Dear doctor

Is too much TSH a bad thing?

Q A blood test seven years ago showed that there was a problem with my thyroid stimulating hormone (TSH). I saw my GP, who didn't think it was a problem, and it was monitored every six months for 18 months. I had another blood test recently that showed that the TSH was higher. My GP referred me to a specialist, but did not explain why the TSH was high. I'm a 40-year-old 10-stone male who exercises occasionally. Should I be concerned? The TSH was 18.0.

A This happens a lot nowadays. Many of us feel a bit sluggish, crawl along to the GP and end up having a blood test to check for an underactive thyroid. Occasionally, the blood test shows low levels of thyroid hormone (T4) circulating in the blood. The low level sends a message to the pituitary gland in the brain to pump up the volume by producing more of a hormone that stimulates the thyroid gland. This hormone is TSH. So if your T4 is low, your TSH goes up to try to compensate your deficiency.

If you have symptoms of an underactive thyroid (weight gain, dry skin, feeling cold - a general slowing-down and thickening-up) together with the blood tests results, you'll be advised to take thyroid tablets (thyroxine) and should feel better for it. In your case, you're obviously not overweight (I don't think I know any 40-year-old men who weigh 10 stone!). If you have no other symptoms of an underactive thyroid, don't treat the high TSH alone. Your pituitary gland is obviously working overtime to keep the thyroid levels in your bloodstream up to normal levels. But so long as it's achieving that, and you're feeling OK, I wouldn't go looking for trouble. An annual blood test should be fine.

Concerned about chest pain

Q I had some chest pain recently, which my doctor didn't think was from my heart. But he said I should have an exercise ECG to be certain. A friend told me there is a new scan which is better. Should I have it done, and can I get it done on the NHS?

A An exercise ECG is cheap and cheerful and will probably tell you what you need to know. You get wired up to an ECG, which records the electrical activity of your heart while you exercise on a running machine. Any strain on the heart shows up as an abnormal ECG. If it's normal, you can be reassured. If there is strain on the heart, you'll be advised to have an angiogram in which dye is injected into a vein and watched as it moves through the blood vessels around your heart. Any narrowings or blockages show up and you can have treatment with drugs or surgery to open or bypass the blockages.

The scan you mention is a CT scan of the heart called EBCT (electron-beam-computed tomography). It's been hyped a lot but will cost you around £500 as it is not available on the NHS or covered by insurance. It uses multiple X-rays to detect calcium deposits in your coronary arteries. A zero score means there's no calcium detected, which is a good thing and will certainly put your mind at rest.

But life is often not that simple. Many people get an intermediate score and it is not clear how to interpret that. Even a high score doesn't always mean you have heart disease. A cardiologist friend of mine reckons magnetic resonance imaging (MRI) scanning will get better and will become the ultimate screening tool. He says you should do the common-sense things to keep your risk of heart disease to a minimum; don't smoke, exercise, keep your blood pressure and cholesterol low. He would have an exercise ECG and hang on to the £500.

Painful soles

Q I have got small fluid-filled blisters on the soles of my feet. They are filled with a clear yellow fluid and some look brown. The skin around the blisters is red and flaky. It's sometimes itchy and can get sore. I've been treated for athlete's foot but none of the creams have helped. Any ideas?

A You've probably got pustular psoriasis. It usually affects both feet and sometimes the palms of your hands. You may have the skin condition, psoriasis, or it may run in your family. It is said to be more common among women, smokers and diabetics. Most people I've seen with this condition don't conform to any of those characteristics. It's a devil to treat. Ladle on a greasy preparation to keep the skin from getting cracked and dry. Vaseline at night under a pair of cotton socks is good. Prescribable ointments include coal tar and salicyclic acid, steroids or dithranol. If they don't work, ask for a referral to a dermatologist who can offer light treatment (PUVA) or heavy duty anti-psoriasis drugs.

· These answers are intended to be as accurate and full as possible, but should never be used as a substitute for visiting a doctor and seeking medical help. If you have a question for Dr Robinson, email or write to her c/o The Health Editor, The Guardian, 119 Farringdon Road, London EC1R 3ER. She regrets that she cannot enter into personal correspondence.

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