DEAR READER: The thyroid gland is situated in the lower neck — below the larynx and above the collarbone. This gland uses iodine to make hormones essential for the proper function of every cell in the body. The pituitary gland and hypothalamus at the base of the brain regulate the rate at which the hormones are produced and released. The TSH to which you refer stimulates hormone production. The normal range for lab work at my local hospital is anything between 0.34 and 5.60. Thus, by these standards, both your readings were normal.

The most common causes of a goiter are from the over- or underproduction of thyroid hormones, nodules that develop within the gland or a lack of iodine in the diet, which, in the United States, is uncommon. A goiter doesn’t necessarily indicate that the thyroid gland is malfunctioning. Even when visibly enlarged, the thyroid may produce sufficient hormones or too much or too little thyroxine (T4) and T3 (which is the most active form of thyroid hormone).

Your ultrasound revealed an abnormality of the right lower lobe without directing the abnormality to a specific lesion within the gland. Your physician has you on Synthroid because you have been diagnosed with hypothyroidism. Your gland does not produce sufficient amounts, and your body requires supplemental medication. My guess is that you have Hashimoto’s thyroiditis (an underactive thyroid), which can be successfully treated with medication.

If questions remain, I suggest you speak with your physician or request a referral to an endocrinologist to obtain additional information on your condition. In the interim, I am sending you a copy of my Health Report “Thyroid Disorders.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order payable to Newsletter. Mail it to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: Levothyroxine is synthetic thyroid-hormone replacement therapy that can be taken successfully by most people, primarily because thyroid hormone occurs naturally in the body. There are no common side effects. However, when side effects do occur, they can include allergic reactions to one or more of the inactive ingredients and symptoms of hyperthyroidism caused by therapeutic overdose. If your physician has your complete medical history and believes you should be on replacement therapy, you can either take his or her word for it or you can request a referral for a second opinion.

To provide related information, I am sending you a copy of my Health Report “Thyroid Disorders.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

He takes synthroid, 175 mcg, once a day. I am wondering and have asked if there is a possibility of him having a reaction to this medication. It falls on deaf ears.

Last night, I called the ambulance, as he was having one of those spells again and could not walk. His speech and thought processes were slow. When the EMTs arrived, he seemed normal. Four hours of observation confirmed that everything was normal. This is not normal for him and never has been. I was questioned why I was wasting precious time calling an ambulance for something like this. I responded I am not a doctor and cannot diagnose what is happening. We have done everything the doctors have required and still want answers as to the cause. I feel they are treating the effects without checking into the possibility of it being a reaction to medication.

DEAR READER: Seizures are commonly brought on by sudden, abnormal electrical activity of the brain. Causes include head injury, drug overdose, brain tumor, accidental poisoning, low blood sugar or sudden lack of oxygen to the brain. They are divided primarily into two categories — focal or partial. Focal seizures occur on both sides of the brain, partial seizures on one side. They may present with muscle spasms, unusual sensations (such as your husband’s taste of burnt beef), loss of consciousness and more. In some cases, the cause is never identified, but the activity doesn’t necessarily represent epilepsy.

I would like to address your husband’s daily use of synthroid. When was he diagnosed as being hypothyroid? Is there a correlation between the time he went on the medication and the time the seizure activity began? The dosage is a rather strong one. Was he begun on a lower amount and increased over time? Has he been tested on a timely basis? The inert ingredients in synthroid include confectioners’ sugar, acacia, lactose monohydrate, magnesium stearate, povidone and talc. The dose also includes FD&C blue No. 1 Aluminum Lake and D&C red Nos. 27 and 30 Aluminum Lake dyes. Perhaps he is responding to the coloring. Were he on a lesser dose, the dyes would vary in intensity.

If he had a CT scan to rule out a brain tumor, didn’t sustain a head injury within the past month or so, hasn’t been accidentally poisoned, and can’t attribute the activity to a recent occurrence, perhaps the medication is the cause of the seizure activity.

