Elevated TSH does not always require treatment
DEAR DR. ROACH: I am a 64-year-old woman in fairly good health and who takes no medications. Both my mother, 88, and my sister, 53, take medication for hypothyroidism. In the past four months, I have had bloodwork done three times to check my thyroid and had slightly elevated TSH scores (between 5 and 7). My doctor then had me tested for antibodies, which came up negative.
I was told that since I don't have antibodies, I should not be treated. When I asked about the elevated TSH levels, I was told, "We do not treat 'old age' hypothyroidism." If my levels are elevated, what does the presence of antibodies mean? Am I hypothyroid or not? -- S.S.
ANSWER: I don't know if you are hypothyroid either. I suspect not. But the issue, as far as I can see, is not so much the antibodies, but the level of your actual thyroid hormone -- free T4. The thyroid-stimulating hormone is made by the pituitary gland in the brain, and its job is to stimulate the thyroid gland in the neck to make more thyroid hormone.
If the thyroid gland is not producing quite enough hormone, usually because of autoimmune disease (antibodies attacking the thyroid), the brain senses this and increases TSH. Sometimes the thyroid gland is able to make enough hormone to be in the normal range. We call this "subclinical hypothyroidism," or "compensated primary hypothyroidism." Most physicians do not treat this condition if there are no other symptoms of hypothyroidism, such as fatigue, cold intolerance or muscle weakness. However, in this situation, having thyroid antibodies, showing autoimmune disease, makes the development of symptomatic hypothyroidism much more likely. If you have no symptoms, no antibodies and normal free T4 levels, then I don't think you need treatment, but just to have periodic tests of both TSH and free T4.
Some people feel that the range of normal TSH in the elderly (and you aren't really quite there) should include levels as high as you reported.
DEAR DR. ROACH: I am an 83-year-old woman who has osteoporosis due to removal of ovaries at age 38. I took Fosamax and Actonel for seven years, but I do not like the side effects. I never broke any bones. I have read about strontium. Is it safe to take? In the U.S., strontium citrate is sold, but not strontium ranelate. Please advise. -- B.
ANSWER: Prescription-grade strontium ranelate was studied, and a study published in 2004 showed improvement in bone density. Strontium absorbs X-rays better than calcium, so bone density would be expected to be improved. However, there was also a big reduction in bone fractures. It's an impressive result and I understand why you would be interested in taking it.
There are a few issues. The first is that, as you correctly mention, strontium ranelate is not approved for use in the United States or Canada. Strontium products sold as health supplements have not been evaluated in the same way as the prescription-grade strontium ranelate.
Second, because of the X-ray absorbing effect of strontium, the results of the bone density test needs to be interpreted cautiously.
Finally, no drug is side-effect-free. The major side effect in the strontium study I mentioned was diarrhea.
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