?

The President. Well, the low was -- I hit a low of 185 in the morning, weighing in. You drop a little overnight with this. And this morning I was 190. That's a dangerous -- --

Q. Coming back.

The President. Yesterday I got a little tired at the end of the day, and today I feel fine. You have to pace yourself a little. But I'm sleeping much better, and I really do feel good and wish I had about 4 more days here.

Q. Is the medication any different? Are you still -- --

The President. No, they're taking it, but they're trying to phase it out. They're going -- the doctor -- here, get over here, Larry. I may need some -- [laughter] -- no, but they're cutting it down, and then they balance it out. And it's a balance situation. I got very dry in the mouth when I was talking, and they suggested maybe I needed to push fluids. But it's a balance question.

In terms of feeling good, though, I really do. I'm not just putting that on; I feel very good. I almost feel like getting some aerobics up this afternoon on the bike or a short jog, just to -- because I don't feel good unless I have that kind of exercise. This, if I walk the thing, would be better, but I enjoy playing so much that I'd rather get more golf in.

Q. Are they going to let you jog now?

The President. Well -- --

Dr. Mohr. That's left up to The President. He's feeling well, his medication is being tapered according to the original plan, and everything is going very well, according to our plan. So, we're very pleased.

Q. Doctor, what do you think of these reports of the water at the White House being -- --

Dr. Mohr. That's something that is being checked, largely to answer the kind of speculation that is being propagated right now. We have no reason to suspect that there's any problem, but we did ask the Secret Service to check the water for lithium and iodine, which are two substances known to cause thyroid problems. We think the probability of that being a cause of this is very small, but largely, just to allay any speculation, we're having that done.

Q. Are you doing anything as a precaution, like having bottled water put in?

Dr. Mohr. No, no. Nothing -- --

The President. We usually take that anyway.

Dr. Mohr. Nothing unusual like that. Absolutely not.

Q. Was this initiated by the story last Friday, or was this something that the doctors had been thinking of looking at?

Dr. Mohr. This is something that we initiated, largely realizing that there might be some speculation about that, and so it's something that we asked the Secret Service to check into. And they have -- --

The President. What do they know about water?

Dr. Mohr. Well, they have the laboratory capability of checking water for -- --

Q. Now he's worried about it.

Dr. Mohr. -- -- checking water for unusual substances. They have the mechanisms for doing that and the contacts for doing that, and they actually do monitor -- --

The President. I'll tell you this, and make a medical contribution. You correct me if I'm wrong. But somebody asked one of our specialists, Colum or Ken Burman, about lead -- lead in the air. And they said that is impossible -- I mean, that's what he told me. Now, I don't know. You know, if there were pipes or something of that nature.

Q. There are no reports that we're aware of, of lead having any relationship to thyroid disease.

The President. But our motto is ``get the lead out,'' so let's -- [laughter] -- --

Dr. Mohr. You bet.

Q. Doctor?

Q. Why did Mrs. Bush bail out on you today?

The President. She hasn't been playing at all, Jerry [Gerald Seib, Wall Street Journal].

Q. Is she playing tennis up there?

The President. Yes, one day she played -- no, I didn't hit yet.

Q. You haven't jogged at all, then?

The President. No. Haven't jogged, haven't rode the bike, haven't walked the treadmill. Going out in the boat now. I may do one or the other this afternoon, or maybe come back up here. But I do feel good. Been taking a little sleep after lunch here, which is good. Sleeping very well. Going to bed real early, much earlier than I normally do.

Q. To what do you attribute the weight gain? Lobster?

The President. No, we haven't had that. Just to the thyroid, I'm afraid, because I loved it at 185. But I'd rather be well at 195 than having these problems at 185.

[...]

Note: In his remarks, The President referred to Kenneth Burman, chief of endocrinology at the Walter Reed Army Medical Center; Lawrence Mohr, White House physician; Colum Gorman, endocrinologist at the Mayo Clinic;


Statement by Press Secretary Fitzwater on the President's Health
May 28, 1991 [91052801]

Because of the remarkable coincidence of the President and First Lady both having Graves' disease, the President's physician is exploring any possible link to environmental or other causes. While the doctors feel it is highly unlikely that their thyroid condition could be related, or in any way related to the lupus disease suffered by Millie, prudence dictates that all such possibilities be examined.

The Secret Service is taking water samples at Camp David, the Vice President's residence, the White House and Walker's Point to ascertain any possible presence of iodine or lithium, two substances which have been associated with thyroid disease. In addition, Dr. Charles L. Christian, head of medicine at the Hospital for Special Surgery in New York, has been asked to review the medical history of the First Family, including Millie, to ensure that there is no relationship in any way. These tests and reviews will be made over the next few weeks. We do not expect conclusions for some time.


