Dear Dr. Roach: I have to take levothyroxine in order to obtain an acceptable TSH (thyroid stimulating hormone) number. I have read that some doctors are stating that there is a relationship between hypothyroidism and gluten intolerance, possibly even celiac disease. Is this proven to the point that a patient should alter his or her diet and give up the basic foods of bread and cereal? R.K.
People with celiac disease have a much higher risk of autoimmune thyroid disease (especially Hashimoto鈥檚, the most common cause of low thyroid) than expected, to the point where everyone with celiac disease should have a blood test to look at thyroid levels.
Celiac disease, or intolerance of gluten in general, may have few or subtle symptoms, and it might be worthwhile to consider testing for celiac disease in people with autoimmune thyroid disease. However, I would not recommend a drastic change in diet for people with thyroid disease if there are no symptoms.
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Dear Dr. Roach: I have had stomach pain on my lower left side for several months. Other symptoms include occasional heartburn, bloating and almost constant burping. My doctor is treating it with metronidazole, clarithromycin and omeprazole. Could these be symptoms of stomach cancer? D.W.
Abdominal pain, heartburn and belching are nonspecific symptoms that can be associated with many conditions. The most common would be GERD (gastro-esophageal reflux disease), gastritis and stomach ulcer. The combination of medications your doctor is treating you with is for the bacteria H. pylori, which can cause gastritis and ulcers. Eradication of the infection, which is very common, can heal ulcers and relieve symptoms. H. pylori can be diagnosed definitively by a breath test or a stool test, or by biopsy of the stomach. A blood test shows evidence of old infection, but it isn鈥檛 completely accurate.
Stomach cancer has vague symptoms as well, and requires a high degree of suspicion. Stomach symptoms that don鈥檛 improve with treatment, or that have worrisome features like weight loss, early satiety (the feeling of being full after eating only a small amount of food) or bleeding should cause the doctor to consider an endoscopy to look at the stomach. A new onset of symptoms in someone over 55 also should be considered for endoscopy.
Treatment of H. pylori may reduce future risk of gastric cancer (that鈥檚 stomach cancer).
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Dear Dr. Roach: I am a veteran and have had digestive problems (gastro-esophageal reflux disease and gastritis) since I came back from Vietnam in 1968. How closely related are these disorders? J.R.O.
GERD very common, and refers to the passage of food and acid backward 鈥� from the stomach into the esophagus.
The general cause of GERD is a relative weakness in the lower esoph-ageal sphincter, the muscular, valvelike structure at the bottom of the esophagus. Gastritis is an inflammation of the lining of the stomach.
Both of these terms are often used imprecisely, as a guess at what might be causing nonspecific stomach pains.
With such a prolonged course, it would be wise to make sure of your diagnosis, as your symptoms actually might be caused a different condition, such as an ulcer or infection by the bacteria H. pylori, which would require different treatment.
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Dear Dr. Roach: I鈥檓 a 61-year-old woman who had notalgia paresthetica diagnosed about five years ago.
Several years later, my general practitioner told me to use capsaicin, which helps with the tingling feeling but sometimes my back feels like someone is pinching my spine and the skin tingles, bringing on a very uncomfortable feeling.
Can you give me any more information about this skin condition? I am beginning to believe that it is getting worse. Anon.
Notalgia paresthetica is common, but often not diagnosed, and usually causes an itching under one shoulderblade.
It sometimes is associated with curvature of the spine (scoliosis). It isn鈥檛 curable, and often gets better and worse.
Capsaicin, lidocaine patch and other creams usually provide some relief. Botulinum toxin and nerve block occasionally are used for people with more severe symptoms who don鈥檛 respond.
