Dr. Keith Roach: TSH measurements might not be one-size-fits-all
Dear Dr. Roach: I’m a 69-year-old woman with hypothyroidism. Although my TSH 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 “normal” 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 “normal” range is the actual optimal range for older women?
Dear 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 “normal” by tests, but who may have symptoms of hypo- or hyperthyroidism. There also will be a few people who appear “abnormal” by TSH testing, but will have no symptoms.
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 “normal.”
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’s 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?
Dear 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 EKG. The blood pressure should be lowered cautiously, not too much too quickly (a usual rule of thumb is about 25 percent 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.
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?
Dear L.H.: Since you aren’t having any symptoms, I would say CoQ10 isn’t necessary. I often have tried it in people who are having muscle aches, and that is where it is sometimes effective.
Email questions to ToYourGoodHealth@med.cornell.edu.