In thyroiditis, should treatment go beyond hormone levels?

DEAR DR. ROACH >> My wife, age 67, has been under treatment for Hashimoto’s thyroiditis for 18 years now. The diagnosis was confirmed by antibody tests, and she has been taking some form of thyroid medication ever since. She has been treated by four different doctors, including two endocrinologists. She has tried both synthetic and natural hormones, as well as generic and brand-name products. What we have found is that it is not hard to maintain acceptable serum levels of these substances as measured by lab tests, but elimination of physical symptoms, such as fatigue, sensitivity to cold, etc., has been elusive. The doctors seem to be satisfied with good lab results, and give only lip service to symptoms. Recently she was told that the goal was to maintain proper hormone levels, and she would just have to learn to adjust to the symptoms.

We would like to know if she has to settle for this, or if she should push for a more nuanced level of treatment? It doesn’t take much internet research to discover that there is a lot more to thyroid metabolism than getting the right balance of TSH and T4, not to mention all of the other conditions that might mimic or aggravate hypothyroid symptoms. But it is hard to confront

a practitioner, who has years of practice, with something we found on “Dr. Google.” A quick check of thyroid forums online shows that this is a very common complaint. — G.C.

DEAR READER >> Persistent symptoms of low thyroid despite lab tests that are normal is indeed a common problem. Knowing that some people’s normal is slightly out of the “normal” range, many experienced endocrinologists will adjust the dose of the replacement hormone somewhat, increasing the amount of thyroid hormone in order to improve symptoms while still being cautious not to cause hyperthyroidism, with its attendant risks, including atrial fibrillation.

One issue I see occasionally is that some people cannot convert T4, the usual replacement form of the hormone, to T3, the active form. A very small dose of supplemental T3 sometimes can dramatically improve symptoms.

Finally, even people with thyroid problems might have other reasons for fatigue and cold sensitivity, and a comprehensive look for other issues (such as anemia) should be done. DEAR DR. ROACH >> Can a stent be used in an artery that is 80 percent clogged?

I am in good health, but at age 87, I do not want to have invasive surgery. — E.F.S.

DEAR READER >> In someone who is 87, using a stent generally is preferable to surgery.

In the stent procedure, the artery in the heart is opened by placing a catheter in the heart (usually through the femoral artery in the groin) and using a balloon or a cutting device to open up the blockage, which is a combination of cholesterol, fibrous tissue and calcium. Even if an artery is 99 percent blocked, it usually can be opened via the catheter. The stent then is placed to help keep the artery open. Some stents are bare metal; others, called “drug-eluting stents,” have medication embedded in the stent lining, which elutes (is released) over months. Only a cardiologist can say whether an individual lesion is amenable to stenting and what the best technique is.

Far fewer bypass surgeries — that is, open heart surgery, where a clogged artery is replaced using a blood vessel taken from elsewhere in the body — are performed now than 10 or 20 years ago. This is because of better medical treatment and because of advances in both the procedure and the materials used.