Talk:Graves' disease/Archive 2

Cure for Graves Disease?
I have Graves Disease, so obviously I'm very interested in finding a cure. I came down with horrible diarrhea (every half hour) and horrible stomach pains, and the VA doctor refused to give me medication. Eventually my immune system generated the antibodies, I suppose, and after FOUR DAYS the problem stopped (and what a horrible four days). But then I came down with Graves Disease, arthritis and vitiligo (all autoimmune diseases). I'm assuming I contracted Yersinia enterocolitica, and the antibodies stopped the diarrhea but they also attached to my TSH receptors. So the CURE for Graves Disease, to me, seems to be to bind a LIGAND to the PARATOPE. This should change the antibody just enough so that it will still attack the invading organism but at the same time will not attach to the thyroid gland. Does anybody out there know of anyone doing research along these lines or have any useful input? I'd like to know if I'm on the right track. I think the answer can be found in molecular biology, and that's where I'm concentrating my research. 63.198.18.137 (talk) 11:40, 17 February 2010 (UTC)mike peters

Summary section that need to be harmonized with the related main articles
The summary section about radioiodine treatment, surgery treatment, and Graves' ophthalmopathy, need to be harmonized with the related seperate articles, and vice versa. Can someone add the appropriate template, I think it's something like "this article section needs to be integrated with ..." or something like this. I don't think that "merge" is the appropriate action in these cases.Starvee44 (talk) 13:45, 23 April 2010 (UTC)

Major edits revert
I just given up trying to work through several hundred edits of the last few days. Some very sensible current text repositioning and good rephrasings, but an awful lot of neuropsychiatric addition and prognosis section that is just too difficult to tweak - so I've cut the Gordian Knot as it were.

Neuropsychiatric symptoms, whilst noncontroversial in acute phase, are not generally thought to persist once thyroid function stabilised, e.g. read the eMedicine link given in top infobox "Subjective cognitive dysfunction are often reported... which remit after treatment of Graves thyrotoxicosis". Section then had series of study results which are highly problematic. Firstly that only positive association reports listed, yet http://www.ncbi.nlm.nih.gov/pubmed/8437644 (1993) as a review indicates why unlikely and http://www.medscape.com/medline/abstract/17097812 (2007) each of these seems post-date the cherry picking in stated study summaries and then general discussions. Secondly it is not Wikipedia place to start listing out studies in abstract form (a statement may be given with references, but not original research of interpreting the studies or stating why one thinks they are important or not). WP:MEDRS needs to be considered in not accumulating primary studies to make an overall case - for that counts as WP:Synthesis.

Sections which have their own sub-articles excessive expanded up (e.g. of thyroidectomy).

Article length increased from 35 kilobytes to 153 kilobytes which was far too long. This is WP:NOT, but a summary of knowledge.David Ruben Talk 23:06, 25 April 2010 (UTC)


 * As one can conclude from the long hours I'm working on this article, it’s not yet a finished product (like most of Wikipedia): I am still adding information, while making (preliminary) rewrites, deletions, summarizations, rearrangements. However, the latter cannot be the main focus at first, when one is trying to manage and incorporate a LARGE amount of complicated information. I've tried to keep a balanced point of view, and try not to forgo critical notes and reservations, also in the highly controversial issues like T3 treatment. Basically, you’re disagreeing with one statement, the amount of neuropsychiatric symptoms that linger in a subgroup of patients after treatment. I’ve used quite a lot of fairly consistent articles (that have specifically investigated this phenomenon), that underscore this observation. I’m NOT cherry picking from old and obscure sources. I agree that it might be more a matter of debate and degree than it now appears in the unfinished article, that there might be publications that I’ve missed that need to be incorporated to give more balance. If there are more critical note(s), they of course need to be mentioned, so take it to the discussion page or put some work into it yourself, instead of simply DELETING EVERYTHING. I find that quite illogical and anti-productive. When one sees someone spending a lot of hard work, would it not be in the best interest of the advancement of Wikipedia to have this guy let a go? Instead of further honest effort in improving the article, I am now wasting time writing this. I am very aware of the fact that some things are not yet as they should be; I’m also not very familiar with Wikipedia’s guidelines. Yes, of course the work of one man needs other peoples’ intake, especially from experienced Wikipedians, and editorial tailoring. But wait ‘till he’s done if he’s on a run. It's not all that often that one has the material, the time and the will to put such a large amount of energy into an article… You wrote on my talk page: "I suggest letting people have a read of the before & after versions and proceed steadily through this (…) 250+ edits is not something anyone can follow." I think that in this case it is very unlikely and unmanageable (and will cause the loss of information) to "letting people have a read of the before & after versions". Is it not a lot more manageable to work with the end product? Normally, your approach is probably commendable and the natural way things happen around here, but not when someone spends literally dozens of consecutive hours in consecutive days to incorporate a lot of information (ánd keep a grip on it). I’m not going to spend idle months to make (sourced) changes every so often, waiting until they are reviewed (by no-one, as activity appeared quite dead on this article). You almost make it appear that a lot of intense work on an article is not good, you write on my talk page to “slow down”. How is this sensible? If I was a Wikipedian and noticed a heavy worker, I would tell him to “keep up the good work and don’t worry about the little things for now”, and start reviewing and editing when he’s done with his contribution. Yes, I’ve noticed that the article has grown in length (about as long as the feautured article on Alzheimer).  I’ve noticed the automatic statement by Wikipedia that this article might be too long and be cut in pieces.  Yes, yes, yes! But not bloody yet. First, there needs to be a general rewrite (which I was almost coming to – fase 2 of the work). Then, if sections of an article seem to be too long, someone needs to replace it by a good summary and make a separate article.  Yes, yes, yes, of course! But let me finish my adding of information (almost done), and my general rewrite. I’ll try to finish it up this weekend. After that, bring in your “wider number of editors”, and I hope the article will eventually end up as something stable, balanced, and informative. By the way, before I started on this article, it was not only quite simple and rough, but also heaviliy unsourced. I didn't see you making any fuss about that (or effort into it). I’ve sourced many unsourced statements, and 99% of the information that I added is sourced, often by more than one article. And yes, that doesn’t mean I’m doing a perfect job that doesn’t need reviewing. But wait, damnit.  Starvee44 (talk) 11:03, 26 April 2010 (UTC)
 * WP:OWN might be worth reading - and I'm sorry but WP:NPOV is non negotiable, an article can't be part edited to show a less widely accepted viewpoint (however much it is the "truth" of research) on the basis that the relevant section may be adjusted later. Hence my suggeston to work on one area at a time, getting it as good as possible with full range of quotes (and copyediting writing style for this is WP:NOT) and then move on to another section. If you want to work in stages across a whole article (ie outside of collaboratinve process) then may be an idea to do the recrafting as a subpage of your user space, and then bring in sections at a time or ask for review of the whole redrafting ? Please do not take this as a rebuf not to work up this article - I'm learning a lot reading through on the references you are giving (well the English language ones I can locate) :-)David Ruben Talk 23:24, 27 April 2010 (UTC)
 * I am concerned about the reliability of the info as well as the quantity and the undue balance. I just removed a plainly false assertion coupled with a citation that was nothing except an unverifiable repetition of the same assertion. If Starvee believes it, I would ask him to back up and put in one assertion at a time so we can thrash it out. Removed sentence was Minute changes in the way thyroid hormone is delivered to or dispersed in the brain can have drastic effects on mood, emotions, attention, and thinking. Ref was The thyroid system is one of the body’s most tightly and precisely regulated systems. Minute changes in the way thyroid hormone is delivered to or dispersed in the brain can have drastic effects on mood, emotions, attention, and thinking., Arem Ridha  More accurately, large changes in thyroid hormone levels can sometimes have a large effect on mood, emotions, attention, and thinking. There is no evidence that minute changes of thyroid hormone level can have a large effect on any of these. Part of this problem is of course what is meant by "minute" and "large". In my experience with young patients with thyroid disease, change of thyroid hormone levels of >50% will perhaps produce perceptible neuropsychiatric effects in maybe 50%, but a large effect in maybe 10%. I would understand a "minute" change of thyroid hormone level to be maybe a 1-5% change and there is no evidence that such a small change can produce perceptible neuropsychiatric changes. If you disagree, how about a real citation rather than a fake one?   Thanks alteripse (talk) 18:08, 30 April 2010 (UTC)
 * As for that quote, that information comes from p.107 of the book The Thyroid Solution, by Ridha Arem, "author and editor of Clinical Thyroidology, a well respected widely read periodical publication for physicians on thyroid disorders".(http://www.randomhouse.com/author/results.pperl?authorid=794). Don't know if it's appropriate to include this information, as it's indeed not an article, but a popularized thyroid disease book aimed at patients and physicians, be it by a reputable author. A few notes on the revisions already made: "general consensus that neuropsychiatric problems settle once euthyroid status reached" - I think that is overstating it, there's a ton of studies that this is not entirely the case in a not unsubstantial group of patients. About revision and loss of information: when you do not agree that some section (eg sublicnial hypothyroidism) is on topic, why not put it in a seperate article, or add the info to the that section in the article in hypothyroidism, instead of simply deleteing and thereby losing information that as yet is not present in that topic. Same with my summarizastions of articles, why delete everything, and sometimes not summarize/retain the core information? Anyway, have your way with it, as you deem appropriate. As for the article, I lack the time and the will to further work on it, but it appears that other editors will readily step in. I don't have the Wikipedia guidelines experience to adequately edite my resulting article anyway (nor was that my intention). Good luck with it, and happy editing. Starvee44 (talk) 14:03, 1 May 2010 (UTC)
 * I am curious what "minute" and "drastic" mean to you? I specified above what they mean to me and if her book is the source of that quote, some piece of the meaning of those words is quite different from ordinary or she is peddling hyperbolic sympathy that is not intended to be an objective description of average human physiology. I am sure that saying things like that helps her establish a relationship with a patient looking for a sympathetic explanation for their distress; but it's way too much of an exaggeration to put in an encyclopedia. alteripse (talk) 18:30, 1 May 2010 (UTC)
 * I agree that it does indeed seem like an exaggeration Starvee44 (talk) 18:44, 1 May 2010 (UTC)

