A Question of Health

What's the right dose?

What's the right dose?

Just under a year ago I was diagnosed with an underactive thyroid and put on 0.5mg thyroxine daily. Although most of my physical symptoms have improved, I'm still experiencing memory and concentration problems, depression and slightly irregular periods. Is it possible that my dosage needs increasing? Or, as I'm 43, could my memory and concentration problems be down to some other age-related hormone imbalance? Also I have been infertile for 14 years - we gave up on IVF treatment five years ago due to poor egg production. Is it worth having more treatment now that my thyroid problem has been identified, or is it too late?

If you are still getting some of the symptoms that were there when you were diagnosed with an underactive thyroid gland, you may well need a higher dose of thyroxine. Different people with underactive thyroids need different doses, and the only real way of telling if you are on the correct dose is by measuring your hormone levels and assessing your symptoms. Most thyroid specialists use the TSH (thyroid stimulating hormone) test as the gold standard to get the dose of thyroxine right. TSH is produced by the pituitary gland. It stimulates the thyroid gland to produce its natural hormone, thyroxine. If the body is short of thyroxine, the pituitary gland pumps out TSH in an attempt to force the thyroid gland to produce more thyroxine. So if your TSH levels are high, that means you are not getting enough thyroxine and should increase your dose. Some patients say they only feel well when they take extra thyroxine - more than is indicated by their TSH levels. You will need to discuss this with your doctor if your TSH levels are OK on your current dose. With regard to fertility, an underactive thyroid can cause reduced fertility or infertility. Unfortunately, the success rate of IVF for women of your age is not brilliant. The good news is that if the original cause of your fertility problems was related to your underactive thyroid, your chance of success now may be better. But the bad news is that because you are now five years older than when you abandoned treatment, your chance of success is going to be worse.

A healthy cuppa

Can you give me any information about the health benefits of rooibos tea? Friends from South Africa swear by it, and say it is the reason South Africans live so long. What does it contain? Is it genuinely healthier to drink than ordinary tea?

Rooibos is an Afrikaans word meaning "red bush". Rooibos tea is made from the fermented leaves of the rooibos plant. The leaves themselves are green, until they are fermented and dried. This process turns them red. Rooibos tea does not contain any caffeine, so if you are trying to avoid that it may be useful. It also contains small quantities of vitamins and minerals, but these can be obtained from eating a good mixed diet with plenty of fresh fruit and vegetables. The leaves contain some quercetin, which is an anti-oxidant that is said to reduce the risk of some cancers and heart disease. But you can also find quercetin in apples, onions, raspberries, black and green tea, red wine, red grapes, citrus fruit, cherries, broccoli, and leafy greens. It looks like rooibos tea is safe, and perhaps even delicious (I haven't tasted it). But I doubt if it is the elixir of longevity that your friends claim it to be.

Too many docs...

I've been referred to a rheumatologist, a neurologist, an HRT expert and a haematologist for my symptoms. Specialism is inevitable with the growth of medical knowledge, but how can I make sure someone looks at me as a whole person, and considers all my symptoms together?

This is a genuine dilemma. As medical science becomes more specialised and more complicated, it is impossible for any one doctor to be up to date with everything. Thirty years ago, someone like you might have been looked after by a general physician. General physicians turned their hand to anything and everything, apart from surgery. They were "experts" across a broad area, and one likes to think they saw their patients as unified human beings (although I'm sure this was sometimes wishful thinking). Now that your care is divided up between four specialists, it's inevitable that you think each one of them is only thinking about the part of your body that interests them most. Of course, just because a doctor is a super-specialist, does not mean that he or she is unable to look at you as a "whole person". I have two suggestions. The first is that you make it your business to remind all of your doctors, in the nicest possible way, that your symptoms don't respect the boundaries of their specialities. Your joints (rheumatology), your nerves (neurology), your hormones (HRT) and your blood (haematology) are all dependent on each other. If one system is not working properly, it may affect all the others. My second suggestion is that you use your GP as your primary doctor. GPs may not know everything about everything, but they are remarkably good at seeing patients as whole people. Perhaps you should even dispense with one or two of your specialists.

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