Month: January 2023

Perhaps you’ve seen this ad about a drug for thyroid eye disease. If so, you may be wondering what thyroid eye disease is — and why the woman in the ad is wearing five pairs of sunglasses at once. Read on for answers.

What is thyroid disease and how does it affect the eyes?

The thyroid gland is a small, butterfly-shaped organ at the front of the neck. It releases thyroid hormone, which helps control many functions in the body. If it releases too much thyroid hormone (hyperthyroidism) or too little (hypothyroidism), bothersome and sometimes serious symptoms may develop, including changes in muscle strength, bowel function, and heart function.

An overactive thyroid gland can cause thyroid eye disease, prompting swelling and inflammation in tissues surrounding the eyes. The condition causes bulging eyes, a dry, gritty sensation in the eyes, tearing, pressure or pain behind the eyes, and blurring or double vision.

As many as half a million people in the US have thyroid eye disease. It affects up to half of people with Graves’ disease, an autoimmune illness marked by an overactive thyroid.

Thyroid eye disease ad: The pitch and the evidence

The ad opens with a woman wearing large, dark sunglasses, identified as a real patient named Jeanne. “With thyroid eye disease,” she explains, “I was always wearing sunglasses to hide my bulging eyes. I wore them just about everywhere.”

She removes her sunglasses to reveal that she’s wearing another pair underneath. In fact, she’s wearing three pairs of sunglasses and later will be wearing five!

As the music turns upbeat, she continues: “But then my doctor recommended Tepezza, a prescription medicine for thyroid eye disease, and I didn’t have to hide so much.”

A drawing of a bulging eye morphing into a more normal eye accompanies her next words: “In a clinical study, more than eight out of 10 patients taking Tepezza had less eye bulging. And nearly seven out of 10 saw improvements in double vision.”

Warnings about this medicine

You know what comes next: a fast-talking voiceover warning of possible side effects. For Tepezza, these include:

• Infusion reactions. Now we learn that Tepezza is an intravenous (infused) medicine. A course of treatment is eight 90-minute infusions, each separated by three weeks. Infusion reactions may be mild or severe, including allergic reactions (such as itching or hives) and other side effects that occur during or just after the infusion (such as fever or sweats).
• When to call for advice. “Tell your doctor right away if you have symptoms such as high blood pressure, fast heartbeat, shortness of breath, or muscle pain,” the voiceover instructs. Keep in mind that most people with high blood pressure have no symptoms, but if severe it can cause headaches, blurry vision, or chest pain.
• Before starting treatment. If you have diabetes or inflammatory bowel disease, or if you are pregnant or planning to become pregnant, you should tell your doctor before starting treatment. That’s because Tepezza may harm a developing fetus or worsen other diseases.

A big finish: Controlling thyroid eye disease

As the commercial winds down, Jeanne is back, removing her fifth consecutive pair of sunglasses to reveal normal-appearing eyes. “I look more like my old self again. Now I wear sunglasses because I want to.”

“Ask your doctor if Tepezza is right for you,” the narrator advises before suggesting a visit to the website for before and after pictures of Jeanne. I checked; they’re impressive.

What the ad gets right

The ad accurately describes

• thyroid eye disease symptoms
• how the condition alters appearance and can cause embarrassment
• results of a single, small study investigating the risks and benefits of Tepezza.

What else do you need to know about treatments for thyroid eye disease?

• You must treat thyroid disease as well as your eye condition. Medicines or surgery are often good options. Radiation therapy may be effective, but sometimes makes thyroid eye disease worsen.
• Selenium, a mineral supplement, is recommended by some experts.
• Quitting smoking is always recommended, partly because smoking may worsen thyroid eye disease.

If thyroid eye disease is mild, moisturizing eye drops, eye shades or patches, or dark sunglasses may be sufficient.

If thyroid eye disease is moderate to severe, options include:

• medicines that suppress inflammation or an overactive immune response. Examples include glucocorticoids, teprotumumab (Tepezza), mycophenolate mofetil (Cellcept), tocilizumab (Actemra), or rituximab (Rituxan).
• surgery to remove excess tissue around the eyes.

Small studies, like the one cited in the ad, may not detect all side effects, especially rare ones.

Last, but certainly not least: Tepezza is expensive. The price for a year of treatment can be $300,000 or more — and insurance coverage varies.

The bottom line

I still don’t know why the woman in the ad wears multiple pairs of sunglasses at the same time. Maybe it’s to emphasize how serious she is about hiding her eyes. Or maybe it’s just a way to grab our attention. Direct-to-consumer drug marketing strategies can be even more mysterious than the illnesses they hope to treat.

