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People’s Pharmacy: Will taking prednisone for poison ivy shrink the brain?

By Joe Graedon, M.S., and Teresa Graedon, Ph.D. King Features Syndicate

Q. After pulling weeds in my backyard last month, I came down with a terrible itchy, weeping red rash. The dermatologist diagnosed poison ivy and prescribed prednisone. The dose started high and dropped gradually over two weeks.

I was about halfway through the treatment when I read headlines that steroids change your brain structure. That’s got me a bit freaked out, to say the least.

Prednisone is a steroid, isn’t it? How much does the brain change? Is this something I should worry about?

A. The recent research published in BMJ Open (Aug. 30, 2022) is disconcerting. But we don’t think you have much to worry about.

The scientists reviewed MRI brain scans of 222 people taking oral corticosteroid medications on a regular basis. They also reviewed scans from 557 people using inhaled steroids and 24,106 controls not using such medications.

They found that people who regularly took corticosteroids (oral and inhaled) had decreased white matter integrity in the brain.

This brain shrinkage may pose problems for people on long-term steroid therapy. The authors of the research point out that chronic exposure to such drugs may also increase the risk for depression, mania and cognitive impairment.

A short course of prednisone will provide dramatic relief from a severe allergic reaction. It might cause insomnia, but it should not produce lasting brain changes.

Q. I had thyroid surgery to remove a goiter in 2005. Then I spent the next 10 years in hell on levothyroxine only.

I was on a thyroid roller coaster. When my thyroid levels were high, my symptoms included high blood pressure, anxiety, panic attacks and suicidal thoughts. If the level dropped too low, I had no energy, rapid weight gain, low body temperature, high cholesterol, heavy periods and terrible muscle cramps. The doctor said none of those symptoms had anything to do with my thyroid.

My body was out of balance from being on T4 only. Why would endocrinologists think we need only one thyroid hormone when our bodies make two? I started taking natural desiccated thyroid gland, and I am finally getting my life back.

A. Most doctors learned in medical school that the body converts levothyroxine (T4) to the active hormone triiodothyronine (T3). In the past several years, however, scientists have discovered that some people do this less efficiently than others.

Increasingly, leaders in the field recommend individualized treatment, including T3 for people who don’t respond well to levothyroxine alone (Frontiers in Endocrinology, July 9, 2019). Desiccated thyroid extract from pigs contains both hormones, although not in exactly the same proportions that healthy human thyroid glands produce.

You will find far more information on this research as well as many complementary treatments and considerations in our eGuide to Thyroid Hormones. This online resource is located under the Health eGuides tab at www.PeoplesPharmacy.com.

Q. The antihistamine diphenhydramine aggravates my restless legs syndrome. I have learned to avoid it and “PM” pain relievers that include it.

Don’t assume your physician knows this. Several doctors I spoke with knew nothing about it. As far as I’m concerned, I’m allergic to these drugs, and that is what I tell the nurses when they ask.

A. There is little research about this link. Nevertheless, the National Institute of Neurological Disorders and Stroke advises that diphenhydramine could make RLS worse (www.ninds.nih.gov/restless-legs-syndrome-fact-sheet).

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, Fla. 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”

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