DEAR DR. ROACH: I have taken the same dosage of Synthroid for several years. Since this dose successfully maintains my thyroid level, is it still necessary for me to have my blood work done once a year, or could I either stop having blood work done or have the test performed every other year? — R.M.

ANSWER: In general, the dose of replacement thyroid remains roughly constant over the long term. However, the dose may need to be adjusted for several reasons, including weight change, other medication use, change in absorption due to gastrointestinal developments or pregnancy. Also, even normal aging alters the metabolism of thyroid hormone, so I’d recommend continuing to check levels once yearly at a minimum.

The booklet on thyroid disorders provides insight into the various forms and treatment of this disease. Readers can order a copy by writing: Dr. Roach — No. 402, 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. ROACH: I am an 81-year-old male in generally good health. I am maybe 10 pounds overweight. I have had no heart attacks or cardiac symptoms. I walk on the treadmill for exercise.

I have controlled hypertension, and have been taking simvastatin, 10 mg. My LDL is 71, very favorable. My HDL is also good, at 73.

Several years back, when I started the statin, my doctor added Zetia, 10 mg. At the time, I wondered why this would be OK, and he said, “Well, there is a certain synergy there.” While I have continued taking the Zetia and suppose it might be helpful, I wonder if I need it. I say this because it is rather expensive (about $500 a year with my part D coverage). It is the only thing I take that costs me this much.

My reading of the literature suggests that while Zetia might help the LDL level, there is no evidence that it improves longevity (i.e. cardiovascular). — J.P.

ANSWER: This is a confusing subject, because the theory (that lowering cholesterol protects your heart) and the evidence (that it actually works) don’t exactly align. High cholesterol certainly is associated with a higher likelihood of heart blockages, which can lead to heart attack and death. However, not all treatments that lower cholesterol reduce risk of heart attack.

On the one hand, there are treatments that lower cholesterol that do help your heart. The Mediterranean diet clearly reduces risk of heart attack. Dr. Dean Ornish’s plant-based diet of very little fat and little or no meat, in combination with stress reduction and smoking cessation, actually reverses blockages in arteries in some people. Statin drugs reduce cholesterol and help prevent heart attacks, at least in people at high risk for them.

On the other hand, ezetimibe (Zetia) reduces cholesterol, but like most nonstatin drugs to treat high cholesterol, it has not been proven to reduce heart disease risk. It tends to have few side effects and probably is not harmful. But you are correct that it is expensive, and like all medications, it can possibly cause harm. Being conservative about medication, I very rarely prescribe it. Studies are ongoing, and I will readdress this topic when there is more evidence.

DEAR DR.ROACH: I am writing to you regarding your recent column about psoriasis.

My husband spent most of his life suffering from severe psoriasis, until he was told of an all-natural solution: cilantro. In a matter of a few months he was completely symptom-free, and remains so after more than a year. He simply adds a few sprigs of cilantro to a garden salad once a day. — J.L.

ANSWER: I also have read that eating fresh cilantro helps psoriasis. I couldn’t find any study that looked at this, and people responding to online support groups reported mixed results. However, it is very safe and might be worth a try.

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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