According to Dr. Peter C. Whybrow, head of the department of psychiatry at the
University of Pennsylvania, mild depression can be an initial symptom of hyperthyroid
disorder. People with overactive thyroid glands "don't perform quite so well," in his view.
"They feel, for reasons they cannot explain, a little agitated, a little preoccupied with
themselves, jumpy. Their concentration is a little off." According to Altman, "some
experts have raised the possibility that Mr. Bush could have had a mildly overactive
thyroid in the 1988 Presidential campaign, or even earlier." Any normal medical checkup
administered by a private doctor would have detected Bush's thyroid ailment through a
$20 blood test that is done automatically unless it is specifically ruled out by the
physician in advance. [fn 39]
These views were supplemented by a piece in the Washington Post by Abigail Trafford,
the editor of that newspaper's weekly health supplement, who was herself a victim of
Graves' disease. Ms. Trafford warned her readers of "the bad news: It is difficult to live
with and adjust to Graves's disease. What's missing in all the upbeat press releases from
the White House is the powerful emotional impact the disease has on many patients and
the effects of hyperthyroidism on mood, behavior, and judgment. And while Graves' is,
indeed, curable, it can take months, sometimes years, for people to get their thyroid
function back to normal." Joshua L. Cohen, assistant professor of medicine at George
Washington University, told Ms. Trafford that "Graves' disease strikes on a psychological
basis and it strikes a population that is not used to the concept of being sick." According
to Washington endocrinologist James N. Ramey, "There's no question that the emotions
are severely out of whack." Terry Taylor, acting chief of endocrinology at Georgetown
University Medical Center described Graves' patients: "Emotionally, they can be feeling
very good and then very bad. There are a lot of ups and downs....They cry at TV ads.""It
takes several half-lives to get the thyroid level in the blood down." Therefore some
patients take three months to feel like "their old selves," and some take a year. Ms.
Trafford recalls that on August 10, 1990, during the first week, of the Gulf crisis, when
Bush left for his summer vacation in Maine, he was heard to say:
Life goes on. Gotta keep moving. Can't stay in one place all the time. [fn 40]
According to the Textbook of Medical-Surgical Nursing by Lillian Sholtis Brunner and
Doris Smith Suddarth, hyperthyroidism "may appear after an emotional shock, nervous
strain, or an infection -- but the exact significance of these relationships is not
understood." According to these authors, "patients with well-developed hyperthyroidism
exhibit a characterstic group of symptoms and signs. Their presenting symptom is often
nervousness. They are emotionally hyperexcitable; their state of mind is apt to be irritable
and apprehensive; they cannot sit quietly; they suffer from palpitation; and their pulse is
abnormally rapid at rest as well as on exertion." The disease "may progress relentlessly,
the untreated patient becoming emaciated, intensely nervous, delirious -- even disoriented
-- and the heart eventually 'racing itself to death.'" These authors also point out that "no
treatment for hyperthyroidism has been discovered that combats its basic cause," even
though a number of forms of treatment are available. Within the context of treatment, the
following "overview of nursing management" is recommended: