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Irregular Heartbeat Returned Briefly

May 8, 1991

WASHINGTON (AP) _ President Bush this morning underwent the first test on his overactive thyroid gland, which doctors blame for an irregular heartbeat that returned briefly on Tuesday evening, his spokesman said.

The heartbeat returned to normal within a few minutes, and the president was administered an anti-coagulation drug called coumadin, press secretary Marlin Fitzwater said this morning.

Fitzwater said the president will remain on the drug for a period of time, along with two other medications he began taking over the weekend, digoxin and procainamide.

However, Fitzwater said, Bush’s overall condition remained good.

″There’s no change in his overall condition,″ the spokesman said.

The president told reporters at a news conference that doctors had advised him, due to the thyroid problem, to ease up on his physical activity for a few days.

But he said he did not have to change his work schedule.

″They’ve said that with the thyroid thing, I might not get into as active an athletic regime as I’d like to. They told me that this morning,″ Bush said.

He said doctors also assured him that the thyroid condition ″is going to be okay″ and would soon be cured.

Bush’s doctors said he underwent a background scan at Bethesda Naval Hospital early today, then swallowed a diagnostic dose of radioactive iodine before leaving the hospital.

Dr. Burton Lee, the president’s physician, said Bush will return Thursday for another scan that will allow doctors a closer look at his thyroid problem. It takes a day for the iodine ″cocktail″ to sink in.

Fitzwater said a thyroid specialist from the Mayo Clinic in Rochester, Minn., was being brought in as a consultant on the president’s case. He is Dr. Colum Gorman, who also has helped treat Barbara Bush. She also has hyperthyroidism, caused by the production of excess amounts of hormones from the thyroid gland.

Fitzwater said the re-occurrence of atrial fibrillation took place Tuesday evening around 6 p.m. while Bush was in his residence, with his heartbeat monitored continuously by a Navy doctor.

Fitzwater said the erratic heartbeat ″only occurred for a few minutes.″

Bush is wearing a portable telemetric monitor around his waist that allows the 24-hour surveillance.

Lee said earlier today, ″He doesn’t like the monitor.″

The anti-coagulant drug is intended to ensure that a blood clot does not form in the president’s heart and then move elsewhere in the body, possibly causing a stroke.

″Whenever you move in and out of arrhythmic conditions, from normal to fibrillations, they like to apply this just as a precaution against any coagulation problem that might occur,″ he said.

Returning from his medical test early today, Bush playfully pulled down his shirt collar and exposed his throat when reporters asked what had been done.

Lee and other physicians working on the president’s case said Tuesday the thyroid problem is easily treatable.

The tests will help the doctors determine what treatment to follow. The alternatives range from drugs to surgery.

″It will take us at least a week to make sure we have all the tests we need,″ Lee said.

Lee told reporters that blood tests taken after the president suffered an irregular heartbeat on Saturday confirmed that Bush’s thyroid was secreting too much hormone.

He said the finding was good news for Bush because it provided a simple, clear cause for the heart problem and because an overactive thyroid was easily treated.

″It makes President Bush’s longterm outlook much better,″ Lee said at a news conference at Bethesda Naval Hospital. ″If you know what’s wrong and can fix it, it’s a much more satisfactory result.″

Bush’s doctors also said it was now definite that the president’s heart was organically sound and that the irregular beat, called atrial fibrillation, was not a basic weakness in the heart.

The president is expected to wear a portable heart monitor for at least another week, doctors said.

Fitzwater said Bush was ″elated″ at the finding.

″It has nothing to do with his heart. You treat the thyroid condition and that takes care of the fibrillation,″ Fitzwater said. ″It means that he doesn’t have to worry about exercise or stress or any of those things that are related to (heart) problems.″

On Tuesday, tests showed that Bush’s thyroid was secreting 10 percent to 20 percent too much hormone.

The thyroid is a small, butterfly-shaped gland in the front of the neck. It secretes hormones that help regulate the heart, liver, brain and muscle function.

A generally enlarged thyroid can cause a condition called Graves’ Disease, the disorder discovered last year in Mrs. Bush. Other problems can include one or more lobes of the gland being greatly enlarged and overactive. Still another possibility, though doctors said it was remote, is the presence of a tumor.

Dr. Kenneth Burman, an Army colonel and the Walter Reed thyroid expert who also is treating Mrs. Bush, was brought in to consult on the president’s treatment.

Depending on what is found in the tests today and later, Burman said Bush’s condition will be corrected in one of three ways:

-A radioactive iodine cocktail designed to destroy cells in his thyroid gland and thus reduce the amount of hormone secreted.

-An anti-thyroid drug that will neutralize the excess hormone.

-Surgery that would remove part or all of the gland.

A fourth possibility, said Burman, is that the gland has a transitory inflammation that will resolve itself.

Lee quickly discounted the surgical possibility.

″The chances of President Bush being operated on is basically nil,″ he said.

Lee said there had been some clues about his thyroid condition. The president had always had trouble losing weight because of his hearty appetite, the doctor said, but ″within the last week or two, he has lost three or four pounds more than anyone would have expected.″

Moreover, he said, there had been episodes of weakness while jogging that go back two or three weeks.

″We would gather that this disease has had an onset only for the last six to 12 weeks,″ said Lee.