March 2010

Q. I had been on a low dose of Armour then Naturethroid with no side effects for several years until they became unavailable for various reasons. I was put on Synthroid 50 mcg and Cytomel 5 mcg 2 x’s daily. While on this medication ( total of 2 months) I developed bad muscle and joint pain w/ weakness that was relieved only by Lodine, another prescription. I was constantly cold. At that time my TSH was 0.37, T-4 7.6, T3 total 141.

With my Dr.’s approval I slowly stopped both medications and have completely stopped for just over a week now. He feels that since I was on such a low dose and with my current lab results that I may not need to be on medication at all. That is fine but how long after stopping those meds before I should feel “normal” again which I did on the old Armour. I will have another lab draw when I have been off meds for 2 months.

A. I agree with your physicians decision to see how you feel and how your thyroid responds to no medication at all. IF you need thyroid, your TSH will begin to rise and be quite high within 6-8 weeks. In the meantime, if you suddenly feel sluggish, your pulse goes way down, you just don't feel right - this too could be a sign you need thyroid.

If you really don't need anything, you should have all of the thyroid out of your system within 10 days to 2 weeks.

Q. I was interested to hear the interview with you on the radio program "Sound Medicine" several weeks ago. First of all, I was happy that you were not only in favor or taking hormones but were taking them yourself.

You mentioned in the interview that women who take estrogen in pill form need to take high doses in order to have enough of it get past the liver. Perhaps my metabolism is atypical but this has not been my experience. In 1978 when I was 32 I had to have a hysterectomy because of constant infections of undetermined origin. At first I was put on a high dosage - 125 mg, I think - and I had bad side effects. My doctor cut the dosage in half and I was fine. When the WHI study came out I cut back still more and I now take half of the .625 mg pills most days, occasionally more. I don't get hot flashes, though I sometimes feel a little warm at night, and my bone density, though in the osteopenia range, is not decreasing. For me, then, the premarin pills have been a success. At one point I tried a vaginal cream with estrogen and found it to be of little value so I am dubious about externally applied hormones in my case. My overall health is excellent, including my heart.

I realized that my situation may be unusual but probably it is good to have a variety of options available to deal with this problem. Thank you for giving advice to women about this important issue.

A. Premarin has been used for over 60 years and obviously has been life- saving for many women. Although I prefer the transdermal/patch route, many women prefer the ease of the oral tablet. The estrogen/Premarin only arm of the research trial showed lots of benefit to Premarin, so I think the progestin/Provera is the bigger concern. As you had a hysterectomy, you don't need to worry about adding a progestin.