Your friend is correct — almost.
But before I tell you why, let me explain a bit about your condition.
Hypothyroidism, an under-active thyroid gland, is a condition requiring lifelong treatment.
A properly-functioning thyroid produces the hormone thyroxine — this has widespread effects throughout the body and plays a key role in dictating how much energy your body uses.
As a result, the hormone affects many different processes.
Symptoms of low thyroxine levels include feeling the cold, constipation, weight gain, water retention, fatigue and a slow heart rate.
The condition is diagnosed with a thyroid function test, which tests levels of thyroxine as well as of thyroid- stimulating hormone.
A deficiency is treated with synthetic thyroxine, and the symptoms usually disappear within a few months.
The dose of thyroxine needed varies from person to person, partly to account for different body weights, and is usually between 50 to 200 micrograms per day.
Therefore, at the start of the treatment it is necessary to carry out a blood test periodically every few months to judge adjustment of the dose depending on the hormone levels.
The dose may also depend upon the cause of the hypothyroidism — some patients have had the entire gland surgically removed (for instance, an over-active thyroid can be treated in this way) while in others the condition is caused by the immune system mistakenly attacking the gland, and there is still some residual functioning thyroid tissue.
CONTACT DR SCURRTo contact Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email drmartin@dailymail.co.uk — including contact details.Dr Scurr cannot enter into personal correspondence.His replies cannot apply to individual cases and should be taken in a general context.Always consult your own GP with any health worries.
Any food, but particularly those containing calcium, fibre or iron, can affect absorption of thyroxine, so the medication should be taken on an empty stomach; ideally an hour before breakfast.
It’s best to wash it down with a glass of water — there has been a study showing coffee interferes with absorption.
Milk is high in calcium and hence your pills should not be taken with this.
We’re not sure of the mechanism, though I haven’t heard of milk wrapping around the thyroxine pill.
Other medicines can also interfere with the absorption of thyroxine — these include proton pump inhibitors (tablets such as omeprazole or lansoprazole) which are used to suppress acid production in the stomach, calcium pills, iron pills (ferrous sulphate) and a commonly used antibiotic called ciprofloxacin.
The conclusion, therefore, is that your friend is right — it is best to take thyroxine on its own, apart from with the necessary mouthful of water.
Five years ago I was diagnosed with an abdominal aortic aneurysm of 3.7cm. It is now 4.3cm. For some reason the health professionals I see appear reluctant to say at what stage I should be considered for an operation. I’ve seen online that 5.5cm should be the upper limit — is this true?I’ve also read that keyhole surgery is less risky. I am 71. Mr Terry Heathcote, Stafford.Such concern is understandable, for this can seem a frightening condition and may make you feel as if you are walking around with a ticking timebomb.
An aneurysm is a bulge in an artery, caused by a weakening in the vessel wall — rather like how old hosepipes start to show bulges over time.
The aorta is the main artery coming out of the heart and it’s responsible for carrying blood to the rest of the body.
It travels through the abdomen, and for some reason it is usually here that weakness occurs, and a bulge appears.
The risk factors are age, being a man, smoking, being Caucasian and a family history of the condition.
Screening, using ultrasound scanning, informs us that about 4 to 8 per cent of older men have an aneurysm of the aorta. The abdominal aorta is usually about 2.5cm in diameter, and anything over 3cm is considered to be an aneurysm.
The risk, however, is that the aneurysm can continue to bulge and eventually burst — this is a serious medical situation.
However, aneurysms grow slowly, which is why they are monitored.
There are numerous factors that influence the gradual rate of expansion — and the risk of rupture — the most important being the size of the aneurysm and smoking.
More from Martin Scurr... How can I get this heavy feeling off my chest? 03/06/13 Ask the doctor: Bad breath is ruining my self-confidence 27/05/13 Ask the doctor: Will my shingles pain ever go away? 20/05/13 Ask the doctor: Is blood in my urine a reason to worry? 13/05/13 Ask the doctor: Why am I seeing stars in my eyes? 07/05/13 Ask the doctor: What has caused my unbearable leg pain? 29/04/13 Ask the doctor: Why are my teeth starting to crumble? 22/04/13 Ask the doctor: Simple steps for easing a hormone headache 08/04/13 Ask the doctor: Why do my wife's hands bruise so easily? 01/04/13 VIEW FULL ARCHIVEMedium-sized ones (less than 5.5cm), such as yours, expand at about 2mm to 3mm a year, but bigger ones expand at 3mm to 4mm a year.
If the aneurysm is expanding at 5mm or more over six months, it’s at high risk of rupture.
These figures help us decide when you should be undergoing an operation, and my rule has always been to help patients make plans at 5cm or above.
At the current size, your chances of rupture in the next year are between 0.5 and 5 per cent, but this increases to between 3 and 15 per cent once the aneurysm reaches 5cm or above in size.
As you imply, a planned repair is safer than the emergency operation that would be needed if the aneurysm did rupture.
An important advance has been endovascular aneurysm repair (EVAR): in this, a type of tiny metal tube is placed in the artery and runs through the aneurysm.
The blood flows through the tube instead of the aneurysm, taking the pressure off the sides of the walls.
Long-term studies have not yet proved this procedure is superior to an open operation.
But increasing experience convinces many this is the better technique when it is possible, and it is certainly the better option in patients for whom surgery poses the highest risk.
An open operation involves a long incision in the abdomen. The aorta is exposed, clamped above the aneurysm (for as brief a time as possible) and a graft — woven from an artificial fabric — is sewn in place to replace the diseased section of aorta.
The time is coming when you should talk to your vascular surgeon about future plans.
Hopefully, you will prove suitable for the keyhole procedure, which may be available with an experienced team locally.
By the way. . . Sometimes we have to talk down to patientsThe dismissal of the jury by the judge in the Vicky Pryce trial set me thinking about the difficulty of communicating effectively in our diverse culture.
The judge in the case, Mr Justice Sweeney, was quoted as saying the jury had a ‘fundamental deficit’ of understanding of their role and of the case.
Those of us who give service to the public and spend much time explaining sensitive and often upsetting details must continually upgrade our skills and reflect about the general levels of understanding within the community.
It does not follow that patients have any real understanding at all about the nature of their illness - the origins, the possible treatments or the prognosisFor doctors, just because most patients take the time and trouble to research their problems on the internet, it does not follow that they have any real understanding at all about the nature of their illness — the origins, the possible treatments or the prognosis.
It is important to remember this, yet without being patronising.
A friend was telling me that her retired hairdresser was incensed when he was in consultation with a neurosurgeon who was about to operate on his neck.
The specialist asked him about his former occupation, and when he wondered why it was important or relevant, the doctor explained that he always tailors the level of his explanation to the level of understanding of the individual, and knowing their job was helpful in this.
This may have been seen as a rather curt and patronising way of detailing what we must do when talking to patients about the nature of their complaint, but our culture is changing fast.
Only this week I was talking to the administration department of an insurance company about one of my patients who had suffered a fall while on holiday in Costa Rica.
I was asked: ‘Costa Rica — where’s that? Is it in Lancashire?’
This occurred in the same week a new receptionist in the practice asked: ‘What does it mean when it says lord or lady in front of a person’s name?’
Take a deep breath and proceed slowly...