Reference citations queries
I've started looking through references. Aside from major work needed to merge duplicate use of same souce (name tag in the reference markup), several entries are very difficult to understand:
 * UpToDate is obviously an established provider of medical information, but its subscription only service makes it difficult as a source for anyone to verify - not even as if a subscription medical journal for which one's local medical library could provide for one. I suspect over reliance on this for fairly basic (non-controversial) points. Does UpToDate cite its sources (in which case those sources might be better) or are there more available sources that might be used instead ? (As I'm not familar with UpToDate, I've raised a wider query on its extensive use at WT:MEDRS, although subsequent discussion might be had at WT:MED.
 * "Clinical manifestations and diagnosis of hyperthyroidism in children and adolescents, Stephen LaFranchi, Last literature review version 17.1: januari 2009 | This topic last updated: april 24, 2007" - what does this refer to ? PubMed gives 3 hits for "LaFranchi hyperthyroidism adolescent" of which only earliest 1994 paper has him in 1st author position
 * "Bone disease with hyperthyroidism and thyroid hormone therapy, Douglas S Ross, Last literature review version 17.1: januari 2009 |  This topic last updated: november 5, 2007" - what is this meant to refer to ?  is a 1994 paper, and the most recent paper listed by PubMed search on "Ross bone hyperthyroidism"
 * "excerpts from an edition of the magazine Endocrinology and Metabolism Clinics of North America, KAPLAN ed., Vol 27, no. 1, march 1998" is really hard to pin down. PubMed tried for a number of searchs to get a reasonable hit: "Kaplan 1998 hyperthyroidism" gives just one for "Endocrinol Metab Clin North Am. 1998 Mar;27(1)", being "Treatment of hyperthyroidism with radioactive iodine." - seems unlikely being source for some of citation points used. David Ruben Talk 23:13, 1 May 2010 (UTC)


 * As for the UpToDate references: on of their primary "characteristics" is that they want to be as uptodate as possible, hence they date all the updates of their articles. I have access to UpToDate via my university, and get you copies of the articles, if you want. As for the Kaplan source, I have indeed been a bit messy with referencing it, and have looked it up again in my archive: some of the information is taken from the introduction of this edition of the magazine, written by guest editor and endocrinologist Michael M. Kaplan, MD. Most information is taken from one of the articles in that edition, named "Clinical and laboratory diagnosis of thyrotoxicos", by Dabon-Almirante and Surks. To my knowledge, this article has no digital counterpart, but I can send you some scans if you wish it.Starvee44 (talk) 13:18, 2 May 2010 (UTC)
 * Endo Metab Clin N Am is a hardback serial that was published by Saunders in 1998. If Dr Ruben is English, he might be familiar with Bailliere's Best Practice series (both series are now published by Elsevier). The March 98 edition of Endo Metab Clin N Am was on thyrotoxicosis and featured about 20 review articles. Michael Kaplan was the guest editor for the issue, and should not be cited for any articles except the one he wrote: Kaplan MM, Meier DA, Dworkin HJ. Treatment of hyperthyroidism with radioactive iodine. 27:205-224. It does occur to me that anyone referring to EMCNA as a "magazine" has never actually seen a copy and probably should not be using it as a reference unless he is working from a PDF of the article. Another article in the same issue is Dabon-Almirante CLM, Surks MI. Clinical and laboratory diagnosis of thyrotoxicosis 27:25-36 but Kaplan's name should not appear in the citation. By the way, these articles are readily available online full-text to anyone with university or hospital access to MDConsult or other medical reference access, as the Clnics series are considered core medical journals for many US medical libraries. Are they not available in the UK or is endocrinology not your thing? alteripse (talk) 17:23, 2 May 2010 (UTC)
 * Endocrinology is "one of my things", but being a community located GP, means sadly no easy access to medical libraries (well I think I can apply through local PCT for recomendation to local teaching hospital to then apply there, and Athens seems quite ropey and having got timeout then difficult to be reauthorised - like I've nothing better to do... hmmm like manage cases of thyrotoxicosis that the hospital service eventually get around to seeing 'urgently' after several months when finally euthyroid) and one can't go subscribing to everything that interests one. By and large down to some great local consultants who do pass on information on changing practices and PubMed to look sources up. David Ruben Talk 02:22, 3 May 2010 (UTC)
 * Sorry about that. If you need any specific sources email me. Clinical management of Graves disease has been pretty static for the last decade or so-- about the only significant change that comes to my mind is the recent proscription of PTU for young patients due to liver damage risk. alteripse (talk) 12:03, 3 May 2010 (UTC)
 * I actually did have a hardcopy of the "magazine" in my hands (it's darkblue); as for the term magazine, the term in Dutch (my primary language) stands for magazine, periodical, journal,... and it is most commonly used for and translated as "magazine", but should in this case indeed not be translated into English as magazine. Hence the mixup. Starvee44 (talk) 10:49, 3 May 2010 (UTC)
 * Perhaps you will forgive me for not thinking of that possible explanation if I explain that your english was otherwise too good for it to have occurred to me! The Clinics are actually a very good source of references for an article like this. alteripse (talk) 12:03, 3 May 2010 (UTC)
 * per WT:MED UpToDate probably not suitable as a major citation (tertiary source and its material is constabtly being updated, so no fixed version people could lookup) - alternative secondary sources should be found where points need verifying. If Kaplan references not pointing to specific articles, then references were inappropriate and so removed. Neuropsychology is controversial; as in, research fails to be conclusive eitherway. So citing Smith, a study on rats, for 'cognitive impairment' does not rate against other studies on humans which dispute any association. Neuropsychology therefore rewritten from NPOV (lots of studies suggesting, other studies fail to confirm), and as not definitely present, moved after the fully accepted physical symptom section. Merging duplicate refs and some copyediting brings article down from 153kb to 98kb and apparent references 357 to 120. Still more duplicate references to merge and workup on citation details... David Ruben Talk 11:27, 3 May 2010 (UTC)

Complement System, C1 to C9 and Graves Disease
Firstly, I think everyone is doing a good job on this article; it's one of the better Wiki articles. I think a section should be added dealing with the COMPLEMENT system (C1 to C9) and it's effect on accelerating the TSH receptor on the thyroid, since the complements are affected by IgG and IgM. Complements seem not to work at temperatures above 55 degrees Celsius (I think that's 131 degrees F), so would hot towel wraps around the throat help in the treatment of Graves Disease? Would moving to a hot desert climate help? Anybody know of any research in this area? 63.198.18.18 (talk) 01:00, 3 May 2010 (UTC)mike peters

Misuse of sources
This article has been edited by a user who is known to have misused sources to unduly promote certain views (see WP:Jagged 85 cleanup). Examination of the sources used by this editor often reveals that the sources have been selectively interpreted or blatantly misrepresented, going beyond any reasonable interpretation of the authors' intent.

