DEAR DR. ROACH: I had my thyroid removed for a goiter 35 years ago. My doctor put me on 100 mcg of thyroid medication; however, when I took it, I got sick. My hands shook, and my heart beat very quickly (over 100). So one doctor told me to split it, and take 50 in the morning and 50 in the afternoon. I felt better, and I took it twice a day for 30 years. After menopause, a different doctor changed it to 88 mcg and said to take it one time a day. This what I have been taking for five years, but I was feeling better and happier when I split the dose. My question is, Can I split this medication? Does it make any different for the body if the TSH is normal? Does it make any difference what time of the day I take it? — H.T.

ANSWER: Many people do split the dose of thyroid hormone, especially if they are taking a type of thyroid, such as Armour, that contains T3. If 88 mcg is the dose that has the right amount of TSH (a hormone made by the pituitary that helps determine whether the dose is correct as far as your body is concerned) for you, then the TSH shouldn’t be affected by taking half the dose in the morning and half at night. Most people don’t find that it matters, but if it relieves your symptoms to take it twice a day, that’s OK.

DEAR DR. ROACH: How much good does it do for the body to just lie there with your eyes closed all night long when you can’t sleep? — D.R.

ANSWER: It doesn’t do much good at all; in fact, it causes harm, in that it makes it more likely for you to associate the bed as a place to stay awake. My advice is, if you are lying in bed and not sleeping, get up out of bed and do something. Listen to soft music. Read a book, as long as the light isn’t too bright. Write in your diary. When you feel like sleeping, get back into bed, but don’t stay there if you aren’t getting to sleep in 15 minutes or so and know that you aren’t going to.

Getting a little high-intensity exercise during the day, avoiding caffeine after midday and staying away from naps are good ways to feel ready for sleep at bedtime.

DEAR DR. ROACH: I am a 77-year-old woman with severe osteoporosis of the lumbar spine. My T score was -3.3. I was on Fosamax, but developed stomach troubles on it. I started Reclast in 2010, but had rapid acceleration of my pre-existing gum disease. In addition to taking these medications, I was in an exercise program and walked a mile every day. In spite of it all, there has been no change in the T score.

My doctor wants to put me on Prolia, but I am hesitant, based on the possible side effects. Should I take Prolia, or take nothing and continue with exercise? — L.M.

ANSWER: Your T score is a measure of how much bone mass you have relative to that of a healthy young woman. A score below -2.5 is osteoporosis, so your score of -3.3 puts you at high risk for fracture. As such, I would recommend some kind of drug treatment.

Your doctor should have looked for vitamin D deficiency, and you should be taking calcium (and vitamin D, if you aren’t getting enough through diet, which is hard to do). There are several options, including denosumab (Prolia), but also raloxifine (Evista) and teripartide (Forteo).

TO READERS: Questions about breast cancer and its treatment are found in the booklet on that subject. To obtain a copy, write: Dr. Roach — No. 1101, 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.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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