I recommend he ask his physician for a little indulgence. If the medication isn’t vital, perhaps they can compromise on a trial without it. He might consider diet modification — include cabbage, Brussels sprouts, lima beans, broccoli, cauliflower, potatoes, bananas, and supplemental vitamins B and C. Fats, sugars, red meats and eggs should be consumed in moderation. And he should exercise 15 to 20 minutes every day unless his doctor says otherwise.

If no improvement is found, request a referral to a new neurologist for a second opinion.

To provide related information, I am sending you a copy of my Health Report “Thyroid Disorders.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: There are a number of possible causes, including exposure to cold, hypothyroidism, peripheral neuropathy, peripheral-artery disease and Raynaud’s. Many disorders share symptoms, so you might need some follow-up.

If you were exposed to extreme cold without adequate protection, exposure could be the answer. Perhaps you were outside for a long time in frigid temperatures without benefit of socks, footwear or warm boots.

Hypothyroidism (low thyroid) is easy enough to determine with a simple blood test but is often accompanied by a number of other symptoms, such as fatigue, that you don’t mention. If it is time for an annual physical examination, ask your physician to test you for a thyroid disorder. Include cholesterol and blood-sugar levels. If abnormalities exist, it is likely simple medication will help you.

Peripheal neuropathy is caused by nerve damage and commonly presents with numbness, tingling and a burning sensation. This certainly might be an answer.

Raynaud’s is an interruption of blood flow to the extremities caused by exposure to cold and made worse by emotional stimulation. Symptoms include burning, tingling, pain on exposure to cold and whitish/blue skin, followed by redder skin when circulation improves.

Peripheral-artery disease is a common problem involving circulation that occurs when there’s an insufficient flow of blood to the hands, legs and feet. A person may complain of cold extremities, foot ulcers that fail to heal and intermittent claudication (pain or discomfort in leg muscles after walking a certain distance). I would expect, and perhaps incorrectly, that you are too young to suffer from PAD.

Discontinue smoking if you currently do so. Exercise to improve your circulation. Cover your feet with socks and warm slippers or shoes, even when at home. Avoid excess coffee, chocolate and other caffeine-containing products that constrict blood vessels. Substitute green and black teas that contain flavonoids, as they help support blood-vessel health. While I have no personal experience and cannot endorse the alternative, magnesium taken in doses of 1,000 milligrams daily is purported to relax blood vessels and promote blood flow. Too much magnesium, however, can cause diarrhea, so be careful not to overdo it.

Have a thorough examination by your primary-care physician or see a specialist to determine whether there is an underlying cause for your symptoms. Ask about the possibility of an ultrasound or angiography, which will identify blocked or narrowed arteries.

To provide related information, I am sending you a copy of my Health Report “Thyroid Disorders.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

I am on a diuretic and Timolol for my glaucoma, Zocor for high cholesterol readings and Ativan for sleep. I’m also on a daily multi-vitamin, kelp 150 mg daily, 2 fish oil tablets, a 400 IU cod liver oil tablet, four calcium with D pills, magnesium, an 81 mg aspirin, 1,000 mg niacin, and Echinacea. My doctor doesn’t endorse vitamins but I’ve taken them for 60 years. I’m told I look 55 and attribute that to good genes.

DEAR READER:
Hypothyroidism presents when an individual has an under-active thyroid gland. Most cases are caused by the gland itself; however, certain diseases and some medications can decrease thyroid function.

Symptoms vary, but hair loss and thinning are common. Weight gain, cold intolerance, fatigue, brittle nails, elevated cholesterol levels, depression, a slowed heart rate, and swelling around the eyes are often reported.

Now, let’s take a look at a few of your medications. Timolol can cause depression, glaucoma, cold hands and feet, cardiac arrhythmias and nightmares. Synthroid therapy can be responsible for hair loss early on, but ordinarily levels off once the system adjusts to the medication. Adverse reactions include headache, insomnia, palpitations, decreased bone mineral density, weight loss, anxiety, and more. I feel your Timolol is directly related to your nightmares. And, if we can pinpoint Synthroid for your hair loss, we have that answer as well.

I appreciate your 60 year devotion to supplements; however, you can successfully eliminate the kelp, fish oil, cod liver oil, magnesium, niacin and Echinacea. With the exception of one good multi-vitamin, I recommend you bank all the money that would be spent on these supplements. If you eat properly and exercise regularly, one vitamin that contains the recommended daily allowance is all that is necessary. I must side with your physician on this count. Speak with him or her regarding a replacement for the Timolol.