Please help by viewing the entry for this article shown at the cleanup page, and check the edits to ensure that any claims are valid, and that any references do in fact verify what is claimed. Tobby72 (talk) 17:57, 17 September 2010 (UTC)

Article status update
Status of the article is still "start-class", which is not the case anymore. Reading the criteria of the quality scale, I think it should be at least B-class (probably even higher?). What do you guys think? Starvee44 (talk) 08:45, 21 April 2011 (UTC)
 * Indeed, definitely more than "start-class". Mikael Häggström (talk) 12:04, 23 April 2011 (UTC)
 * I'm updating the article status to B-Class, which I think is fair? It definitely doesn't fall in the C category. Three important tasks remain: a summary of the symptoms and signs section (and creation of new article to move all the info to), adding more pictures, and the thing with the lost references to UpTodate (which need to be retrieved, and eventually replaced by the sources used by UpToDate).Starvee44 (talk) 20:52, 27 April 2011 (UTC)


 * I believe the article is pretty much complete... What tasks remain? Starvee44 (talk) 14:02, 7 September 2011 (UTC)

Split symptoms and signs section
The length of both this section and the article as a whole motivates splitting away this section. For those who want a quicker read of this article, leaving a more summarized piece in this article would very likely be appreciated. Mikael Häggström (talk) 12:08, 23 April 2011 (UTC)


 * Just reporting that I performed the split now. Mikael Häggström (talk) 15:07, 28 April 2011 (UTC)


 * Good work.Starvee44 (talk) 17:03, 28 April 2011 (UTC)

Adding pictures
I've added 3 pictures, one is my own (I took a picture of thyroid medication), two were already part of Wikipedia (Marty Feldman & Von Basedow). I've contacted some websites to ask permission to use a picture of Robert James Graves, which would be a bit more appropriate, as the name Graves is more commonly used. It would be nice to have another picture of Marty Feldman, in which his eyes and comedy work are more central to the photo. This one would be very nice to have here: http://whataface.tumblr.com/post/2516988629/marty-feldman-1934-1982

I've contacted some websites, patient organisations, and individual patients, in the search for pictures. Hopefully I will have some results.

If someone has a picture that is in any way related to Graves disease, please add it, or contact me if you can't do it yourself.

The most obvious pictures would be of a goitre, thyroid eye disease, Pretibial myxedema, Plummer's nail, and a drawing which makes clear the enlargement of the thyroid, like this one: http://2.bp.blogspot.com/-9ScQ_GmeEg4/TaJGcTdSEXI/AAAAAAAAAE0/JAC79wAjeyg/s1600/goiter-1.gif. Starvee44 (talk) 20:20, 27 April 2011 (UTC)

Deleted references from UpToDate.com
A lot of references have been deleted: this happened when the information was taken from UpToDate.com (references were to articles on that website). It was decided that, since access to this website is restricted, the references should go to the sources which are used in the articles of UpToDate.

The references to UpToDate have thus been deleted, but the information has been kept (the article would be cripled otherwise). What should be done: someone should go into the archive of the Graves' disease article, retrieve the references to the particular articles of UpToDate. Then go to thoes articles (if you have access), and retrieve the references to the primary sources. Then add them to the article in the original places.

My advice would be to put the references to UpToDate back in the article (dig in the history of the Graves' disease article), so this job would be a little easier, untill they have been replaced with the references from within the UpToDate articles. Better to have references to (the btw very highly regarded) Uptodate.com articles, than no references at all!

PS: You can find the discussions about Uptodate here (search "uptodate"): Wikipedia talk:WikiProject MedicineStarvee44 (talk) 20:38, 27 April 2011 (UTC)


 * I guess it's mainly the discussion at Wikipedia_talk:WikiProject_Medicine/Archive_18. I do not have full access to Uptodate myself, but it sounds like a good idea. Mikael Häggström (talk) 14:38, 28 April 2011 (UTC)


 * I have gone through the entire article, and have added the original sources on which the articles at uptodate are based (acces via my university library). Same with the article Symptoms and signs of Graves' disease. Case closed. Starvee44 (talk) 12:57, 6 September 2011 (UTC)

Notables
You have Nedezhda Krupskaya in there twice. I don't know enough about this to trust that I would combine them properly, although it looks like it's just info from two different references. Curiously, in the first instance, her name is in red, indicating that she doesn't have a page of her own. However, in the second, it is a blue link. So, needs to be fixed. Zlama (talk) 00:24, 19 February 2012 (UTC)

Done, thanks for the heads up Starvee44 (talk) 08:40, 22 February 2012 (UTC)

External links discussion
User:Catchamackerel has been adding an external link to this article to the site elaine-moore.com. When I looked at the link, it struck me as link spam, and as a "violation" (as it were) of the guidelines on external links. In particular, it seemed to me to violate the following provisions:


 * '''Links mainly intended to promote a website, including online petitions. See external link spamming. (ELNO 4)
 * Based on Catchmackerel's contributions, the only edits he has made to Wikipedia have been adding links to two sites to a few articles over and over again. This seems to me to be an attempt to promote these two websites wherever and whenever possible.


 * '''Links to individual web pages that primarily exist to sell products or services, or to web pages with objectionable amounts of advertising. (ELNO 5)
 * In looking at the Elaine Moore page, I see a prominent list of Elaine Moore's books down the right side of the page, as well as numerous links to Elaine's books in the top menu. This seems like too much overt, personal promotion and advertising to me.


 * '''Links to blogs, personal web pages and most fansites, except those written by a recognized authority. (This exception for blogs, etc., controlled by recognized authorities is meant to be very limited; as a minimum standard, recognized authorities always meet Wikipedia's notability criteria for people.) (ELNO 11)
 * I see little on the Elaine Moore page to make me think it's anything more than a personal web page designed to promote Elaine Moore and sell her books. The site is comprised of her blog, her products, and some of her articles. I don't see why her personal web page on this topic is deserving of a link here, or what it brings to the table for anyone other than Elaine herself.

As such, I deleted the link. The user sent me an email, and I replied (much as above) on their talk page. Reverts ensued. In order to prevent more reverts back and forth, I wanted to discuss the issue here, and hopefully engage others to share their opinions. At present, the link is not in the article, but that could certainly change.

As noted above, the only contributions made by this editor over 3 1/2 years have been adding links to various articles that point to Elaine Moore's web sites (elaine-moore.com and the seemingly defunct ahsta.com). While this isn't necessarily a problem, it seems to me that this editor has an agenda, and possibly a conflict of interest, though they deny that. If anyone would like to weigh in, I would welcome it. Thanks. --  Transity (talk &bull; contribs) 20:56, 25 July 2011 (UTC)


 * I stand by Transity's decision on this. The external link section has been cut down to the most qualitative websites, and IMO Elaine Moore doesn't belong there. I searched Elaine Moore's credentials, and she is a Medical Technologist, and a Graves' disease patient herself. The information she provides is not hardcore science. For example, she blantly quotes: "In Solved:The Riddle of Illness, Dr. Steven Langer writes that many hyperthyroid patients may be cured by correcting their Vitamins C and E deficiencies. These deficiencies, he says, cause symptoms of hyperthyroidism." Highly doubtable, and some of her views are too much away from the consensus on thyroid disease; eg herbs, chacras, acupunture, the focus on nutrients and vitamine supplements,... Her website is too commercial and a bit chaotic. I don't doubt she helpes a lot of patients, in whatever way, though I do doubt she belongs in the external link section of the Wikipedia article on Graves disease. I think/hope a consensus on Moore's website can be reached by the editors of the Graves' article, and there will be little need to take the issue any further. Starvee44 (talk) 14:01, 26 July 2011 (UTC)

---Response Part I by Catchamackerel---

This discussion is about an "editor" ["Transity", gender unknown, use of masculine for convenience] who has expunged a link from External Links for elaine-moore.com Graves’ Disease Education. I think the spirit of Wikipedia is to include, not exclude, various contributors and authoritative sources. It is with some regret that I find myself in a position to reply to all these comments, but in the end, I will have to be in abject horror over the censorship. I would like to shed light on the facts, which were not completely revealed by Transity (sorry, Transity), who may have cherry-picked some items in support of his actions, while neglecting all the rest.

