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TREATMENT FOR A SLUGGISH THYROID

Q: I was checked for low thyroid 18 months ago and was put on a thyroid medication (Synthroid, 0.05 mg). I took the pills every day for three to four months but saw no results. I became impatient and stopped taking them for about six months.

Another physician sternly put it to me that I should never stop taking them and that it takes a while to see results. I started back with them in January 1996. I've been checked recently and my levels are OK, but I still don't see results. I am 40 years old now. I get disheartened by not seeing anything improve -- hair, nails, etc. My hair stopped growing many years ago and my nails are very thin and brittle.

A: I don't blame you for being disheartened. You've been treating your problem for some time and obviously want some better results. By working more closely with your doctor, I think that can happen.

Low thyroid, or hypothyroidism, occurs when the thyroid gland fails to produce enough thyroid hormone. This hormone is critical to body function, so the disorder can have widespread and long-term effects. Hypothyroidism can range in severity from mild (and unrecognized) to severe, called myxedema.

Early symptoms include fatigue, weakness, intolerance to cold, muscle cramps, dry skin and constipation. Later, if the disease progresses, weight change, hoarseness, hair loss, menstrual irregularities and slowing of mental function are seen. If left untreated, hypothyroidism can lead to coma and even death, but this is rare.

Hypothyroidism can usually be diagnosed from the symptoms and confirmed by blood tests for levels of thyroid gland and pituitary gland hormones.

Your drug, Synthroid, also known as levothyroxine, is a commonly recommended drug for hypothyroidism. Surgery is considered only when the thyroid gland has grown large enough to interfere with breathing or swallowing.

It's recommended that elderly people and those with heart problems be started out on low doses, which are increased as appropriate. Others can receive larger starting doses. The amount of medication recommended depends on your body's response and to the levels of hormone measured in your blood.

If you have been taking the medication for more than a year and still have the symptoms you describe, then increasing your dose of the medication is something to discuss with your doctor. This is true even if the blood level of hormone appears to be normal.

As with any medication, too much can cause unwanted side effects. Please make sure that you know what the common side effects are so you can report any problems immediately. Blood tests are done routinely to check blood levels of hormones.

Hypothyroidism is not usually life threatening and therapy returns most people to a satisfactory normal state. The doctor that admonished you for not taking your medication may have been on target, but I hope you discussed with him the reasons you stopped.

Commentary: Be careful what you ask for, because you may get it -- and not want the results. An article published in the August issue of the Archives of Pediatrics and Adolescent Medicine states that 15 to 20 percent of pediatricians don't follow nationally accepted recommendations for treatment of pharyngitis (sore throat). Parents and grandparents may have a lot to do with that.

To understand better, imagine you're taking your child or grandchild to the doctor for a sore throat. Let's also imagine you did so a few months ago as well; at that time, a throat culture was taken and you were sent home without an antibiotic being recommended.

So now you are getting anxious and tired of the situation. You let the doctor and office staff know how you feel. You relay that your neighbor's child is treated with antibiotics every time he gets a sore throat, and you wonder out loud about whether something else is wrong that's being missed.

What would you do as the doctor? Well, it may be a lot easier and perhaps more reassuring to a parent or grandparent to take a bunch of tests and prescribe an antibiotic. But that's not what is recommended.

Although the extra tests cause minimal harm (except for the trauma of taking blood) and the potential bad effects of using an unneeded antibiotic one time may be minimal, the experts have determined that the medical benefit doesn't warrant doing so.

One big difference, however, is the cost. Depending on which tests are ordered and what antibiotic is prescribed, the cost increase can be $100 to $200.

You can get what you want, not simply what you ask for, if you spend some extra time talking with your health care providers about what you really want and what you're willing to pay extra for. Maybe the extra money is worth it simply for relief of anxiety. But in this case, be sure you know who the patient is who's being treated.

Dr. Allen Douma welcomes questions. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Avenue, Suite 1400, Chicago, IL 60611.

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