If you’re concerned you may have thyroid disease or thyroid eye disease, talk to your doctor. A costly new drug may be an option for some people, but it pays to learn about all options. Academic medical centers, the NIH, or a medical society are more likely to give you reliable and balanced information than a drug ad.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

Trauma can register within our bodies on a cellular level. What that means to an individual — and how best to heal from serious traumas encountered in life — is the focus of a newer form of mental health counseling known as somatic therapy.

The resounding success of The Body Keeps the Score — a fixture on the New York Times bestseller list for more than four years running — testifies to mounting public awareness that trauma affects people deeply. Thus far, though, somatic therapy hasn’t caught up to cognitive behavioral therapy (CBT) and related techniques in understanding, use, or research proving its worth, a Harvard expert says.

What is somatic therapy?

Most people likely haven’t heard of somatic therapy, says Amanda Baker, director of the Center for Anxiety and Traumatic Stress Disorders and a clinical psychologist in the department of psychiatry at Massachusetts General Hospital. Unlike other mind-body approaches such as mindfulness meditation, mind-body stress reduction (MBSR), and mindfulness and self-compassion (MSC) — which are steadily growing in use — somatic therapy hasn’t hit the mainstream.

What’s the fundamental concept? “It’s a treatment focusing on the body and how emotions appear within the body,” Baker explains. “Somatic therapies posit that our body holds and expresses experiences and emotions, and traumatic events or unresolved emotional issues can become ‘trapped’ inside.”

Who might benefit from somatic therapy?

Since disturbing feelings often show up in the body in debilitating ways, somatic therapy aims to drain those emotions of their power, relieving pain and other manifestations of stress, such as disrupted sleep or an inability to concentrate.

These types of emotions can stem from a variety of conditions and circumstances that somatic therapy may potentially help alleviate. They include

• post-traumatic stress disorder (PTSD)
• complicated grief
• depression
• anxiety
• trust and intimacy issues
• self-esteem problems.

“Anxiety can lead to muscle tension, particularly in the neck, shoulders, jaw, and back,” Baker says. “It can cause a lot of discomfort, pain, stiffness, and trouble with daily activities. If we’re experiencing chronic anxiety or distress, it’s almost like we have our foot on a gas pedal. It’s not a panic attack, but we’re never feeling a reprieve and there’s a constant wear and tear on the body.”

How does somatic therapy differ from talk therapies?

Typical talk therapies such as CBT engage only the mind, not the body, encouraging people to become aware of disturbing thoughts and behavior patterns and work to change them.

But in somatic therapy, the body is the starting point to achieve healing. This form of therapy cultivates an awareness of bodily sensations, and teaches people to feel safe in their bodies while exploring thoughts, emotions, and memories.

“Cognitive behavioral therapies focus on conscious thought and work on challenging thoughts in relation to anxiety and behaviors, helping desensitize people to uncomfortable sensations,” Baker says. “But somatic therapy is more about relieving the tension, as opposed to desensitizing people to it.”

Even mindfulness meditation, which some experts consider somatic in nature, differs in one key way from somatic therapy, Baker says. “Mindfulness meditation lets any feeling or emotion come into our minds without judgment, as opposed to homing in specifically on bodily sensations that are happening,” she says.

How is somatic therapy carried out?

A somatic therapist helps people release damaging, pent-up emotions in their body by using various mind-body techniques. These can vary widely, ranging from acupressure and hypnosis to breathwork and dance.

Other techniques are just as integral but aren’t household terms. Some on this list include:

• body awareness, which helps people recognize tension spots in the body as well as conjure calming thoughts
• pendulation, which guides people from a relaxed state to emotions similar to their traumatic experiences and then back to a relaxed state
• titration, which guides people through a traumatic memory while noting any accompanying physical sensations and addressing them in real time
• resourcing, which helps people recall resources in their lives that promote feelings of calm and safety, such as special people and places.

What to know if you’re considering somatic therapy

Scant scientific research has focused on somatic therapy and its benefits, Baker notes. That’s one reason why she always recommends cognitive behavioral therapy, which has proven benefits, as at least a starting point.

“Anecdotally, I’ve heard people do find tremendous benefit from somatic therapy, but it doesn’t have the same research backing yet as CBT and some other forms of therapy,” she says.

Health insurance may be more likely to cover somatic therapy, she says, when a person is dealing with extreme symptoms of mental trauma, such as seizures. Otherwise, insurers are more apt to cover established therapies such as CBT.