Before I respond to all of Transity's reasons for expunging the link (see Part II), I want to say first that I've never seen an editor, et al, apply such force against a respected writer and author who has done much to help alleviate the suffering of those who have Graves' disease. Although even Starvee44 admits that Ms. Moore has likely helped many people, the discussion slips into how the site is not worthy because the site owner is – gasp! – a former medical technician/manager of many decades and author of a dozen health/medical books. Are you all suggesting that only Ph.D. and M.D.s have the right to participate as a source or external link? Does Wikipedia know this? Does it know, “Do not apply without a Ph.D. or M.D. for any scientific topics at Wikipedia”? And is this the space to discuss the efficacy of complementary medicine with traditional medicine?

I don’t think Wikipedia intends for contributors to impede the contributions of others, especially authoritative sources. An editor, according to Wikipedia guidelines and policy, is anyone who edits pages of Wikipedia -- "anyone with Web access can edit Wikipedia, and this openness encourages inclusion of a tremendous amount of content." This is the heart and spirit of Wikipedia: openness, inclusion, a tremendous amount of content, but what I see here is exclusion, close-mindedness, and of course the elimination of content by expunging an external link, in spite of the fact that everyone here seems to agree that surely many (some?) might’ve benefited from the site we just censored.

I will be back with my bulleted points to Transity. I’ve not had time to address each point, but you can be sure I will.

Catchamackerel (talk) 21:05, 26 July 2011 (UTC)Catchamakerel


 * Before you post a multi-part reply here, I urge you to review the policies and guidelines I have provided both here and on your talk page. I also urge you to be mindful of your tone and of tossing about accusations and sarcasm.  You might also look through the archives of this talk page, as this is not the first discussion concerning what to include and what to exclude from the external links for this article.  The article isn't going anywhere.  Take some time to understand the guiding policies, the history of the discussion, and the opinions of others before you make your case.  Anyway, that's my two cents.  --  Transity  (talk &bull; contribs) 21:36, 26 July 2011 (UTC)

Transity, As I mentioned before, I will reply to your bulleted items, but I am working under certain time constraints and cannot get to all of it now. Also, if there is something you think I'm not applying as it relates to any policies and guidelines, I'd prefer specifics, otherwise it will start to look like pin the tail on the donkey. I don't even time right now to play with the Wikipedia formatting. Please be patient.

Finally, my sarcasm is a knee-jerk reaction to some of the slightly arrogant remarks made above. This is not all about me, just so you know. But point well-taken: we can all do better. Thank you for your understanding. --Catchamackerel (talk) 23:11, 26 July 2011 (UTC)


 * The pages I suggest that you read are: the guidelines on external links, especially the links to be avoided; the guidelines on SPAM; and the guidelines on conflicts of interest. In addition, you might find Wikiproject Spam a useful read as well (though it's not a guideline or a policy, it may help you understand why your approach hasn't met with more success). You can view the archives of this talk page for some history on discussions concerning external links for this article as well. Here is a good place to start. More importantly, think about the advice I left on your talk page and consider not posting a point-by-point reply, at least for now. --  Transity (talk &bull; contribs) 01:31, 27 July 2011 (UTC)

--

Thank you for all your helpful suggestions on useful links. However, I do not think this website or any website like it, whatever its efficacy, relevance, and authoritativeness would've met with success under your editorship. I completely disagree with your arguments, as follows, applying my own undestanding of Wikipedia guidelines:

1. "Links mainly intended to promote a website, including online petitions. See external link spamming. Based on Catchmackerel's contributions, the only edits he has made to Wikipedia have been adding links to two sites to a few articles over and over again. This seems to me to be an attempt to promote these two websites wherever and whenever possible.


 * There are no petitions on this website and never have been.

2. Links to individual web pages that primarily exist to sell products or services, or to web pages with objectionable amounts of advertising. In looking at the Elaine Moore page, I see a prominent list of Elaine Moore's books down the right side of the page, as well as numerous links to Elaine's books in the top menu. This seems like too much overt, personal promotion and advertising to me.
 * The site is not "promoting" itself. It provides a wealth of information for its readers. The word "promoting" is being used incorrectly here. Wikipedia is intentionally vague on this point, understandably, because it does not want to chase away information providers who are dynamic in having gained some credential, work effort, or acclaim.


 * The External Link was to a website on Graves' disease education. The website houses up to a 1000 free articles on Graves' and autoimmune disease. The site also has hundreds of links to articles and scientific papers related to Graves' disease (see also Val's Thyroid Corner at the site).


 * Ms. Moore presents as part of her total portfolio and contribution to Graves' disease education a proud list of books. Even with this list, the book section only represents about 5% of the total website real estate, and has been presented by the editor in an unbalanced way. Furthermore, Wikipedia considers "books published by respected publishing houses" to be legitimate sources of information.


 * The site owner does not generate revenues or accept donations at her site. She does not have carts, baskets, a donation page, a gift donation page, or any other venue for collecting monies. She cannot benefit from Amazon associate’s revenue because of State laws. She does not use sponsors from pharmaceutical companies or any other large corporation. She does not leverage her content for the purpose of monetization. And most of all, the site is designed as an educational resource intended to empower patients, not to badger them.


 * The site complies with strict rules from HONCode.com (see certification on the homepage). The Honor Code of Conduct for medical and health web sites is an organization that ensures health and medical websites contain the proper authority, citations, etc., whether information is written or provided through articles, books, blogs, or any other electronic venue.

3.a. Links to blogs, personal web pages and most fansites, except those written by a recognized authority. (This exception for blogs, etc., controlled by recognized authorities is meant to be very limited; as a minimum standard, recognized authorities always meet Wikipedia's notability criteria for people.) (ELNO 11)


 * Ms. Moore is a recognized author and authority in the area of Graves’ disease and other autoimmune disease.

3.b I see little on the Elaine Moore page to make me think it's anything more than a personal web page designed to promote Elaine Moore and sell her books. The site is comprised of her blog, her products, and some of her articles.


 * (Reply already provided to similar statements elsewhere.)

3.c. I don't see why her personal web page on this topic is deserving of a link here, or what it brings to the table for anyone other than Elaine herself. As such, I deleted the link. The user sent me an email, and I replied (much as above) on their talk page. Reverts ensued. In order to prevent more reverts back and forth, I wanted to discuss the issue here, and hopefully engage others to share their opinions. At present, the link is not in the article, but that could certainly change.


 * (Requires no comment.)

This completes my response. If it were me, I would err on the side of fairness and more information (not less information), and not give the illusion of "promoting" a single education site in External Links. A more balanced portfolio of education links would demonstrate professionalism, fairness, and balance. I don't think Wikipedia was ever designed for editors to cherry-pick which education sites it would "promote", which is why this information needs to be presented to someone in Wikipedia arbitration who has not roosted here.

Thank you for your time and attention.

Catchamackerel (talk) 03:28, 27 July 2011 (UTC)


 * My position remains unchanged as I don't believe your statements have adequately addressed the issues raised. It is also clear that you haven't taken the time to read and/or digest the information at the links I provided -- the talk page archives alone would give you much needed perspective on this discussion which you are lacking today. --  Transity (talk &bull; contribs) 13:18, 27 July 2011 (UTC)


 * Anyone have an issue with adding a link to dmoz in the External Links section? The category already exists.
 * 
 * That way, it's easier to submit a link there right from the article. Anyone: feel free to discuss, or just add it if you like. --  Transity (talk &bull; contribs) 21:09, 27 July 2011 (UTC)

Transity - In the comment you edited, you were accusing me of having a "motive" for wanting to make contributions. This violates Wikipedia principles on "good faith". Please read Wikipedia:Assume Good Faith. Wikipedia states that it's not for any editor to assign motives to people to the extent that contributors are providing relevant and qualified information. You have continually implied motive to my contributions.