Interview With Linda Douglas of KNBC, Jim Lampley of KCBS, and Paul Moyer of KABC in Los Angeles, California
June 15, 1991 [91061500]

[...]

Q. You won't play in an hour and a half, I guarantee you. You won't get around.

The President. Even in a cart?

Q. If you drive fast, you might.

The President. -- -- a little golf today.

Q. Gaining some of the weight back, are you?

The President. Unfortunately.

Q. Do you still do the stair-climber?

The President. Is that a vicious assault on my figure, or what? [Laughter]

Q. No, you look good. I know you dropped -- --

The President. Actually, I got it down. I was, normally, weighed out about 198. Got it down to 185 in a not-very-pleasant way. The medicine drove it -- now I'm at 190.

Q. Can you feel the thyroid medicine's side effects?

The President. Not anymore. I feel it in that it's not quite right in the tummy and stuff, when it affects you in that way.

Q. Doesn't make you feel logy and tired, though?

The President. By the end of the day I'm probably a little more tired than I would have been, but I have a full schedule. Go to work at 7 a.m. and all of that; work normally. Like yesterday, though, I came home before going to the ball game and took a little nap, which I might have done anyway because of the 3-hour time change.

Q. Have you had any other recurrence of the accelerated heartbeat? Has that happened?

The President. I don't think so. I think it's supposed to from time to time, but if it has, it's been very, very short. But I think it's been normal 99.9 percent of the time. They don't seem to worry about that anymore. [...]

Q. Can we get, just very quickly -- we touched on it in the beginning -- --

The President. This is the longest 15-minute interview I've had, too. But I've enjoyed it very -- --

Q. I know you've got to go tee it up at Sherwood.

The President. Let's get our priorities sorted out here. [Laughter]

Q. How are you feeling?

The President. Healthy.

Q. Are you still taking the medication?

The President. Yes, I take medication, and I've brought along my doctor, who's tethered out here somewhere, who would be glad to give you -- oops, he's not tethered out there somewhere. But if you really want it, on-camera question, I'm sure he'd be glad to answer it. I'm on medication. The medication is trying to get the thyroid in balance and guards against, in the process, fibrillation of the heart.

Incidentally, I think every other guy on the street has had a heart fibrillation. I have never seen so much mail from people across the country. Not only that, but they're all doctors. They're all telling me exactly what to do. We had a letter from one saying it was a conspiracy of the Mossad, which happens to be the very good security agency in Israel. It's the damnedest thing I have ever seen.

Q. Are you running again?

The President. And I'm flattered with the interest. But I feel very good.

Q. Running? Are you running again?

The President. I ran 2 miles on Monday. I worked out on one of those bicycles this morning. Play golf today. Play tennis tomorrow. So, I feel good. I can't tell you I feel perfect yet, but I'm getting there. Weight got low and now bounced up a little. And I'm back. But I want to get off all this medicine. And I think they proclaim in a couple of weeks I'll be there.

[...]


The President's News Conference With Turkish President Turgut Ozal in Ankara, Turkey
July 20, 1991 [91072001]

[...]

Q. You've been keeping to a whirlwind pace, sir, on this trip. You have another one coming up which is scheduled in much the same way. And I wanted to ask first, sir, how are you feeling? And second, I wonder how your staff is doing and how you expect it will be doing by this time next week? [Laughter]

President Bush. I'm feeling great. I plan to exercise when I leave here. I'll confess to being a little bit tired -- a lot of evening action out there coupled with getting up pretty early. So, I'm 67 still, and I have to confess that from time to time I get tired. But I've been spared a lot of the work by my staff, a lot of the behind-the-scenes work. Some of the staff are fatigued. Others are ready to charge. But I think when we get home we'll have an opportunity to relax. The doctor -- you know, because of this recent -- I don't want to bore the Turkish press with it -- but I had a little flare-up a while back. And because of that, well, the doctors check it every day and give me the pulse treatment, and I'm on some kind of medication to get the thyroid in balance and all of this.

But, Brit [Brit Hume, ABC News], generally speaking, I feel good. I feel up for all of this. I can't say that at some points along the line in the last few days I haven't gotten tired. But I know that we'll have enough time to do two things when we get home. Monday I have a speech, as you know, Monday afternoon, but -- which might not be one of the heroic successes. It may rank with my empowerment speech, which fell a little flat. But that being over, I will be prepared to do two things: one, get some rest in our own bed and be ready to go; and secondly, brief for the important meetings with President Gorbachev.

But, no, I'm very blessed with, you know, the ability to keep charging.

[...]


Statement by Press Secretary Fitzwater on the President's Health
August 2, 1991 [91080206]

... The President continues to recover from Graves disease and his treatment and response are normal. ...


