DEAR DR. DONOHUE: How can I lower my TSH without thyroid medicine? Is a high TSH dangerous? I took Synthroid (thyroid hormone) for several months, and I had many symptoms, which went away when I stopped taking it. Insomnia, diarrhea, tremors, hair loss all started within weeks after I began it. They worsened over the five months I took it and went away when I stopped. My doctor told me to start again. I did, and the symptoms reappeared. My TSH is 9. What should I do? – C.C.

ANSWER: TSH is thyroid-stimulating hormone. It comes from the pituitary gland at the base of the brain. It does what its name says: It stimulates the thyroid gland in the neck to make thyroid hormone. When the thyroid gland does so, the pituitary turns off its production of TSH. A normal TSH is 0.5 to 4.7. A high number indicates that the thyroid gland is not making thyroid hormone. Without any thyroid hormone, the pituitary goes wild and pours out TSH.

Your TSH value of 9 indicates that your thyroid gland is on the blink. You’re not making enough thyroid hormone but you have no symptoms of hypothyroidism. The only thing that can be done to lower TSH is to take replacement thyroid hormone, and Synthroid is a popular brand for replacement. However, when you take thyroid hormone, you get all the symptoms of an overactive thyroid gland – diarrhea, insomnia, tremors and the rest.

You have two options: One is to take a smaller dose of Synthroid; the other is to take no medicine and wait until the signs of hypothyroidism (sluggish thyroid gland) appear. People with a gland that’s not making enough thyroid hormone eventually develop chronic tiredness, dry skin, brittle hair, constipation, menstrual irregularities, memory lapses and a feeling of being cold all the time. The symptoms don’t come on suddenly. You’ll know when they start, and then you will know it’s time to take Synthroid.

The thyroid booklet deals with both an underactive and overactive thyroid gland. Readers can obtain a copy by writing: Dr. Donohue – No. 401, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: Something strange happened to me last week. All of a sudden, I found it impossible to get words out of my mouth. I knew what I wanted to say, but I couldn’t say it. At the same time, I was unstable – I couldn’t keep my balance. My husband says it was a faint. What’s your opinion? – G.K.

ANSWER: You make a good case for a TIA, a transient ischemic attack. It’s a temporary interruption of blood flow to the brain. The symptoms disappear when blood flow resumes.

The danger of a TIA is that it can be an omen that a stroke is about to happen. About 10 percent of people who have had a TIA will have a stroke within three months. With a stroke, the damage is permanent. You definitely don’t want that to happen. There are medicines you can take to prevent one.

See your doctor quickly. If I’m wrong, the visit is overkill. If I’m right, you can avoid a tragedy.

DEAR DR. DONOHUE: After many tests and seeing many doctors, my husband has been diagnosed with hereditary spastic paraplegia. Last year he was in three different rehab facilities, and he now lives in an assisted-living facility.

Of all the people he has seen, only three knew what HSP is. Can you tell me why? – M.D.

ANSWER: The only answer I can give you is that hereditary (or familial) spastic paraplegia is rare. There are only about 20,000 cases of it in the United States. Most doctors and medical personnel never see a patient with it. It’s an inherited condition where the leg muscles are stiff (spastic) and movement is awkward. Paraplegia indicates paralysis or weakness of the legs. No medicine stops or reverses the illness, but there are medicines and therapies that make life more livable. Are you aware of the Spastic Paraplegia Foundation? The Web site is: www.sp-foundation.org.

DEAR DR. DONOHUE: I have occasional heartburn, for which I use antacids. Is that OK? Do they cause any problems? – O.J.

ANSWER: Antacids are perfectly OK for heartburn control. They should be taken one hour and three hours after eating and then again at bedtime.

If you find yourself having to use them daily, then you should see your doctor for medicines that suppress acid production. Furthermore, if you use antacids too frequently, they can cause a rebound increase in acid production.

Some antacids cause diarrhea, while others are constipating. Read the label carefully. You might have to alternate between the two kinds.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com

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