Also, your entire argument on "spamming" is ill-fitting. By your standard, Solzhenitsyn would've been classified as a "spammer" for trying to get articles and books published, only to be met with Soviet censors repeatedly. That is what I've been doing: trying to get resources published, but you are playing the role of information gatekeeper, and when it's challenged, you call it "spamming". I hold fast to my belief in the strength of the human spirit which has never had a taste for censorship by limiting information or marginalizing providers of information.

This is probably the most important point: Wikipedia writes, "Try to avoid deleting things as a matter of principle. When you amend and edit, bear in mind that others may find something useful in what you remove. Almost everyone – including you – has something useful to say. Deletion upsets people and makes them feel they have wasted their time..." Please read the section on Wikipedia:Staying Cool.

The above is my main complaint against your actions and stance, Transity -- your unwillingness to allow the reader to decide what is useful.

Today, I did a search at Google for "Graves' disease education", which produced the following links in this order of ranking. Hopefully, you won't be rankled that the site you continue to delete and censor repeatedly ranks #1 on this list.


 * Elaine Moore Graves' and Autoimmune Disease Education A repository of articles and resources on Graves' disease


 * Graves' disease - MayoClinic.com Comprehensive overview of Grave's disease


 * Foundation and Corporate Support - Graves' Disease Foundation (already in External Links)


 * Hyperthyroidism and Graves' Disease Articles on Graves' disease, symptoms, treatments, and coping

If you don't post these additional links in their entirety, I will. Does anybody have a problem with that? I ask that you not violate the principles of Wikipedia by acting in bad faith towards me, such as deleting my valuable contributions. I also have a concern about you stalking my User/IP in this regard. I'd rather not have to resort to Administrative Tools, but will if I see it continue. The only person who rallied to your cause was someone who maligned a career, fussed sujectively over web design, but at least admitted the site probably did help people after all.

Thank you for your time and attention. Catchamackerel (talk) 23:17, 27 July 2011 (UTC)


 * Yes, I have a problem with you adding the link to elaine-moore.com, as I have explained (I haven't looked at the others, and can't comment on them yet, but I ask that you discuss their merits here before simply adding them).
 * Do whatever you feel is proper with regard to taking administrative action re: adding the links, or re: my actions. I gave you several options on your talk page that you should explore before trying ArbCom (WP:EA and WP:RFC are good options), but you are (of course) free to do whatever you like. However, if you add back the link to elaine-moore.com, you do so against the current consensus. That consensus may change, but as of this moment, it is not in your favor. As such, the link will be removed, and you may be reported for administrative action yourself given the number of warnings you've already had. If you're points are convincing, and if my opposition to you is as irrational as you believe it to be, then at least a few of the 84 people who watch this page will surely agree with you. I urge you to wait until that happens to add the links back. --  Transity (talk &bull; contribs) 23:29, 27 July 2011 (UTC)

Transity: it's been discussed. The consensus is 1:1, which is not a consensus, unless you include the one other comment that seemed mixed. On the one hand, the person considered it a valuable resource for Graves' disease patients (that's a legitimate reason), but on the other hand, that same person mocked the site owner's career choice in a medical field (too personal). Does that make the consensus 1.5:1? I intend to move this matter up the line to let everyone defend their comments, but hopefully others will jump in to support the freedom to share information that ranks high among users who have benefited from that information, as follows:


 * Elaine Moore Graves' and Autoimmune Disease Education A repository of articles and resources on Graves' disease
 * Graves' disease - MayoClinic.com Comprehensive overview of Grave's disease
 * Hyperthyroidism and Graves' Disease Articles on Graves' disease, symptoms, treatments, and coping

If you agree with me that these links are worthy of representation in the External Links section of Wikipedia:Graves' disease and that Transity has unfairly been singling out the top link known as elaine-moore.com as a whipping post, simply write in your comment:

"Free a mackerel!"

Thank you.

Catchamackerel (talk) 00:36, 28 July 2011 (UTC)catchamackerel

To elaborate my previous input: my comment on Elaine Moores credentials was to highlight that she is not a scientist, and that her status as a Graves disease patient is not beneficial (though that status can provide insights non-patients lack), because she is in the first place a patient. Her career as a medical laboratory scientist (earned after a bachelor's degree in medical laboratory science) touches our subject, but doens't make her competent, other than the basic intellectual proof that she has earned a bachelors degree. My intend was purely a weighing of the person's scientific value in this matter, and in no way a mocking. My saying that she might help a lot of patients, doesn't merit an inclusion in the external link section of a scientific encyclopedia. (Also, a reference is a different matter that an inclusion in the external link section.) My judgement on Elaine Moore's website was not mixed, as you state, but a definitive no-no. To point out, again: in the past there has been a large, large debate about many websites that might be included. Check out the archives. In the end, a consensus was reached, and the four websites that remain are the cream of the crop. The Wikipedia article is very elaborate, and thus websites like Mayoclinic & about.com with basic information add nothing, and don't belong in the external link section, as has been concluded in the past (again, see the extremely large discussion about the external link section in the archives). I find Elaine Moores endorsement of "alternative" medicine telling (as clarified in my first comment): it's too much away from the scientific consensus (which basicly is that alternative medicine = quackery). I don't even think Transity's suggestion that we could add a link to dmoz (http://www.dmoz.org/Health/Conditions_and_Diseases/Endocrine_Disorders/Thyroid/Hyperthyroidism/Graves%27_Disease/), is a good one: the external link section of this article is tight, is very good, is very qualitative. A lot of websites have been deleted, and that should be kept so. Less is more in this matter, since the article is getting top-notch. Transities use of the term spamming was IMO merrited, since your only contributions in 3 1/2 year were adding links to Elaine Moores website (as Transity pointed out). To your credit, you have now come out of the dark and started a debate. I believe Transity has been fair, balanced, and erudite in handling this case. I would also like to point out that the elaborate article you have before you, is for a large part constructed by me, with the help of several other editors, like Transity. I think this gives me the right to an entire vote, so as for now, the consensus is 2:1. Starvee44 (talk) 11:53, 28 July 2011 (UTC)

I'll make it 2:2. The site has an HONCODE certification http://www.hon.ch/HONcode/, and as such I suggest it should be deemed to have sufficient quality. shoi (talk) 23:20, 2 January 2013 (UTC)
 * We are not a collection of external links per WP:ELNO. There is an organization that specializes in external links and typically we simply link to them. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 23:27, 2 January 2013 (UTC)

Orientation needs work
I believe it is not correct to start out saying Graves is a thyroid disease and then way down the page throw in the eye and skin effects, which are unrelated to the thyroid. It should start out Graves is an autoimmune disease which attacks, etc.

I am not knowledgeable enough to do these edits myself. Trudyjh (talk) 14:17, 16 March 2012 (UTC)

Notable cases
Over the years, a lot of names had been added in the section "Notable cases". On 29/12/2012 uses Yobol removed most of them as "non notable". He had a point: a lot of the people who were listed were quite obscure. However, in my view, Yobol deleted too much. I restored a selection of people whom I think are indeed notable cases. Starvee44 (talk) 18:35, 2 January 2013 (UTC)

List of symptoms
The current list under "signs and symptoms" is unsourced, and does not make any attempt to present things logically. Clearly diplopia is not a symptom if there is only hyperthyroidism but no ophthalmopathy. I'd say it should be replaced by a structured and sourced list as soon as possible. JFW &#124; T@lk  06:46, 21 January 2013 (UTC)
 * Thanks and have readded this bit. Will check for copyright issues. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 07:05, 21 January 2013 (UTC)

Copy and paste
Found a concern. Parts of our article appears to be word for word the same as http://www.thyroidmanager.org/chapter/diagnosis-and-treatment-of-graves-disease/ Need to figure out who copied from whom. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:58, 2 January 2013 (UTC)
 * Okay this word for word text was added April 2010 by User:Starvee44 Unless  this editor is Leslie DeGroot we have a problem. Will revert back to before their first edit.  Doc James  (talk · contribs · email) (if I write on your page reply on mine) 00:08, 3 January 2013 (UTC)
 * Another editor had issues for other reasons  Doc James  (talk · contribs · email) (if I write on your page reply on mine) 00:23, 3 January 2013 (UTC)

Other word for word


 * "Personal problems can strongly affect therapy by interfering with rest or by causing economic hardship"


 * "patients are nutritionally depleted in proportion to the duration and severity of their illness. Until metabolism is restored to normal, and for some time afterward, caloric and protein requirements may be well above normal. Specific deficiencies may exist, and multivitamin supplementation is indicated. The intake of calcium should be above normal."