To give you related information, I am sending you a copy of my new Health Report “Thyroid Disorders”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

About 30 years ago I became hyperthyroid and lost a tremendous amount of weight. I then became hypothyroid and my menses stopped abruptly, never to reappear. I was told my thyroid condition was responsible for both.

I’ve developed a very large stomach, although my arms and legs are thinner. I’ve been tested several times for uterine cancer with consistent negative results. My face is also puffy and more rounded.

I’ve had periodic back aches that are so severe I can hardly walk. I’ve become diabetic and two years ago was put on insulin. This year my high blood pressure became permanent, even though my stress and anxiety levels are low, and lately I am always tired. It seems some of my symptoms are escalating while others — the backaches, depression and anxiety — have disappeared. I would think the insulin is responsible for my sleepiness and exhaustion after slight exertion, but I’ve had most of these symptoms for 10 to 30 years.

Until I read about Cushing’s, I felt hopeless, alone, and resigned to the fact that these were side effects of my medical conditions. Can the tests be wrong and if not, do you have any idea what could be occurring? I’d like to have some energy so I can at least function the way I did two years ago.

DEAR READER:
The common signs and symptoms of Cushing’s include abdominal weight gain, fatigue, a rounded face, depression, anxiety, and high blood pressure. The most common cause is the use of oral corticosteroid medication. The main issue here is that Cushing’s is difficult to diagnose since it shares many symptoms with other conditions.

Symptoms of hypothyroidism include weakness, a cessation of menstruation, fatigue, an extended abdomen, facial puffiness, and more. Symptoms of diabetes include fatigue, weight loss, blurred vision, poorly healing wounds, and more. Sound familiar?

I feel I am removing any hope you might have of putting a diagnosis to your symptoms, but I do not feel you have Cushing’s. Rather, the laboratory work you included with your letter indicates you do have diabetes and hypothyroidism, exactly as you pointed out. The problem is that neither condition is under complete control, despite the insulin and Glucophage for your diabetes and the Levothyroxin for your hypothyroidism.

Return to your primary care physician for referral to an endocrinologist, if you aren’t already seeing one. Sit down with your list of questions to determine together what can be done to bring both conditions under control. Once that happens, your blood pressure should drop, your fatigue should disappear, your energy should return, and life should be back to a more normal state. It’s often difficult to hit upon the right dose for a particular condition, but through the process of trial and error, it can be done.

To give you related information, I am sending you a copy of my Health Report: Living with Diabetes Mellitus”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR READER:
Let’s consider the big picture here. You are on a host of medications and supplements for your Parkinson’s, hypothyroidism, depression, anxiety, hypercholesterolemia, and osteoporosis.

I would like to clarify the dosage of Levoxyl you are taking for hypothyroidism. While I left out the dosages of the medications you are on, you stated you take 50 mg daily. This amount is beyond comprehension. Could you have meant to say 50 micrograms (mcg)? Levoxyl should be taken in the morning on an empty stomach and at least four hours apart from other drugs taken that are known to interfere with its absorption. At what time of day are you taking this drug and how often do you follow-up with your other medications?

Side effects include anxiety, nervousness, insomnia, weight loss, heat intolerance, headache, hyperactivity, diarrhea, hair loss, and more. A consequence of over-or-under treatment for women with long-term use includes a decrease in bone mineral density. You don’t indicate whether you are male or female. Could your insomnia and osteoporosis be a consequence of the Levoxyl?

How often do you have blood drawn to test for your hypothyroidism? One consideration you should speak with your physician about is that drugs that have worked well for years can become ineffective for no apparent reason. We anticipate things will not change. Unfortunately, our bodies respond in different ways and what worked in the past simply might not work that way permanently.

Now on to your question of insomnia. Serotonin and melatonin are essentially the same. Serotonin kicks in when light is present and is a naturally-occurring chemical found in the brain and intestines that controls wakefulness and mood. It converts to melatonin when darkness occurs and is a hormone released into the bloodstream by the pineal gland in the brain. Many individuals with depression have low serotonin levels, leading to low melatonin levels and an inability to sleep. In many instances, light is present in the room a person sleeps in — either from a night light or television.

