What could be wrong with Reyes?
PORT ST. LUCIE, Fla. -- Jose Reyes was to appear in his first true game of the spring season, and naturally those in attendance were interested in seeing how Reyes looked in competition coming off of hamstring surgery. Reyes has been upbeat about the health of his legs this spring and got off to a seemingly good start in a Monday intrasquad game. He has not yet played in Grapefruit League competition however; Tuesday he was scratched due to a wet field and Thursday he was following up with a physician locally related to results of his recent physical. Unfortunately, all anyone could see Friday was a concerned Reyes who was about to make his way back to New York ... and not because of his hamstring.
Reyes told reporters Friday that doctors feel he may have an overactive thyroid and he is returning to New York for further testing at the Hospital for Special Surgery. The Mets emphasize that they are "going to be conservative," according to general manager Omar Minaya, explaining why Reyes will not participate in any baseball activity until test results are complete. Translation: We will not see him testing the hamstring in a game for a few days, at least.
While we don't know any specifics about Reyes' lab results or which tests he will undergo in New York, based on the revelation of a suspected overactive thyroid, there are several things to consider.
First, the thyroid is a butterfly shaped gland located in the neck which produces hormones that help control metabolism. An overactive thyroid -- or hyperthyroidism -- means the thyroid gland is producing too much hormone. Symptoms of hyperthyroidism can include irritability, tremor, heat intolerance, fatigue, elevated or irregular heartbeat and weight loss. It is worth noting that Reyes indicated that he experienced no unusual symptoms and was feeling fine when he was informed of the abnormal test result. There is the possibility that Reyes' thyroid hormone levels were increased as the result of a transient viral infection or other insignificant occurrence and that they will return to normal baseline levels on their own.
Reyes is likely to go through more detailed testing to confirm the diagnosis and help determine the cause of the problem. Doctors may repeat the blood work that Reyes had done in Florida. They may also choose to do a radioactive iodine uptake test, in which a small dose of radioactive iodine is administered to the patient and the thyroid gland's uptake or absorption of the iodine is measured. The thyroid gland uses iodine to help produce hormones, hence the importance of this test. Other testing can include a scan or ultrasound of the thyroid to image the gland and observe whether any nodules are present. While the presence of nodules alone does not necessarily spell gloom and doom, they can be hyperfunctioning and contribute to abnormal hormone levels and consequently need to be evaluated.
Treatment options will ultimately depend on the results of the tests that Reyes is set to undergo. Dr. Gary Clark, an experienced endocrine surgeon and president of the San Francisco Surgical Society, outlined several possible options, depending on the symptoms associated with the condition and the source of the problem.
One step is generally to counter the clinical side effects of hyperthyroidism. For instance, if the athlete is experiencing an elevated or irregular heart rate, beta blocker medications may be prescribed. Clark cautions that sometimes, for an athlete, the subsequent effects of those medications can present their own challenges. "Clinically the athlete feels that it slows him down, which can be problematic if he depends on speed," Clark said.
Another possibility includes taking anti-thyroid medications which help prevent the gland from overproducing hormones. Clark noted that the risk with these particular medications is that they can negatively affect the body's white blood cell count, which can lead to an increased risk of infection.
Treatment of a hyperactive thyroid with radioactive iodine is another option. The medication can be taken orally and is highly effective in slowing thyroid activity. Clark states that sometimes this treatment requires only a single dose, although the individual may need to be secluded for a few days due to the radioactivity. In some cases, surgery may be warranted to remove most of the gland (or half of it) but this comes with some increased risk and is rarely the first course of action chosen.
All in all, there is good news here in that the condition of hyperthyroidism is treatable and once addressed, individuals generally respond very well. The critical piece is identifying and fully evaluating the condition, so the Mets' medical staff is taking all the appropriate measures to ensure that that happens.
In the meantime, the Mets' baseball staff will adjust to another delay to Reyes' return to play. Manager Jerry Manuel told reporters during postgame interviews that Ruben Tejada will get increased playing time in Reyes' absence.
And so we will wait a while longer to see how Reyes looks when he's back running the bases ...
Stephania Bell is a physical therapist who is a Board Certified Orthopedic Clinical Specialist and a Certified Strength and Conditioning Specialist. She is a clinician, author and teacher with extensive experience in the area of orthopedic manual therapy and sports medicine.