By Rick Wilton
March 11, 2010 8:30pm CST

Jose Reyes Update
There are times when I get notes from BIR subscribers that I "dumb down" the medical information to a fault and I won't argue that point. I do not want to lose subscribers because the information is too complex, so it is written with a broad audience in mind. With that said, there are some exceptions and an explanation of what is likely going on with Jose Reyes and his reported 'hyperthyroid' condition requires more detailed information.

Hyperthyropidism - refers to any condition in which there is too much thyroid hormone in the body. Excess thyroid hormone levels can increase metabolism (how energy is used), and increase the risk of other health issues such as heart disease and bone loss. (note: the medical definitions are from eMedicine.medscape.com)

Hyperthyroidism Symptoms (partial list) - Nervousness and irritability, palpitations and tachycardia, Heat intolerance or increased sweating, lower leg swelling, sleep disturbances, Fatigue and muscle weakness, Thyroid enlargement .

Causes - Grave's Disease, Toxic Adenoma, Plummer's disease, Subacute Thyroiditis, Drug-Induced Hyperthyroidism.

Testing - It sounds like the Mets and the specialist physicians have turned over just about every rock looking for causes of his thyroid imbalance. We can probably eliminate all of the causes listed above with one exception. Drug-induced hyperthyroidism. Using what the Mets have reported in the press and an explanation from a physician who provides me with some terrific medical insight, I believe his condition is drug induced. In this PED phobia phase of baseball, drug-induced does not mean Reyes was using any illegal drugs of any kind. It refers to iodine, which is found in sea water and some minerals.

Likely diagnosis - Euthyroid Sick Syndrome. This described as abnormal findings on thyroid function tests that occur in the setting of a nonthyroidal illness (NTI), without preexisting hypothalamic-pituitary and thyroid gland dysfunction. After recovery from an NTI, these thyroid function test result abnormalities should be completely reversible. In Plain English: Reyes' abnormal thyroid test was not caused by any of the usual sources (thyroid gland etc). The fact the Mets have told Reyes not to eat seafood and fish, which can be a source of iodine in the diet and can cause the elevated thyroid reading. Putting two and two together, it appears that the medical staff believes changes in his diet should be enough to correct the problem.

Long-Term Prognosis - Once Reyes' thyroid imbalance is corrected via diet, he will be allowed to resume workouts. The current prognosis from the Mets is anywhere from 2-8 weeks of inactivity. This large window could mean Reyes begins the year on the disabled list because he will have missed a good portion, if not all of spring training. Depending on how long he will be on the non-exercise portion of his recovery plan will determine how much time he will miss during the season. From our vantage point, he is likely to land on the disabled list at the start of the season and miss a minimum of 1-2 weeks, with a return in mid-April to the later part of May.

Brian Roberts (2B, BAL)
As late as yesterday, the Orioles had just about anyone (including yours truly) convinced that Brian Roberts was right on schedule in his recovery from what was termed a minor herniated disc in the lumbar region of his lower back. Andy McPhail stated yesterday that he could start the year on the disabled list. Furthermore, he added the front office is looking at possible trade options and players within the system. I may be wrong on this point, but major league teams don't go looking for two-week replacements via trade if the player will be back in the short term. This would suggest there is a chance Roberts will need much longer to recover and that is where the trading option comes from. He is in shutdown mode for at least a week, most likely longer.

Russell Branyan (1B/DH, CLE)
Branyan developed a herniated disc in his lower back during the second half of the 2009 season. His season officially ended on September 30 and he rest the back then began a rehab program during the winter. The latest word is he is not ready to play in a spring game and there are conflicting reports he is noticeably behind his fellow position players. If that is the case, Branyan is getting closer to starting the season on the disabled list to allow his back more time to heal. Branyan elected to forego surgery and that may have been a mistake. He is almost six months since the end of the 2009 season and he still is not game ready. The Indians indicated they knew he was still rehabbing his back. That said, did they plan for him needing extra time to recover with the possibility he lands on the disabled list at the start of the season? It does not sound like it based on the latest reports.

Albert Pujols (1B, STL)
The Cardinals are expected to sit Pujols for another 3-5 days to allow his weak back to recover. He states it is not a big issue and everyone is trying to downplay the situation. Reportedly, several Cardinals observers do not believe it is serious, but we know that back problems can derail a player's season. Back weakness or pain can also reduce a player's power yet he remains in the lineup. We will keep a close eye on this situation.

Josh Kinney (RHP, STL)
Kinney indicates that he has an impingement in his right shoulder, a condition he deals with almost every spring. In most cases, impingement means pinching of one of the rotator cuff tendons in the shoulder. The Cardinals were hoping he would grab one of the available bullpen spots this spring. If his malady is anything more than very minor, he is either likely headed to the DL at the start of the season or to Triple-A to work through his problems.

Jesus Flores (C, WAS)
Flores underwent surgery last September to have a torn labrum in his right shoulder. He is well behind his fellow position players and the nationals are having the surgeon, Dr. James Andrews take a second look at the shoulder. He looks like a sure bet to start the year on the DL. The only question remaining is how long will he be out.

Rafael Betancourt (RHP, COL)
Betancourt developed some inflammation and soreness in his right shoulder last week. He is now being treated with medication and has started doing some long toss. He is far enough behind his fellow starts that he is a good bet to start the year on the disabled list to allow his right shoulder more time to recover.

Joe Nathan (RP, MIN)
Nathan is resting with the goal of trying to pitch in a couple of weeks instead of having Tommy John surgery now. The ulnar collateral ligament, when torn significantly, needs to be repaired. In Nathan case, it sounds like he has a partial tear and is hoping a little rest and strengthening the forearm and upper arm muscles will help him avoid the DL and surgery. While it is possible he could pitch in 2010, it is remote, at best.

Quick Pitches...Matt Holliday (OF, STL) is battling a slightly strained ribcage. At this time it does not look serious... Coco Crisp (OF, OAK) is working his way back from surgery on both his shoulder last spring. Now he has a new problem - a strained left hamstring. This injury pushes his first game for the A's until mid-to-late next week, if not farther...David Price (LHP, TB) was hit in the left hand by a broken bat yesterday. X-rays were negative and he is expected to make his next start as scheduled.