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Dear Dr. Roach: I am 67 years old and in good health. I had some thyroid tests that showed a mildly high TSH (6.7), but normal T3, T4 and free thyroxine index. I am not on thyroid medication, but my doctor said if the TSH gets much higher, we should talk about thyroid replacement.

I don’t want to take thyroid medication. Do you have any suggestions to assist me in lowering the TSH level?

A.C.

Dear A.C.: You have a not-uncommon problem, often called subclinical hypothyroidism or compensated primary hypothyroidism. The most common cause is Hashimoto’s thyroiditis, an autoimmune disease in which the body attacks and damages the thyroid. As the gland becomes less able to produce hormone, the TSH produced in the pituitary gland increases slightly, leading the thyroid to increase the output of T4, which is converted to T3, the active form of the hormone. Since your T3 and T4 are normal, and if you have no symptoms of hypothyroidism, most experts recommend not treating.

Over time, some people will progress to having overt, symptomatic hypothyroidism. It’s estimated that a third to half of people with subclinical hypothyroidism will progress over 10-20 years. The higher your TSH, the more likely you are to progress, with some experts recommending treating if the TSH level gets above 10, as there is also some evidence that there may be an increased risk of developing heart disease in this group. Pregnant women are more likely to benefit from treatment, and older people are at higher risk of side effects of inadvertent excess thyroid hormone.

I think it’s reasonable to periodically check the TSH level and check on any symptoms of hypothyroidism, especially fatigue, inability to tolerate cold, constipation and weight gain.

Dear Dr. Roach: I am a 64-year-old female recently diagnosed with celiac disease. It was confirmed with blood tests and a small-bowel biopsy. I am struggling every day with the diet to maintain my health. Before celiac, I ate a very healthy high-fiber diet. I am at my wits’ end trying to eat enough fiber to keep diverticulitis from coming back. As long as I was on the high-fiber diet, I had no other digestive problems. My question is whether a high-fiber diet could trigger celiac. Would there be any bad results if I go back to a reasonable nonceliac diet? No one can answer these questions, and I am at the end of my rope with the gluten-free diet.

W.K.

Dear W.K.: If the diagnosis of celiac sprue is made clearly, as it has been in your case, then a gluten-free diet is absolutely essential. Even very small amounts of gluten cause damage to the intestine, leading to inability of the bowel to absorb key nutrients.

There are many healthy gluten-free fiber sources in food. I found some great information at gluten.org, including brown rice, quinoa, flax and gluten-free oats, in addition to many fruits, vegetables and legumes. If you need a supplement, find a psyllium supplement such as Metamucil, or methylcellulose, such as Citrucel.

Email questions to ToYourGoodHealth@med.cornell.edu.

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