The Saddest Disease to Prevent

Shrimp, Andouille sausage, oyster gumbo, Abita beer, and a drink called a Hurricane are the raw materials of a uric acid load that needs more than an infusion of uricase to handle.

When I was an intern, our chief of medicine would make a regular trip to the wards for a case presentation. The event was a high-stress affair where we all donned our clean white jackets and had our charts looking spiffy and organized, lab values charted accurately and up to the minute. The cases for discussion were usually very challenging and complicated, allowing the ward team to show its stuff with elaborate workups that included everything from A to Z.

Sometimes we showcased our management skills as we described the rescue of a poor patient with horrible wheezing and a white-out on chest X-ray with a deftly administered elixir of heparin, digoxin, and penicillin. That’s hepatadigacillin for you novices. Trust me, it works magic when you are clueless about what you are treating.

Once during one of these conferences, the chief—surrounded by a posse of interns, residents, and students, all looking anxious and fearful—went to the bedside to interview a young woman who was about 20 years old. The woman had been hospitalized for thyrotoxicosis and teetered on the precipice of thyroid storm, a very dangerous occurrence that can genuinely kill. The young woman was a veritable metabolic blast furnace, cheeks blazing red and heart racing. She was jittery and jazzed from the thyroid hormones surging through her circulation as her heart clocked 140 beats a minute.

The brain of the young woman was definitely lit up. She was witty, funny, and vivacious, and when the chief, looking formal and sober, asked her the usual questions—Have you lost any weight? Does the heat bother you?—she giggled and laughed. She utterly charmed the chief, whose usual dour visage brightened. He even cracked a smile.

When the entourage of house officers and students returned to the conference room to discuss the case, we all expected the grilling and pumping that were often the basis of rounds in those days. What is LATS? Why did you wait to give propananol? Where are indications for radioactive iodine? Instead, the chief turned reflective and, in a quiet and wistful voice, said that the saddest disease to treat was hyperthyroidism in a young woman since, as the thyroid storm abates, the radiance disappears, and the body thickens with flesh.