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Spate of Thyroid Cases Baffles Army

Graves disease struck Special Force unit in late 1990s

TUESDAY, Dec. 17, 2002 (HealthDayNews) -- A dramatic spike in cases of an overactive thyroid struck a U.S. Army Special Forces unit in the late 1990s, and Army doctors are at a loss to explain why.

Military physicians say the unit, based in Fort Campbell, Ky., had eight cases of apparent Graves disease over a 21-month period ending in 1999. That's 62 times the expected incidence of the condition in young men, who seldom contract the autoimmune disorder.

Severe stress or contact with thyroid-harming substances such as iodine can bring on Graves disease. Yet the soldiers didn't appear to have been contaminated with iodine and they didn't report excessive stress. Several had worked in the motor pool or with organic solvents, raising the possibility of contact with substances that might have triggered the disease. The researchers also wrote that it's possible an "infectious agent" could be the culprit. However, no particular agent or cause could be identified, says Dr. Henry Burch, a hormone specialist at Walter Reed Army Medical Center in Washington, D.C.

"This appeared to be an isolated incident," says Burch, who believes the cluster was probably a statistical glitch. Burch and his colleagues reported the investigation as a research letter appearing in tomorrow's issue of the Journal of the American Medical Association.

Graves disease might earn a potential recruit a medical rejection, but it's treatable and doesn't demand discharge for soldiers in the service, Burch says. All of the men who developed the disease were doing well at last report, he adds.

Dr. Leonard Wartofsky, a retired Army colonel and a leading thyroid expert, says he was aware of the Graves cluster and couldn't explain it. "It's an unusual cohort of people and it raises the question [of why]," he says. "It could be a total fluke, or it could be something that is precipitating the Graves disease."

Several of the men had a family history of thyroid problems, which is considered a risk factor for susceptibility to Graves. However, even in these people some kind of trigger is required to turn the body against the thyroid gland.

The revelations about Graves disease come on the heels of an order by President Bush -- whose mother has the condition -- that roughly a half million military personnel receive the smallpox vaccine.

Smallpox vaccine is effective, but it causes deadly reactions in about one to two people per million who receive the inoculation.

So far, officials say, the demand has provoked no rebellion. However, a similar order in the late 1990s regarding the anthrax vaccine prompted many soldiers to reject the shot over safety concerns. Jim Turner, a Pentagon spokesman, says the military disciplined 450 personnel who refused the vaccine between 1997 and August 2000. About 110 have been forced out of the armed forces as a result of their stance, including three last year.

Phil Kraft, program director of the National Veterans Services Fund says he's not expecting any mutiny with the smallpox vaccine.

"It's not an experimental vaccine like the anthrax vaccine was, so that has the soldiers feeling somewhat comfortable about it," says Kraft, who received a smallpox booster before he was sent to Vietnam to fight. "It's not that they're experimenting on the troops without their permission."

Turner says soldiers with conditions such as eczema that would leave them vulnerable to a smallpox vaccine won't be forced to take it.

Turner vehemently rejected the notion that the anthrax vaccine is experimental. Indeed, the shot was approved in 1970. However, at that time it was limited to people who worked with animals or animal products. They are prone to skin anthrax but not the more deadly lung form that is feared in a bioterror attack such as the one that killed five people in this country last year.

Last March, a government panel concluded the anthrax vaccine was "reasonably safe" for people and that it worked against inhaled infections.

What To Do

For more on Graves disease, visit the American Thyroid Association or the National Graves Disease Foundation.

SOURCES: Col. Henry Burch, M.D., chief, endocrinology, Walter Reed Army Medical Center, Washington, D.C.; former Col. Leonard Wartofsky, M.D., chairman, department of medicine, Washington Hospital Center, Washington, D.C.; Jim Turner, spokesman, U.S. Department of Defense, Washington, D.C.; Phil Kraft, program director, National Veterans Services Fund, Darien, Conn.; Dec. 18, 2002 Journal of the American Medical Association
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