Exchange With Reporters in Kennebunkport, Maine
August 15, 1991 [91081500]

[...]

Q. What happened to your arm, sir?

The President. Donated a little blood to the cause.

Q. Where? Here in town?

The President. No, no. The nurse took it out.

Q. On purpose? [Laughter]

The President. No, they check me about once a month on that blood withdrawal.

Q. What are you doing instead of running these days?

The President. I ran yesterday, 2 miles.

Q. Did you?

The President. Yes.

Q. Where?

The President. On the place. Yes.

Q. And you're running how often?

The President. About once a week. And then I'm playing tennis out there and playing golf here, which isn't a lot of exercise, except for the amount of swings I'm taking.

Q. Are you using a Stairmaster or anything like that?

The President. No, I've run -- I use one at home, but I ran 20 minutes yesterday which is 2 miles.

Q. You're not cutting back on that on doctors' orders, are you?

The President. No, no. I'm cutting back on it because I'm playing a lot of tennis and a lot of other stuff, getting up early around here and -- cast for 45 minutes yesterday steadily which was fantastic fishing. So, it's a mixed program.

Q. What was the blood test for?

The President. They just take it out of here and test it every month or so.

Q. Just routine?

The President. Yes, just to see the balance on the thyroid. I'm still taking thyroid stuff, and will be, I guess, for the rest of my life.

[...]


The President's News Conference With Prime Minister Kiichi Miyazawa of Japan in Tokyo
January 9, 1992 [92010902]

[...]

Q. Mr. President, people all around the world yesterday saw some very disturbing video of you collapsing in apparently very severe distress that many of us are not accustomed to when we see people with the flu. Can you describe what you were experiencing there? And also, can you say that your doctors have conclusively ruled out anything other than the flu, or will there be further tests?

The President. No further tests. Totally ruled out anything other than the 24-hour flu. I've had an EKG, perfectly normal. I've had blood pressure taken and probing around in all kinds of ways. And it's all going very well, indeed. And I got a call from Bill Webster today, former head of CIA. I didn't take it, but somebody passed it along, and he told me of exactly the same thing happening to him where he went in and totally collapsed.

So, this is the flu. I'm very fortunate that in all the years that I've been President, I don't think I've had much of it. And so, let me just take this question and then reassure the American people and others that have expressed so much interest that that's all there is to it. Nothing else to it.

And somebody asked me earlier, am I going to slow down my schedule? I don't think it has anything to do with speed or slowness of the schedule. One of the businessmen, who is young and aggressive and eager, this morning -- a young guy on this trip -- got it. I understand some of the journalists have had flu. And people in our country have had it, so why isn't the President entitled to 24 hours? [Laughter]

But really, I'm glad to get the question because they've done all the checking in the world. The heart is normal, the thyroid, or whatever is left of it, is going fine, and -- [laughter] -- I really have no hesitancy or worry at all.

Q. Are you at all concerned that now that you've had two quite, sort of public health episodes, that some of the Democratic political opponents who are a lot younger than you might make a subtle issue out of the fact that you're somewhat older and perhaps you, because of your hectic schedule -- --

The President. Do you think only old people get the flu, Rita [Rita Beamish, Associated Press]? Do you think only old people get the flu? I think Democrats get the flu from time to time. [Laughter] So, I wouldn't worry about that. I think it would backfire if somebody tried to make an issue. I've been blessed by a good, strong physical condition. I played tennis yesterday and then, wham, got hit with the flu. But that's perfectly normal. So, I don't think there's any political downside.

I have always said that if I felt I couldn't do my job for some physical reason, I wouldn't run for President. But all signals are still go.

[...]


Statements by Press Secretary Fitzwater on the President's Physical Examination
March 26, 1992 [92032600]

... His thyroid function remains completely normal, on Synthroid .15 milligrams a day. ...

Cited Sources
  1. The Thyroid Society. Graves' disease: the heart of the matter. [On line]. Accessed 16 December 2002.
        

    Comment: See: http://the-thyroid-society.org/graves.html

  2. Toltzis RJ, Morton DJ, Gerson MC. Problems on Pennsylvania Avenue. N Engl J Med. 1986 Sep 25;315(13):836-7.
  3. Ebner SA, Badonnel MC, Altman LK, Braverman LE. Conjugal Graves disease. Ann Intern Med. 1992 Mar 15;116(6):479-81.
  4. White House Press Release. [various topics]. George H.W. Bush Public Papers. (Kept in the Bush Presidential Library, College Station, TX).
        
    a  Statement by Press Secretary Fitzwater on the President's Health, May 28, 1991

    Comment: Downloaded 26-27 November 2003 from: http://bushlibrary.tamu.edu/papers/


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