Doc: Thyroid treatment hinges on more than just your TSH level

Keith Roach
Your Health

Dear Dr. Roach: I am an 82-year-old woman in good health. I recently had labwork that showed my TSH level is 6.14. I was told that I would need thyroid medicine because eventually I would feel tired and cold all the time.

I do not have either of these symptoms. I’m usually warm when others say they are cold. I wake up at 6:30 and am ready for the day.

Do I have an underactive thyroid? I don’t think so.

— R.K.

Dear R. K. I don’t think you have an underactive thyroid either.

The thyroid stimulating hormone level is a measure of the pituitary hormone TSH, which stimulates the thyroid gland to release thyroid hormone (thyroxine, or T4). Many people, especially older women, have a high TSH level and normal thyroxine levels.

There is some controversy about whether people in your situation need to be treated. Certainly, people with symptoms that are clearly from low thyroid benefit from treatment. There is also new evidence suggesting that younger people may benefit from treatment in order to reduce risk of heart disease. This effect was observed when TSH levels were higher than yours (above 7).

My personal practice is to not treat people with high TSH, normal thyroxine and no symptoms unless the TSH levels are above 10. Treating people under 65 with TSH above 7 might also make sense.

Some of my colleagues will measure anti-thyroid antibodies, since people who have high levels of these antibodies are more likely to go on to develop symptomatic low thyroid levels.

Dear Dr. Roach: I have thin skin on my arms and lower legs due to aging, sun damage and blood thinner (warfarin). My skin is constantly bruised and unattractive.

Is there a body lotion you can recommend to help reduce the impact of trauma to my skin? The slightest “thump” leaves its trace. I’m very active, so I always look as if I’ve been in a wrestling match and lost!

— J.M.A.

Dear J.M.A.: Easy bruising is a common problem with many potential causes.

Warfarin, which prevents the body from making some blood clotting proteins, is certainly a cause, but many older adults have this problem.

Occasionally it can be a serious issue, so it is worth a discussion with your doctor, who may get some blood tests to help eliminate concern of leukemia and von Willebrand’s disease, among other diagnoses. Fortunately, it’s much more common for problems to be benign.

As people age, they do get drier, thinner skin, which can bruise more easily. If your bruises are found most often on the tops of your forearms, that’s a common place for senile purpura.

“Senile,” in a medical context, just means older. The term “senile dementia,” a nonspecific term formerly used to mean Alzheimer’s disease, was sometimes shortened incorrectly to “senile.” “Purpura” are dark, purple/brown marks on the skin.

If there is no specific cause for the bruising, and the appearance of the skin is consistent with senile purpura, then this advice may be helpful: Keeping the skin out of the sun can prevent future damage. Regular moisturizers can help with dry skin.

An oral supplement of bioflavonoids was successful in one study. For more severe cases, some dermatologists use topical vitamin A derivatives to combat the skin atrophy (these are by prescription).

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