Dear Dr. Roach: I鈥檓 a 69-year-old woman with hypothyroidism. Although my thyroid-stimulating hormone score is in the high-normal range, a new doctor recently increased my dosage of levothyroxine just slightly because of fatigue, joint aches and more. I feel great again.
My question: When the 鈥渘ormal鈥� levels of TSH were determined, were they for everyone? There are vast numbers of older, heavy women on disability for depression and arthritis, and I wonder how many of them have TSH levels that are in that high-normal range, and whether they would benefit from thyroid treatment. In other words, is the medical profession really certain that the TSH 鈥渘ormal鈥� range is the actual optimal range for older women?
H.G.
The short answer is no, not always. The range of normal for TSH is quite broad, which means that there are some people who will be interpreted as 鈥渘ormal鈥� by tests, but who may have symptoms of hypo- or hyperthyroidism. There also will be a few people who appear 鈥渁bnormal鈥� by TSH testing, but will have no symptoms. 聽
Because of this, it takes experience and judgment to properly dose thyroid replacement. I should mention that although most people with thyroid disease are women, men also have this condition and also might require dose adjustments, occasionally outside the range of 鈥渘ormal.鈥�
Dear Dr. Roach: When is blood pressure sufficiently high to warrant a trip to the emergency room? I recently had two high spikes, one in the high 190s and the other 188, and I went to the ER both times. A nurse in a physician鈥檚 office criticized me for going to the ER, saying that 188 is not a high blood pressure. I might add that by the time I got to the ER, my pressure was 223. Can you comment on this?
B.A.
Very high blood pressures can lead to life-threatening damage to organs, especially in the blood vessels of the heart and brain (including the retina), but also the kidneys. Symptoms of any of these, such as confusion, vision change and chest pain with a very elevated blood pressure are termed hypertensive emergencies and are taken care of in the hospital, often in the intensive-care unit.
In people with no symptoms but very high blood pressure (greater than 180 systolic or 120 diastolic is a usual definition, but it is somewhat arbitrary), the critical issue is to be evaluated for acute damage to these organs, which means a careful exam (especially of the retinas) and a few tests, such as kidney function and an electrocardiagram. The blood pressure should be lowered cautiously, not too much too quickly (a usual rule of thumb is about 25 per cent in a few hours); otherwise, there is a risk of stroke.
I think the nurse may have been unreasonable, as 188 is a level where prompt evaluation and treatment may prevent permanent damage to the heart, kidney and brain. 聽
Dear Dr. Roach: I have been on statins for many years to control my high cholesterol. One of my doctors says to take CoQ10; another says it is not necessary. I have no side effects whatsoever. What is your opinion on this supplement?
L.H.
Since you aren鈥檛 having any symptoms, I would say CoQ10 isn鈥檛 necessary. I often have tried it in people who are having muscle aches, and that is where it is sometimes effective. 聽
Dear Dr. Roach: I have a 70-year-old male friend who claims that his face breaks out if he eats chocolate, even a small amount. I don鈥檛 believe it! When I was a teenager, I learned that breakouts are due to hormones. Can chocolate cause an acne breakout?
聽聽 聽
sa国际传媒H.
You learned correctly that adolescent acne is mostly due to hormonal changes, which tend to clog pores and allow skin bacteria to cause the familiar pimples of acne.
However, your friend may be right, since a recent study showed an increase in pimples with ingestion of pure cocoa. That might be due to changes in the skin or in the bacteria living on the skin.
Chocolate doesn鈥檛 have a big effect on most people, but it鈥檚 certainly possible that it has a significant effect on your friend.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