Synthetic melatonin is often used as a sleep aid. It is available in most pharmacies and is one of the safest options offered. Before you consider trying it for your insomnia, ask your physician if one of your medications might be the culprit. Perhaps we can get you sleeping and stop any advancement of the osteoporosis, simply by keeping tighter control on your hypothyroidism.

To give you related information, I am sending you copies of my Health Reports “Parkinson’s Disease” and “Sleep/Wake Disorders”. Other readers who would like copies should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

I have been taking a thyroid supplement since 1980. I’m 83-years-old and weighed between 130 and 140 pounds until eight years ago. Now I’ve picked up 20 more pounds.

Peanut butter sandwiches with a glass of milk have been my mainstay diet for about five years. They require no preparation, are satisfying, provide energy, and make life simple. Why the weight increase?

Thank you for being available for correspondence.

DEAR READER:
Hypothyroidism, an under-active thyroid, occurs when the butterfly-shaped thyroid gland in the front of the neck doesn’t produce enough specific (but important) hormones. It rarely causes symptoms in the early stages but, over time, if untreated, can cause obesity, heart disease, infertility, and joint pain. Those most commonly affected are women greater than 50 years of age.

Synthetic thyroid hormone replacement is safe and effective when used according to properly prescribed amounts. Side effects are relatively uncommon.

There are several foods that appear to trigger hypothyroidism, two of which are peanuts and peanut butter. You indicate you’ve been on a supplement since 1980 but have only eaten peanut butter sandwiches for about five years. Your diagnosis was made 23 years prior and can’t be blamed on the peanut butter.

As we age, we become more sedentary. This may be due to arthritis, other medical conditions or just simple boredom. It’s much easier to lounge on the couch in front of the TV than it is to get up and go out, but it is also a lot less healthful and as a result, we gain weight. You probably do not over-eat. You could do a lot worse than enjoying a sandwich loaded with protein as a staple. An easy way to “spice up” your diet would be to spread the peanut butter on fresh apple or banana slices, cut up celery stick or other fruits and vegetables you enjoy. Despite the work involved, fresh fruits and vegetables are important for a well-balanced diet. If you find this beyond your capabilities, consider a program such as Meals on Wheels that will deliver to your door for a nominal amount of money each day. Make snacks of carrot sticks, celery and other raw vegetables. You can cut them up or, easier still, purchase them already prepared at your local supermarket. Stay as active as possible by walking around the block or yard each day and that additional 20 pounds will be off in no time.

It’s my guess you will remain on your thyroid supplement for the balance of your life. Continue as you are, under the direction of your primary care physician.

I had my first physical in over 30 years. I was found to be in good shape, except I was diagnosed with thyroid disease. I take one L-thyroxine 25 mcg pill daily. Periodically I have to have a blood sample drawn to determine if the drug dose is adequate. My question is, do you know of some nutritional practice that can eventually eliminate my dependence on taking synthetic thyroid medication for the rest of my lifetime?

DEAR READER:
There are some home remedies you can take for hypothyroidism; however, the results will likely be less than optimal. Caffeine, alcohol, tobacco and aspartame can all worsen a thyroid condition. Try adding fresh vegetable juices to your diet three days a week. With your doctor’s permission try using products such as Thyroidinium or Tryosine 400 (an amino acid supplement). These are available at health food stores. You may choose to see a naturopathic physician along with your primary care physician. If you choose this route, be sure the two physicians work together to provide you with the best treatments. The naturopath can offer natural remedies while the PCP can provide modern medicines and testing. You must continue to have appropriate testing to ensure your thyroid is within limits.

Having said this, the fact that you have an under active thyroid gland and require medication is an indication to me that you will have to take it for the rest of your life. Your thyroid probably is not going to function properly on its own. Fortunately, L-thyroxine is inexpensive and safe to use. Make some dietary modifications and stick with your doctor‘s recommendation.

To give you related information, I am sending you a copy of my Health Report “Consumer Tips on Medicines”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.