It wouldn’t hurt to ask for blood test

Dear Dr. Gott: Since 1988, I have taken Synthroid for an underactive thyroid gland. Blood tests have shown considerable variation in my thyroid level. About every four months I have to adjust (either up or down) my Synthroid dosage.

Recently, my regular doctor retired. His replacement, a lovely young woman, stopped my Synthroid and started me on Cytomel. After about two months, without a blood test, she told me my thyroid was over-active. Then, again without testing or a heart exam, she concluded that I am in congestive heart failure, for which she prescribed Lasix.

How could I have changed from years of hypothyroidism to hyperthyroidism? How could she diagnose heart failure without testing or examining me?

Dear Reader: You have hypothyroidism (too little naturally produced hormone). This deficiency has been overcome by Synthroid, a thyroid supplement. As you pointed out, you have needed frequent alterations in your dosage, based on blood tests. Some months, your Synthroid dosage was too low; other times it was too high, leading to hyperthyroidism (too much hormone). The same has held true for your experiences with Cytomel, another, slightly different supplement.

If, without testing, you showed evidence of hyperthyroidism (such as nervousness, weight loss, rapid pulse and other symptoms), your new doctor was correct in her clinical judgment. Personally, I would insist on a blood test to verify the over-activity – and, then, I would feel more comfortable making a decision.

With respect to the heart failure issue, the diagnosis can be (and is usually made by) examining the patient, who will typically experience symptoms of shortness-of-breath (dyspnea) when lying down and/or exercising; on exam, moist crackles can be heard at the lung bases, and an extra cardiac sound (“gallop” rhythm) is also audible. A chest X-ray will usually show an enlarged heart with lung congestion.

Therefore, if this situation is to be resolved, you need to question your new doctor about what criteria she is using to back up her diagnosis of heart failure. She may be right on the money – or she may require additional confirmation. Thus, a sit-down explanation is imperative. You need to know what information she is using to diagnose your problem, which is vital because heart failure is a serious and dangerous condition needing aggressive management.

Let me know how this situation is resolved.

To give you related information, I am sending you a copy of my Health Report “Coronary Artery Disease.” Other readers who would like a copy should send a long, self-addressed, stamped envelope and $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.