Carla Overbeck, U.S. National Women's Soccer Team

NAME: Carla Overbeck
TEAM: U.S. National Women's Soccer Team
POSITION: Defense and team captain
INJURY: Graves' disease (hyperthyroidism)

OTHER ATHLETES AFFECTED

Olympic gold medal sprinter Gail Devers

PLAYER BIO

While at the University of North Carolina, Overbeck won four NCAA championships. She was named to Soccer America's freshman team of the year and received All-American honors her sophomore, junior, and senior years while at UNC.

Overbeck has played 161 times for the national team since her debut in 1988 and is considered one of the world's best defenders. She captained the U.S. team to the gold medal in the 1996 Olympics, playing every minute of the team's five matches. That same year, she was named to the U.S. Women's Cup '96 All-Tournament team. Now 31 years old, Overbeck helped lead the U.S. to the 1999 Women's World Cup title.

HOW IT HAPPENED

Graves' disease is an autoimmune disorder in which the body's immune system, for largely unknown reasons, produces antibodies to parts of the body. In Graves', the antibody acts like a hormone and stimulates the production of thyroid hormones by the thyroid gland. The thyroid gland in the front of the neck becomes larger, and the extra hormones it secretes tend to speed up the body's metabolism. The patient may have nervousness, excessive sweating, fatigue, high blood pressure, muscle cramps, fast pulse, weight loss, and frequent bowel movements. Graves' disease is commonly associated with bulging, watery eyes. It is far more common in women than in men and tends to happen between the ages of 20 and 40. In many cases, there is a tendency for this disease to run in families.

For the last few months, Overbeck has said she hadn't felt well, especially during training.

DIAGNOSIS

Symptoms of Graves' disease may be mild or severe, depending on how overactive the thyroid gland is. The symptoms are caused by the increased metabolism that occurs in various body organs as a result of the high levels of the thyroid hormones, known as T4 and T3, present in the blood.

In some cases of Graves' disease, a whispering sound can be heard through a stethoscope placed over the thyroid gland. This is called a "bruit" and is caused by blood rushing rapidly through the gland.

A blood test, called the TSH test, determines the level of the hormone (TSH) most directly affected by the disease process. Once Graves' is diagnosed, other tests may be given. These may include additional blood tests to check for an autoimmune disorder and radioactive iodine uptake tests. The patient is given a dose of radioactive iodine; the next day, a conical, camera-like instrument is placed against the patient's neck area to see how the thyroid handled the iodine.

TREATMENT

"Suppressive therapy" uses medicine to lower the TSH level in the blood, causing less stimulation of the thyroid gland. It often requires several months to work and is not always effective. Also, radioactive iodine may be used to destroy the overactive parts of the thyroid gland.

Initial treatment for thyroid eye disease involves treating the active eye disease, which usually lasts two or more years and requires careful monitoring until stable. Treatment during the active phase of the disease focuses on preserving sight. Prescriptions of artificial tears and ointments, high doses of cortisone (steroids), surgery, and possible additional treatments may be required. Afterward, treatment of permanent changes may require surgical correction of double vision, staring appearance, or eye protrusion.

PREVENTION

Physicians can't always pinpoint the cause of thyroid enlargement, so prevention is tricky at best. The American Thyroid Association recently recommended that people over age 35 be screened with TSH tests every five years.