 * "Sympathetic discussion by the physician, possibly with assistance in environmental manipulation, is an important part of the general attack on Graves' disease"
 * "strongly affect therapy by interfering with rest or by causing economic hardship" from this 1996 book

So it is not an isolated case but appears to be the majority / all the text by this user. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:47, 3 January 2013 (UTC)


 * I restored the article to the state of january 2, 2013. After that date, you deleted the few external links that were the result of a (very) long debate between several editors, and which were unanimously approved as being high-quality and relevant (the best of the dozens of links that had been proposed and evaluated). Take a look at the archive. This issue needn’t be re-addressed…
 * Other than that, you had discovered some sentences that had been copied from an article and not rephrased. Seeing that the editor of that sentence, me, added a lot of information to the article, you deemed it necessary to undo the countless hours of work and hundreds of edits by dozens of editors that followed the start of my editing.
 * In those years, a lot of hard work has been put into this article, not only by adding information but also by adressing issues like lack of references or the amount and selection of external links. The article had become pretty decent, and was being read by over a million readers a year. None have complained about copright issues, might I add. Granted, that is besides the point: copyright issues need to be adressed. And that is what it is: an issue that needs to be adressed, not swooped away.
 * The amount of information I added to the article was the result of two years of research. It was a ton of information to “control” and not easy to keep an oversight, let alone implement the info organically in the article, in a managable timeframe. Many of the text has been rewritten, either by me or by others. It is however so, as Doc James has pointed out, that some information has been left in its original sentence. The solution here is not to throw away all the work and return to a very immature article and start all over again (why would you want that?!), but to rewrite those sentences. Yes, it isn’t perfect, but alas, I’m merely a man.
 * Conclusion: should you find other copyrighted sentences, either rephrase the information yourself, or highlight the issue on the talk page so someone else can do it. I rewrote what Doc James has already highlighted.
 * PS: Doc James also raised that anothe reditor “had issues for other reasons”. This was an argument in an ongoing discussion, not a conlusion. In the end it was adressed and laid to rest. Starvee44 (talk) 17:27, 20 January 2013 (UTC)
 * The amount of information I added to the article was the result of two years of research. It was a ton of information to “control” and not easy to keep an oversight, let alone implement the info organically in the article, in a managable timeframe. Many of the text has been rewritten, either by me or by others. It is however so, as Doc James has pointed out, that some information has been left in its original sentence. The solution here is not to throw away all the work and return to a very immature article and start all over again (why would you want that?!), but to rewrite those sentences. Yes, it isn’t perfect, but alas, I’m merely a man.
 * Conclusion: should you find other copyrighted sentences, either rephrase the information yourself, or highlight the issue on the talk page so someone else can do it. I rewrote what Doc James has already highlighted.
 * PS: Doc James also raised that anothe reditor “had issues for other reasons”. This was an argument in an ongoing discussion, not a conlusion. In the end it was adressed and laid to rest. Starvee44 (talk) 17:27, 20 January 2013 (UTC)
 * PS: Doc James also raised that anothe reditor “had issues for other reasons”. This was an argument in an ongoing discussion, not a conlusion. In the end it was adressed and laid to rest. Starvee44 (talk) 17:27, 20 January 2013 (UTC)
 * PS: Doc James also raised that anothe reditor “had issues for other reasons”. This was an argument in an ongoing discussion, not a conlusion. In the end it was adressed and laid to rest. Starvee44 (talk) 17:27, 20 January 2013 (UTC)


 * Per Copyright violations when substantial copyright concerns are discovered we revert back to the last clean version which was before you began adding this. We than build from there which a number of us have been doing in the last few week. To restore this copyright infringement you have also removed a bunch of good edits. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 04:56, 21 January 2013 (UTC)
 * I have brought this concern to ANI and consensus will need to be obtained before you revert back to how it was before . Doc James  (talk · contribs · email) (if I write on your page reply on mine) 06:22, 21 January 2013 (UTC)


 * I don’t even know where to begin… I thought just to opt out because your decision, however well meant it might be, is so far beyond my comprehension that I have little hope for a non-protracted debate – I fear you will just keep throwing regulations in my face. So I’ll just say what I have to say and then you can do as you please.


 * The admirable castle that the Wikipedia reader could perceive here before january 2 apparently had some balconies, windows and other stuff that you, Doc James, discovered to be in need of tweaking. Nice job. But, instead of starting to identify those issues in order to rectify them, you decided to bring down the entire structure and put a placard on the construction site that read: “Please rebuild”. Because you are not going to do it. Unless you have 100 hours to spare. Do not underestimate the amount of work that went into this. (After you deleted the article, you spent one hour of mainly minor edits, and after that a handfull of minor edits followed. So your comment “to restore the article […] you [starvee44] have also removed a bunch of good edits” is – when one considers the quality and length of the text that is at stake – absolutely pffffffffffff.)


 * You are being unrealistic. Nobody will do the amount of work that is needed to rebuild it properly from the bottom up (and it should be one person who takes the lead because otherwise it’s going to be a chaotic mess). On the other hand, nobody is going to complain about copyright. And if anybody does, or if copyright issues are discovered, then you can change it. It’s called accepting the non-ideal way that articles grow on Wikipedia. Realpolitik. Pragmatism. Life, if you will. Perfect is the enemy of good. But that is what you want. Perfection. Without providing it yourself. Maybe you should follow your strictness through: check out the text in “your” current article. You haven’t reached the end of the line: there is still deleting to be done, be sure of that. Because it’s not lacking in copyrighted sentences. You, however, seem not to realise that what people care about most, and what matters most, is the content quality of the article. And compared to what you deleted, right now it's s***.


 * I really find it utterly ridiculous that you resurrected this antique article back from the dead in order to delete this and this (you have yet to delete this last one, because yes, the lion share of compiling this subarticle is my work. Hmmm, strange. In response to JFW here below, you re-added this subarticle and said you would check it for copyright issues? You clearly haven't gotten to that yet, because this subarticle was an organic part of the entire article so should contain about the same percentage of copyrighted sentences. And you didn’t change a thing. So in order to be consistent, you should also delete this article and start building it from the ground up, starting from what unsourced things existed before I started editing. Oh, I see you already took over my summary of the symptoms and signs. Oh, you changed the last two sentences. Made it one. Thereby eliminating the manner in which milder cases defer from more serious cases. Tsk, tsk. Say it ain't so. - Funnyness aside, you lost information here, chose for less precision. There is an important distinction to be made between milder and heavier symptoms/signs. The gravity of the thyrotoxicity and her accompanying symptoms is a central aspect in gauging the situation of patients. )


 * You should also deal with the fact that, now, the majority of the current (medical) article is unsourced - you should follow these instructions. Maybe you should do that first. Thus, am I presuming correctly that you will adress the copyright issues and unsourced material issues of the current article promptly? You can’t do nothing, because you have not improved anything (the percentage of copyrighted material is about equal and you have caused an unacceptable explosion of unsourced material) – you have only shanged the quality of the article, for worse. Ridiculously worse. So if you will not put in the hours within an acceptable time frame, the article should be restored to its state of january 2.


 * Anyway... I'm not saying copyright isn't an issue. It is. But in a case like this it needn't be adressed with "Abracadabra, it's gone!". Adress it, don't just f*ck all the work away. Search for copyrighted issues and fix them. Keep the gold we worked so hard on. Don't settle for the manure that is now on the table.


