Dear Doctor: Does this thyroid lab result merit an appointment with an endocrinologist?


DEAR DR. GARDON: I am a very healthy 71 year old female. I have been taking thyroid replacement since I was 12 years old. I currently take 125 mcg of thyroxine once a day, as well as 60 mg of Cymbalta. Apart from arthritis and obesity, I have no health problems. My question concerns my lab results. My TSH is 0.04 (normal range is 0.30 to 5.5); my T3 and T4 are in the normal range. My doctor assures me that as long as my T3 and T4 are normal, TSH is not a concern. I can’t lose weight no matter what I try. Are you suggesting that I see an endocrinologist, or is my attending physician correct? – AD

ANSWER: Thyroid stimulating hormone is a signal from the pituitary gland to the thyroid to “tell” the thyroid to make more hormones. Since your TSH level is low, this suggests that your thyroid hormone replacement dose is too high. This is despite the fact that T3 (the active form of thyroid hormone) and T4 (thyroxine, the main thyroid hormone from which T3 is made) are normal, and despite the fact that you are not reporting any symptoms. . The normal range for T3 and T4 is very wide, and the low TSH is good proof that these levels are too high for you.

Too much thyroid hormone can cause bone disease and predispose to heart problems, such as atrial fibrillation. I think an endocrinologist is likely to say that your thyroxine dose needs to be lowered.

DEAR DR. GARDON: I had my first injection of pneumonia (PCV13) in October 2015 and the second injection (PPSV23) in October 2016. My primary care doctor is sending me reminders that my pneumonia vaccine is overdue. The head nurse at the same primary care clinic reviewed my medical records and said that I don’t need additional pneumonia vaccines for the rest of my life. I asked my cardiologist, urologist and gastroenterologist if I should update my pneumonia injections, but they avoid answering me. I am 72 years old and have health problems. Since the COVID virus affects the lungs and many suffer from pneumonia, I am concerned about my protection, despite having both Moderna vaccines. Should I be vaccinated against pneumonia? – CV

ANSWER: Your nurse is correct, you are not recommended for additional pneumonia vaccines at this time. These pneumonia vaccines protect against a single bacterium, Streptococcus pneumoniae, without any protection against COVID-19. You should receive your third dose of Moderna when recommended (at the time of writing, eight months after your second dose). That is, unless the recommendations have changed by then – this is a rapidly evolving area!

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Dr Roach regrets not being able to respond to individual letters, but will fit them into the column whenever possible. Readers can send questions by email to [email protected] or by mail to 628 Virginia Dr., Orlando, FL 32803.

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