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Tuesday, July 30, 2013
Q: I’ve taken Armour Thyroid for 57 years. My T4 and TFTI levels are normal, but my TSH level is low. Why?
A: Armour Thyroid is a mixture of two hormones: T4 (thyroxine) and T3 (triiodothyronine). A low TSH means the body is sensing too high a level of T3 or T4 in the body. Because your T4 is normal, it is possible that your T3 is too high. A measurement of T3 would answer this question. If your T3 is high, your doctor will consider lowering your dose or changing you to T4 only.
Some doctors mix doses of T4 and T3, or use Armour, which contains both. Some endocrinologists recommend against using T3 at all, since the body converts the active T3 from T4 as it needs it, and giving T3 directly bypasses that safety mechanism. On the other hand, some people may not normally convert T4 to T3. The system is more complicated than it looks.
TSH also can vary a bit, so if you aren’t having symptoms of hyperthyroidism, it’s worth double-checking before making a decision to change your medications. A persistently low TSH puts you at higher risk for bone loss and atrial fibrillation.
Some physicians are against the use of Armour Thyroid since it is a natural product (desiccated thyroid gland) and that there may be batch-to-batch variability. However, the manufacturer informed me that T3 and T4 levels in each batch are standardized. Some patients feel that Armour Thyroid treats symptoms better than synthetic levothyroxine. The choice is for the patient and physician.
Q: I am 87 and have pus in my urine. Test results show no infection. What’s causing this?
A: White blood cells (pus) in the urine usually are there due to infection; however, repeated urine cultures showing no infection should make you think of other possibilities. White blood cells can come from the kidney itself. Some kidney diseases can cause white cells in the urine, but usually also demonstrate abnormal kidney function in blood tests.
Chronic infection of the prostate can cause pus in the urine, but your urologist is the expert in diagnosing this. Some bacteria in the bladder or urethra, such as Ureaplasma, don’t easily show up in culture and need to be looked for.
A kidney doctor may be the next place to go.
Dr. Keith Roach’s column runs in Tuesday’s Extra.
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