 * That’s all I have to say, so bye and good luck with it. Really. Though I sadly predict fallow ground for years to come, with nothing but a history to boast about. These were my last words on Wikipedia - had enough. Starvee44 (talk) 23:07, 24 January 2013 (UTC)

There are a few issues besides plagiarism. If we look at this text "==Coping with Graves' disease and the patient-physician relationship== Mentally, Graves' disease can be very disturbing. Mood swings, thinking impairment and other mental symptoms can be difficult to handle, and make it appear the patient is suffering from a severe mental disorder. Patients in some cases have been placed in mental institutions. Given the sometimes dramatic impact and long duration of the disease and its treatment, identifying and maintaining emotional support systems (which are frequently affected) can help patients and their families cope. Because emotional lability of the thyrotoxic patient may create interpersonal problems (often producing significant marital stress and conflict), thorough explanation of the disease can be invaluable. In Graves' disease, the accent should lie on written information, as a host of mental problems, such as decreased attention span and memory problems, can impair a patient’s ability to absorb details of doctor visits. In a complicated and difficult illness like Graves' disease, physicians should therefore furnish patients with educational materials or resources such as handouts, website links and community support groups." Doc James  (talk · contribs · email) (if I write on your page reply on mine) 01:26, 25 January 2013 (UTC)
 * Many of the references are poor. Either they are primary sources, or popular press. Such as http://www.mythyroid.com/hyperthyroidism.html and pmid9081554 And yes no reference is better than a really poor reference.
 * It is written like a self help guide and not in an encyclopdic tone.

Cause and cure
I have Graves disease, I think it was caused by a horrible bout of diarrhea and stomache pain that lasted 4 days (probably from eating bad food at a fast food place or drinking bad water while camping). The doctor refused to give me medication. Could E. Coli cause an onset of Graves disease? I also had my tonsils and appendix out when young (these are supposed to be part of the body's immune system) and had a shot of cortisone in my early twenties. I've read that cortisone shots can cause auto-immune problems later on. I see it all as a case of molecular mimicry--the antibodies attack the invading organism which is molecularly similar to the thyroid. I've also read that the body has "sequestration" areas where it puts invading organisms that it can't normally handle but that these sequestration areas can be disrupted by stress--my mother died during the onset of the disease and that was quite stressful. The key to the cure, I think, is addressing the molecular mimicry issue. 50.202.81.2 (talk) 22:38, 24 October 2013 (UTC)

TSHR antibodies
The link to TSH receptor antibodies redirects here. 10.1210/jc.2012-4309 is a recent review on (3rd generation) antibody tests and their use in the determination of the causes of hyperthyroidism. JFW &#124; T@lk  16:16, 25 December 2013 (UTC)

Main Article Picture
The picture of eyes at the head of the article looks very severe and could scare people with the disease. Perhaps it could be replaced with a close-up of a happy person with the disease, i.e. Marty Feldman or Maggie Smith. Princess Caroline (talk) 18:24, 13 July 2013 (UTC)

That picture made me jump. — Preceding unsigned comment added by 2001:558:6045:97:296F:4186:C0E5:4136 (talk) 21:12, 25 October 2015 (UTC)

Antithyroid drugs
The article refers to "lygole". I can't find a reference to this word anywhere else. Should it say Lugol's iodine? I would go ahead and edit but I can't find evidence that it blocks hormone synthesis. — Preceding unsigned comment added by 129.67.70.107 (talk) 11:52, 6 November 2013 (UTC)
 * Changed it to Lugol's iodine, as that is one method of treatment, however infrequent it is. Wolff–Chaikoff effect usually uses potassium iodide, but Lugol's iodide can be used.Wzrd1 (talk) 17:46, 12 February 2016 (UTC)

Editing the Cause Section
I have been looking for a proper citation for this sentence within the cause section:

" Since Graves' disease is an autoimmune disease which appears suddenly, often quite late in life, a viral or bacterial infection may trigger antibodies which cross-react with the human TSH receptor (a phenomenon known as antigenic mimicry, also seen in some cases of type I diabetes).[citation needed] "

I have not able to find clear evidence of the connection between molecular mimicry and the onset of Graves disease. However, I have found a recent review in 2016 in the New England Journal of Medicine summarizing new findings within the study of the disease that indicates that several genetic and epigenetic factors a key in triggering the disease. In particular, the review summarizes several papers that confirm that genes encoding thyroglobulin, thyrotropin receptor, HLA-DRβ-Arg74, the protein tyrosine phosphatase nonreceptor type 22 (PTPN22), cytotoxic T-lymphocyte–associated antigen 4 (CTLA4), CD25, and CD40 are likely involved in the disease.

I have attached a link to the review here: http://www.nejm.org/doi/full/10.1056/NEJMra1510030

I would like to add on to the first paragraph in Graves Disease section in the following way to indicate these new findings:

The exact cause is unclear; however, it is believed to involve a combination of genetic and environmental factors.[4] Exposure tobacco smoke, infection, dietary iodine, and emotional stress are frequently cited as possible factors that can induce onset of disease (http://www.nejm.org/doi/full/10.1056/NEJMra1510030). There is also genetic predisposition for Graves' disease, with some people are more prone to develop TSH receptor activating antibodies due to a genetic cause. In recent literature, Post-translation modifications of several genes have been correlated with Graves Disease. These modified genes code for expression of thyroglobulin, thyrotropin receptor, HLA-DRβ-Arg74, the protein tyrosine phosphatase nonreceptor type 22 (PTPN22), cytotoxic T-lymphocyte–associated antigen 4 (CTLA4), CD25, and CD40.1 have been identified as genes whose modifications been correlated with Graves Disease (http://www.nejm.org/doi/full/10.1056/NEJMra1510030). However, to date, no clear genetic defect has been found to point to a single gene cause. How these diverse epigenetic and genetic factors contribute to onset of disease remains unknown.

Immcarle44 (talk) 03:50, 19 January 2017 (UTC)Immcarle44
 * That is what this means "involve a combination of genetic "


 * This is way to complicated to go in the lead "In recent literature, Post-translation modifications of several genes have been correlated with Graves Disease. These modified genes code for expression of thyroglobulin, thyrotropin receptor, HLA-DRβ-Arg74, the protein tyrosine phosphatase nonreceptor type 22 (PTPN22), cytotoxic T-lymphocyte–associated antigen 4 (CTLA4), CD25, and CD40.1 have been identified as genes whose modifications been correlated with Graves Disease" Doc James  (talk · contribs · email) 16:56, 19 January 2017 (UTC)


 * True, it would be excessively complicated to go in the lead, but in the cause section, it would be an excellent addition. I recall reading a similar study and thought to add it to this article, but got sidetracked with life complexities. This would add in the cause section, specifics that are more current than a vague "combination of genetic" gives.Wzrd1 (talk) 21:28, 19 January 2017 (UTC)
 * So the text is "Unambiguous identification of the factors underlying Graves’ disease has not yet been accomplished. Genetic and epigenetic determinants are leading candidates for these factors.1,2,22Large-scale genetic analyses have identified several genes conferring susceptibility. These include genes encoding thyroglobulin, thyrotropin receptor, HLA-DRβ-Arg74, the protein tyrosine phosphatase nonreceptor type 22 (PTPN22), cytotoxic T-lymphocyte–associated antigen 4 (CTLA4), CD25, and CD40.1 Hypermethylation of several genes has been identified, including those encoding thyrotropin receptor and proteins involved in T-cell signaling." I guess the question is how should we paraphrase this?
 * Maybe "Genes that are believed to be involved include those for thyroglobulin, thyrotropin receptor, protein tyrosine phosphatase nonreceptor type 22 and cytotoxic T-lymphocyte–associated antigen 4 among others." Doc James  (talk · contribs · email) 18:16, 20 January 2017 (UTC)

That looks perfect, thanks, Doc!Wzrd1 (talk) 00:16, 21 January 2017 (UTC)
 * Done Doc James  (talk · contribs · email) 17:17, 21 January 2017 (UTC)

About 25 to 80% of people with the condition develop eye problems.
Well, that's a bit vague, isn't it? You're not far off from saying that 0 to 100% with the condition develop eye problems. — Preceding unsigned comment added by 217.42.240.74 (talk) 20:14, 2 July 2017 (UTC)

Page name
Should it be "Graves' disease" or "Graves's disease"?

