DEAR DR. DONOHUE: I am 85 and in good health. For the past several years, I have been taking levothyroxine (Synthroid, thyroid hormone) for an underactive thyroid gland. The problem is, I am losing weight and have insomnia. I work in the garden and walk a mile a day. I read that blood tests for thyroid hormone are not always accurate. My daughter says I should stop the drug, and maybe I could gain some weight and get to sleep. What is your opinion? — M.S.

ANSWER: Perhaps your thyroid medicine is responsible for your weight loss and insomnia. I’m sure your doctor would approve of you going off it for a few weeks to see what happens. If you begin to gain weight and get to sleep, you’ve hit a bases-loaded home run.

Symptoms of an underactive thyroid gland include fatigue, dry skin, weight gain in the face of a poor appetite, constipation, hair loss, a slow heartbeat, feeling cold while those around you are comfortably warm and a disruption of menstrual periods in menstruating women.

Testing for hypothyroidism (an underactive thyroid gland) involves taking blood to check the level of TSH, thyroid stimulating hormone. The pituitary gland at the base of the brain makes TSH. It does what it says it does. It stimulates the thyroid gland in the neck to make thyroid hormone. If the thyroid gland is not working, the levels of TSH rise in an attempt to jump-start the gland. A high TSH indicates a low output of thyroid hormone.

TSH is a reliable test. It has a sensitivity of 90 percent. That means nine out of 10 times the test reliably identifies a person with thyroid deficiency. It has a specificity of only 9 percent, which means that many people who do not have a low thyroid hormone output are not correctly identified as such. A confirmatory test for the TSH test is called a free T4 test. It measures the amount of thyroid hormone in the blood. Both tests yield definitive information. If all of this is confusing, just remember that two tests are better than one. After you are off your medicine for some weeks, you can be retested.

The booklet on thyroid diseases explains the many ways that the gland isn’t working properly and their treatments. 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 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: My niece’s husband, 51 years old, was rarely sick. He now has been diagnosed with something called pemphigus vulgaris. He gets these tiny blisters in his throat and on his back and head that are incredibly sore. He takes prednisone, CellCept and a drug to prevent pneumonia. Our family looks forward to learning anything you can share about this disease. — D.R.

ANSWER: “Pemphigus” is a borrowed Greek word that means “blister.” ”Vulgaris” isn’t used to indicate “vulgar”; it’s used to indicate that the illness strikes the population at large. Pemphigus is an autoimmune disease, one in which the immune system attacks its own body — in this case, the skin and mucous membranes of the mouth and throat. Antibodies from the immune system cause skin cells and cells of the mucous membrane to become unglued from each other. Blisters form. When they break, they leave the skin and mucous membranes with raw, open sores.

In the days before cortisone drugs — prednisone being the cortisone drug must often used in treatment — fatality was incredibly high, 60 percent to 90 percent. Now it’s around 5 percent.

Your niece’s husband is taking the standard, worldwide medicines used for pemphigus. Most patients obtain a remission from the illness but have to take maintenance medicines to retain the remission.

Should he not reach a remission, doctors have other medicines waiting in the wings. The newest is rituximab (Rituxan).

I believe you can be upbeat about this man’s chances to obtain a remission.

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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