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Your Good Health: Woman wants new treatment for thyroid

Dear Dr. Roach: My wife, age 67, has been having treatment for Hashimoto’s thyroiditis for 18 years. The diagnosis was confirmed by antibody tests and she has been taking thyroid medication ever since.

Dear Dr. Roach: My wife, age 67, has been having treatment for Hashimoto’s thyroiditis for 18 years.

The diagnosis was confirmed by antibody tests and she has been taking thyroid medication ever since.

She has been treated by four doctors, including two endocrinologists. She has tried both synthetic and natural hormones, as well as generic and brand-name products.

We have found it is not hard to maintain acceptable serum levels of these substances as measured by lab tests, but elimination of physical symptoms — such as fatigue and sensitivity to cold — has been elusive.

The doctors seem to be satisfied with good lab results and give only lip service to symptoms. Recently, my wife was told the goal was to maintain proper hormone levels and she would just have to learn to adjust to the symptoms.

We would like to know if she has to settle for this, or if she should push for a more nuanced level of treatment.

It doesn’t take much Internet research to discover that there is a lot more to thyroid metabolism than getting the right balance of TSH and T4, not to mention all of the other conditions that might mimic or aggravate hypothyroid symptoms. But it is hard to confront a practitioner, who has years of practice.

A quick check of thyroid forums online shows that this is a very common complaint.

G.C.

Persistent symptoms of low thyroid, despite lab tests that are normal, is indeed a common problem. Knowing that some people’s normal is slightly out of the “normal” range, many experienced endocrinologists will adjust the dose of the replacement hormone somewhat, increasing the amount of thyroid hormone in order to improve symptoms while still being cautious not to cause hyperthyroidism, with its attendant risks, including atrial fibrillation.

One issue I see occasionally is that some people cannot convert T4, the usual replacement form of the hormone, to T3, the active form. A very small dose of supplemental T3 sometimes can dramatically improve symptoms.

Finally, even people with thyroid problems might have other reasons for fatigue and cold sensitivity, and a comprehensive search for other issues (such as anemia) should be made.

 

Dear Dr. Roach: Can a stent be used in an artery that is 80 per cent clogged? I am in good health, but at age 87, I do not want to have invasive surgery.

E.F.S.

In someone who is 87, using a stent generally is preferable to surgery.

In the stent procedure, the artery in the heart is opened by placing a catheter in the heart (usually through the femoral artery in the groin) and using a balloon or a cutting device to open up the blockage, which is a combination of cholesterol, fibrous tissue and calcium.

Even if an artery is 99 per cent blocked, it usually can be opened via the catheter. The stent is then placed to help keep the artery open. Some stents are bare metal. Others, called drug-eluting stents, have medication embedded in the stent lining, which is released over months. Only a cardiologist can say whether an individual lesion is amenable to stenting and what the best technique is.

Far fewer bypass surgeries — that is, open heart surgery, in which a clogged artery is replaced using a blood vessel taken from elsewhere in the body — are performed now than 10 or 20 years ago. This is because of better medical treatment and because of advances in both the procedure and the materials used.

 

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers can email questions to ToYourGoodHealth@med.cornell.edu.