The NIH uses the first

The ICD uses "Graves disease" Doc James  (talk · contribs · email) 15:05, 28 September 2017 (UTC)


 * There are two separate questions that should be asked here.


 * 1. A well-posed primary question should be: Which grammatical form of the name Graves do we use, a possessive (Graves'/Graves's disease) or an attributive noun (Graves disease)? "Graves' disease" is just a variant of "Graves's disease" where a possessive of a singular noun Graves is used. "Graves disease", on the other hand, uses Graves as attributive noun. Both could be grammatically correct, although the typical/common use with respect to diseases on Wikipedia is to use possessives of names (e.g. Alzheimer's disease, Behçet's disease, Crohn's disease, Huntington's disease, Parkinson's disease). The consensus in the literature seems to point to the possessive use case for Graves as well.


 * 2. So if we settle on possessive use rather than attributive use (namely, Graves'/Graves's and not Graves), then the secondary question of the spelling still remains: Graves' vs. Graves's. MOS:POSS gives some guidance, although it's pretty vague. Most in-depth discussions on the same subject do agree that despite vague MOS:POSS prescriptions, most published manuals of style do agree on strong preference towards -s's. So that we zero in on -s's being more non-controversial and classically correct than -s' . See e.g. Wikipedia_talk:Manual_of_Style/Archive_126 and Talk:Steve_Jobs/Archive_3 for some examples of extended discussions. Note also, that being a matter of grammar (and not the medical subject itself), this question should not be resolved by medical literature anymore (e.g. by a predominance of one spelling vs. the other), but rather by reference to English grammar and manuals of style – regardless of which spelling happens to be popular in medical literature.


 * If an incorrect (or less grammatically correct) spelling happens to be commonly used, as seems to be the case here, we should acknowledge it by noting "often cited as ". Which is exactly what I did in the edits you reverted before creating this discussion.


 * So the first sentence should read:
 * "Graves's disease (often cited as Graves' disease), also known as toxic diffuse goiter, is an autoimmune disease that affects the thyroid."
 * cherkash (talk) 06:34, 2 October 2017 (UTC)
 * We name stuff based on what name is mostly commonly used in high quality sources not based on English spelling rules. Doc James  (talk · contribs · email) 04:24, 4 October 2017 (UTC)
 * That may or may not be true, but only with respect to article names (and even that is guided by proofreading, etc.). But it's definitely not true with respect to text of the articles. Basic copyediting rules prevail (grammar, punctuation, etc.) regardless of common misspellings (which may and should be given credence when indeed common – like it is in this case, which is exactly what I proposed by adding "often cited as" clause). cherkash (talk) 06:27, 7 October 2017 (UTC)
 * You will need consensus. There is no way around this. Doc James  (talk · contribs · email) 07:22, 7 October 2017 (UTC)
 * Consensus for what exactly? I've laid out the arguments above. You haven't said much about the subject except for repeating "you need consensus" in multiple forums where we've happened to discuss this. Spelling/grammar changes don't need consensus. Agreeing on the name (specifically, on what substitutes the most common name) may require discussion, but it boils down only to the grammatical structure in this case (essentially, what function "Graves" serves – see above), and we don't even seem to have any disagreement on this. So we do have consensus. Pushing for any other notion of consensus, that is, on the subject of spelling alone (which we need to acknowledge, e.g. by "often cited as", but no more than that) seems to be a way to stall any discussion and push back on proof-reading changes which are reasonable by any standard. Again, spelling/grammar changes don't need consensus. That's the end of it. And pushing for more than "often cited as" without any other reasons is just an obstruction of other editors' work on your part. cherkash (talk) 10:45, 7 October 2017 (UTC)
 * I have said we generally go with what major sources use. So I oppose your suggested change in the name. Doc James  (talk · contribs · email) 21:52, 7 October 2017 (UTC)
 * Major sources on this subject are not authoritative on English language (grammar, style, etc.) while dictionaries and manuals of style are. And as been indicated a few times already, the recommendations and guidance are heavily skewed towards "Graves's" in this case. cherkash (talk) 00:25, 8 October 2017 (UTC)
 * English is a descriptive not proscriptive language. Doc James  (talk · contribs · email) 00:44, 8 October 2017 (UTC)

This may or may not be true, depending on whom you ask. But it's certainly beyond the point here. The grammar and sentence construction may certainly be "descriptive" in English, but without the spelling necessarily being so. E.g., we don't give in to the present-day ubiquitous lax spelling and spelling shortcuts in the Wikipedia articles in general (except in direct quotes), and there's certainly no reason to relax the spelling rules and best practices in this article either (outside of direct quotes, e.g. cited reference titles). In fact, as I mentioned, there are great arguments why -s's is a much more preferable construction than -s', and so far you happened to make no language-based arguments whatsoever on why we should prefer the latter to be used in the article text rather than the former.

So let me try to address what I perceive may potentially be couple points of concern for you, and how to deal with them. (I'm doing this purely speculatively, as you didn't really use any argument except the "common use" argument so far.) So here goes, just so that we address it in case you imply one of these reasons.
 * How the subject is being searched for, and whether a different spelling will affect readers' ability to locate it. – Well, this is exactly what #redirects are for, so there shouldn't be any problem here.
 * Acknowledging the common and prominent use in medical literature of the -s' variant in this particular case. – That's what the proposed "often cited as" is for, as it gives acknowledgement to the commonly used (mis)spelling in the very first sentence of the article without having to sacrifice the article's contents to a grammatically much less common and certainly a questionable variant of a singular possessive use in the context of English language/grammar.
 * A particular spelling is entrenched in literature, so we have no choice but to follow it. – That could be a good argument if the subject were a specific word/name that happened to be a single grammatical entity. But this is not the case here: the construction is " disease" which is clearly a language construction consisting of two parts and not a single entity. So the correct spelling must be devised based on language rules which brings this into the domain of copyediting. You actually acknowledged as much in your original question you asked mentioning that ICD uses "Graves" in its attributive form. Hence, the only question left to argue here is not of spelling but of grammatical use. I laid it out in my first response to you above. Please re-read it again.

So would you please address the language issues on their merits, rather than invoking the same argument about commonly used spelling that doesn't really apply to how we write an article's contents and what spelling we use throughout. So again, my challenge to your assertions is that this is the issue of grammar/copyediting and not of challenging the common use (on which we actually do agree! – it resolves towards the use of possessive form, instead of attributive noun). cherkash (talk) 14:04, 12 October 2017 (UTC)
 * You can try a RfC. Doc James  (talk · contribs · email) 07:10, 13 October 2017 (UTC)
 * Your answers look strange to say the least. Despite your own initial pointing to this Talk page as a forum to discuss my changes and your insistence on discussing the subject here, you are trying to avoid any serious discussion. So unless you really address the subject matter – which I already outlined at length above – I think this discussion is over. I'm going to make the editorial changes again unless you become serious about this discussion and are able to put forward something resembling an actual argument. cherkash (talk) 02:01, 22 October 2017 (UTC)


 * What you need to follow is described here Requested_moves Best Doc James  (talk · contribs · email) 15:00, 22 October 2017 (UTC)
 * We are not talking about the page move only. We are also discussing the edits to the page itself that you kept reverting. Do you have no more objections to the page edits at this point? cherkash (talk) 06:36, 23 October 2017 (UTC)
 * What the page is called is generally also the term that we use. Doc James  (talk · contribs · email) 17:58, 23 October 2017 (UTC)

Surgery - Complications May Include Pregnancy and Young Age?
"Advantages are immediate cure and potential removal of carcinoma. Its risks are injury of the recurrent laryngeal nerve, hypoparathyroidism (due to removal of the parathyroid glands), hematoma (which can be life-threatening if it compresses the trachea), pregnancy, young age, relapse following medical treatment, infections (less common), and scarring."

Am I missing something or does that make absolutely no sense? Jwuthe2 (talk) 08:10, 26 April 2018 (UTC)
 * User:Jwuthe2 thanks. Agree it makes no sense and removed. Doc James  (talk · contribs · email) 14:05, 26 April 2018 (UTC)