Additionally, finding an experienced somatic therapist can be challenging. “I think fewer folks are going to be trained in somatic therapies than CBT, so finding an experienced practitioner is definitely a tricky process,” Baker says. One useful resource is the US Association for Body Psychotherapy, which offers a Find a Therapist search tool online.

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

There are warnings just about everywhere you look: The coffee you're about to drink is hot! Construction ahead! This product may contain peanuts!

In many cases, the reasons for these warnings are clear. But sometimes warnings raise more questions than they answer. When I was at the gym recently, these warnings on the exercise bike and treadmill were hard to miss in a bright red font:

• Obtain a medical exam before beginning any exercise program.
• Overexercise may result in serious injury or death.
• If you feel faint, dizzy, or have pain stop exercising immediately.

What exactly did the warning writers mean by "any exercise program"? What constitutes overexercise? Does having any pain anywhere mean you should stop working out?

Finally, I wonder: might these warnings cause unnecessary worry that actually discourages people from exercising?

Is it safe to start exercising without checking with a doctor?

A doctor's approval isn't necessary for most of us. Most people can safely begin a low-intensity exercise program and slowly increase their efforts over time. Choose activities that would allow you to carry on a conversation, such as:

• using light weights that are easy for you to lift
• walking at a leisurely pace
• biking at a leisurely pace (less than 5 mph)
• stretching and balancing activities
• light housework or yard work.

If you're starting at a low fitness level, make small increases in your workout over time. For example, if you start out walking 10 minutes a day, add one minute to your walk every week or two. Once you're walking 20 minutes a day, try picking up the pace a bit.

Who should be careful about exercising?

Of course, exercise is riskier if you have certain health conditions. It makes sense to ask a health care professional to make exercise recommendations if you're concerned about your health or have any of these conditions:

• Coronary artery disease, including symptoms of angina or a previous heart attack. Exercise that's too much too soon could stress the heart and trigger a heart attack or dangerous heart rhythm. Lower-intensity workouts (such as short walks at a comfortable pace) may be preferable, at least until it's clear that you can tolerate more.
• Exercise-induced asthma. Your doctor may recommend inhaled treatment to open up airways in your lungs just before or during exercise.
• Muscle disease, such as a metabolic myopathy. Your doctor may discourage you from engaging in certain exercises, such as sprinting or long-distance running.
• Back pain. Low impact exercise, such as biking or swimming, may be a better choice for people with back pain than higher-impact options, such as jogging or basketball.

If exercise is so good for you, why the warnings?

Let's review possible reasons for certain warnings:

• Having a medical examination before starting an exercise program might uncover a condition that makes exercise risky. The best example is probably coronary artery disease, which could trigger a heart attack during intense exercise. Fortunately, sudden heart problems during exercise are relatively rare (though you might think otherwise based on TV and movies, including an episode from the Sex and the City reboot).
• Overexercise is not a well-defined medical term. But it's true that suddenly exercising at high intensity when you're not used to it might be hazardous.
• Stopping exercise if you're feeling faint or dizzy presumably refers to concerns about severe dehydration or other causes of low blood pressure.
• Warnings about pain could refer to chest pain that might be a sign of heart trouble. Or it could be a warning about a type of severe muscle damage called rhabdomyolysis (which may complicate prolonged or intense exercise).

Of course, it's also possible these warnings have little to do with your health and everything to do with lawyers! That is, the equipment manufacturers might hope these warnings will ward off lawsuits from people who suffer a medical problem while using their equipment.

Are these warnings helpful?

Probably not.

All the warnings, alerts, and cautions in our everyday lives can become background noise. Despite red letters and bold fonts, warnings like these are easily overlooked.

Nor do they add much. My guess is that most people experiencing significant dizziness or pain during a workout will stop what they're doing even without reading a warning label. And serious medical conditions arising during exercise are rather rare, so the impact of warning everyone about them is likely small.

The bottom line

Don't be overly alarmed by alerts slapped on exercise equipment. True, it's best not to drop weights on your foot or exercise way too hard or long. If you are worried about workout risks or have been advised to be especially careful about exercising, it's reasonable to talk about it with your doctor.

But that conversation isn't necessary for most people, including those with well-controlled chronic illness such as high blood pressure, diabetes, or coronary artery disease. In fact, regular exercise helps treat many illnesses.

Exercise is among the most important things you can do to improve your health. And inactivity is a generally a much bigger risk than exercising.

So, if you see warnings on the gym equipment at your next workout, keep this in mind: there are much riskier things to worry about. Like hot coffee.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD