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Is Treatment Required for Higher TSH?

Dear Dr. Roach: I am a 64-year-old woman in fairly good health and who takes no medications. Both my mother, 88, and my sister, 53, take medication for hypothyroidism. In the past four months, I have had blood work done three times to check my thyroid and had slightly elevated TSH scores (between 5 and 7). My doctor then had me tested for antibodies, which came up negative. I was told that since I don’t have antibodies, I should not be treated. When I asked about the elevated TSH levels, I was told, “We do not treat ‘old age’ hypothyroidism.” If my levels are elevated, what does the presence of antibodies mean? Am I hypothyroid or not? — S.S.

Answer: I don’t know if you are hypothyroid either. I suspect not. But the issue, as far as I can see, is not so much the antibodies, but the level of your actual thyroid hormone — free T4. The thyroid-stimulating hormone is made by the pituitary gland in the brain, and its job is to stimulate the thyroid gland in the neck to make more thyroid hormone. If the thyroid gland is not producing quite enough hormone, usually because of autoimmune disease (antibodies attacking the thyroid), the brain senses this and increases TSH. Sometimes the thyroid gland is able to make enough hormone to be in the normal range. We call this “subclinical hypothyroidism,” or “compensated primary hypothyroidism.” Most physicians do not treat this condition if there are no other symptoms of hypothyroidism, such as fatigue, cold intolerance or muscle weakness. If you have no symptoms, no antibodies and normal free T4 levels, then I don’t think you need treatment, but just to have periodic tests of both TSH and free T4.

Some people feel that the range of normal TSH in the elderly (and you aren’t really quite there) should include levels as high as you reported.

Dear Dr. Roach : Recently, when I was in the hospital, I contracted C. diff. When I was free from it, they released me. I have a dear relative who is afraid to visit me because she has a serious celiac disease and can’t afford to be around germs. She claims C. diff stays on the skin for months. How much of a risk am I to her or anyone else? Can this disease come back again? — C.D.

Answer : Clostridium difficile (C. diff) is an increasingly common infection. You acquired yours in the hospital, which is where many people get it. The spore form of C. diff can indeed last for up to five months on a dry surface, which is why it’s so hard to eradicate from hospitals. However, it is killed by hot water and soap, so your skin likely is not infected if you have been cured of your symptoms. People can still shed the germs after being cured, but usually for weeks, not for months. Exposure to C. diff does not result in infection to a healthy person unless that person is on antibiotics or has other reason for increased susceptibility. If you have had no symptoms since leaving the hospital, I feel safe recommending your relative to visit, but washing your hands with soap and water is always a good idea.

Email questions to ToYourGoodHealth@med.cornell.edu.