Dear doctor

Lumpy testicles

Q I went to my GP a while ago as I had a very small lump on one testicle. It was diagnosed as a water cyst. The GP said it would get bigger and it is now almost two thirds the size of one testicle. I have also got another cyst on the other testicle which is half the size of the testicle. Should I be worried? Will they continue to outgrow the testicles? They don't give me any pain, but I would appreciate advice.

A Painless lumps on the testicles must be checked out. You may well have harmless fluid-filled cysts but an ultrasound scan can readily distinguish between cysts and solid lumps. If you haven't had one, get one. If your GP can't organise this for you promptly, you may want to lobby the health authority, with a copy of your letter sent to your local MP (the waiting time for ultrasound scanning in some areas is a disgrace). Or you may decide to get it done privately (appoximately £40). Epididymal cysts can be left or drained. Testicular cancer is rare (600 cases a year in the UK) though it is the commonest cancer in men aged 25-35. It is readily treatable and potentially curable.

Blood test query

Q After a blood test, our nine-year-old daughter has been diagnosed with an underactive thyroid, probably brought on by Hashimoto syndrome. (Her pituitary gland measurement is very high and her thyroid gland measurement slightly low).

This came as a shock as she is bright, fit and, if anything, underweight due to a lively level of activity.

A You need another test, and another opinion. Ideally, no one should be told they have a life-long condition on the basis of a solitary result. This applies to high blood pressure, low sperm counts, diabetes, gout - and an underactive thyroid.

The thyroid gland sits in the same position as a bow tie and is a similar shape. It pumps out thyroid hormones which drive your metabolic rate; too much and you zip around losing weight, sweaty, palpitating and feeling boiling even in Arctic conditions. Too little and life's a bit like wading through treacle. An underactive thyroid is usually due to antibodies attacking the gland for no good reason. If you have a neck swelling too (goitre), it's called Hashimoto's. Thyroid disturbances in kids are relatively rare and may show up if a child isn't growing physically or intellectually.

If there are signs in the blood of thyroid-damaging antibodies, your daughter has a 5% chance per year that she will tip into a truly underactive thyroid and require medication. If there are no antibodies, she has a less than 3% chance per year of needing medication. Request referral to a paediatric endocrinologist (hormone specialist) for an expert opinion.

Leg cramp

Q I regularly suffer from night cramp, always in the right calf. I have high blood pressure so I need to keep my sodium levels down which, I am told, may exacerbate the occurrence of cramp. Is there a supplement I could take? I get plenty of exercise, am vegetarian, on a high-fibre diet and not overweight but do have varicose veins also in the right leg.

A Quinine (available on prescription) helps. No dietary supplement is convincingly proven to work, though vitamin E does no harm. Wearing support stockings helps the varicose veins, but doesn't reduce cramp. Painkillers and even anti-epileptic drugs are sometimes prescribed though there's no good evidence for their use. It may be worth increasing your salt intake and adjusting your medication if your blood pressure does go up as a result.

Sleeping trouble

Q I'm 16 and can't get up in the morning. I went to the doctor who laughed and said she couldn't either and just to force myself. I find it hard to fall asleep at night then when I do, I can't be woken.

A Focus on it to find some solutions. Are you too wound-up, stressed, anxious or depressed? Working or sitting in front of a flickering screen until too late? Too much caffeine, eg Coke, tea or coffee? Drugs - whether the kind you buy from a chemist or get on prescription, street drugs or alcohol? Or are you not tired enough - no sport or exercise, naps when you get in from school? Also, ask your GP for help.

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