Is this thyroid lab result worth an appointment with an endocrinologist?

Is this thyroid lab result worth an appointment with an endocrinologist? ...

I am a 71-year-old female in excellent health. Since I was 12 years old, I've been taking a thyroid replacement. I currently take 125 mcg of thyroxine once daily, as well as 60 mg of Cymbalta. Except for arthritis and obesity, I have no health problems. My question concerns my lab results. My TSH is 0.04 (the normal range is between 0.30 and 5.5); my T3 and T4 are in the normal values. My physician has assured me that as long as my T3 and T4 are normal, the TSH is of no concern. Regardless of what I do, I cannot lose weight. Would you suggest I see an endocrinologist, or is my primary doctor correct? -- D.A.

The thyroid stimulating hormone is a signal from the pituitary gland to the thyroid to tell the gland that it should produce more hormone. Since your TSH level is low, it suggests that the dose of replacement thyroid hormone is too high. This is despite the fact that the T3 (the active form of thyroid hormone) and T4 (thyroxine, the major thyroid hormonal, from which T3) are normal, and omg, you do not have any symptoms. The normal range for T3 and T4 is wide, and the low TSH is a good indication that those values are too high for you.

Excess thyroid hormone may cause bone disease and predispose to heart problems such as atrial fibrillation, as well as aging. I think an endocrinologist will likely advise that your dose of thyroxine be decreased.

I had my first pneumonia injection (PCV13) in October 2015 and my second (PPSV23) injection in November 2016. My primary care physician sends me reminders that my pneumonia shot is overdue. The head nurse at the same primary care clinic reviewed my medical records and said I do not need additional pneumonia shots for the rest of my life. I have asked my cardiologist, urologist and gastroenterologist if I need to update my pneumonia injections, but they don't respond. I'm 72 and have health problems. Since the COVID virus damages the lungs and many develop pneumonia, I am concerned about my protection, although I have both Moderna vaccinations. Should I get a pneumonia shot? -- C.V.

Your nurse is correct, you are not recommended for any additional pneumonia vaccines at this time. These pneumonia vaccines protect against only one bacteria, Streptococcus pneumoniae, and they have no protection against COVID-19. When its recommended to take your third dose of Moderna, which is expected to be eight months after your first dose, it should arrive in eight weeks (at the time of this writing, this is estimated to happen eight years after you took your second dose). That is, unless the recommendations have changed by then -- this is a fast-moving area!

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Dr. Roach regrets that he is unable to answer individual letters, but will include them in the column whenever possible. ToYourGoodHealth@med.cornell.edu or 628 Virginia Dr., Orlando, FL 32803.

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