Dear Dr. Roach: I had my thyroid removed for a goiter 35 years ago. My doctor put me on 100 micrograms of thyroid medication. However, when I took it, I got sick. My hands shook, and my heart beat very quickly (over 100). So one doctor told me to split it and take 50听in the morning and 50 in the afternoon. I felt better, and I took it twice a day for 30 years.
After menopause, a different doctor changed it to 88 micrograms and said to take it one time a day. This is what I have been taking for five years, but I was feeling better and happier when I split the dose.
My question is: Can I split this medication? H.T.
Many people do split the dose of thyroid hormone, especially if they are taking a type of thyroid, such as Armour, that contains T3. If 88 micrograms is the dose that has the right amount of TSH (a hormone made by the pituitary that helps determine whether the dose is correct as far as your body is concerned) for you, then the TSH shouldn鈥檛 be affected by taking half the dose in the morning and half at night. Most people don鈥檛 find that it matters, but if it relieves your symptoms to take it twice a day, that鈥檚 OK.
听
Dear Dr. Roach: How much good does it do for the body to just lie there with your eyes closed all night long when you can鈥檛 sleep? D.R.
It doesn鈥檛 do much good at all; in fact, it makes it more likely for you to associate bed as a place to stay awake. My advice is, if you are lying in bed and not sleeping, get up and do something. Listen to soft music. Read, as long as the light isn鈥檛 too bright. Write in your diary. When you feel like sleeping, get back into bed, but don鈥檛 stay there if you aren鈥檛 getting to sleep in 15 minutes or so.
Getting a little high-intensity exercise during the day, avoiding caffeine after midday and avoiding naps are good ways to feel ready for sleep at bedtime.
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Dear Dr. Roach: I am a 77-year-old woman with severe osteoporosis of the lumbar spine. My T score was -3.3. I was on Fosamax but developed stomach troubles on it. I started Reclast in 2010 but had rapid acceleration of my pre-existing gum disease. In addition to taking these medications, I was in an exercise program and walked a mile every day. Despite it all, there has been no change in the T score. My doctor wants to put me on Prolia, but I am hesitant. Should I take Prolia or just continue with exercise? L.M.
Your T score is a measure of how much bone mass you have relative to that of a healthy young woman. A score below -2.5 is osteoporosis, so your score of -3.3 puts you at high risk for fracture. As such, I would recommend some kind of drug treatment.
Your doctor should have looked for vitamin D deficiency, and you should be taking calcium (and vitamin D, if you aren鈥檛 getting enough through diet).
There are several options, including denosumab (Prolia), but also raloxifine (Evista) and teripartide (Forteo).
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or write him at P.O. Box 536475, Orlando, FL 32853-6475.
