Ask Dr. H: Thyroid pills not likely to cause choking

Question:

According to the patient information I received from Medco for those taking levothyroxine, they advise taking the thyroid tablet with a full glass of water because it can dissolve very quickly, swell in the throat, and cause choking. Given the small size of the tablet, I'm hard pressed to believe there is any real danger of swelling to any appreciable size to cause choking. Is there a real risk of choking?

Answer: I've been a physician for more than 21 years and have never heard about a person choking directly as a result of a thyroid tablet rapidly dissolving and swelling in the throat. The Physician's Desk Reference does not mention any potential tablet swelling issues with Synthroid (brand-name levothyroxine); it says taking Synthroid at the same time as calcium, antacids, iron, Questran, or Xenical/Alli can affect its absorption and decrease its effectiveness.

I agree with you that there are much larger tablets and capsules out there in pharmacy land that can get lodged in the throat - especially in folks who have any esophageal narrowing or motility problems. That said, it's a good idea to take pills with a tall glass of water to help them go down smoothly, reduce the risk of gastrointestinal upset, and move them more easily through the stomach.

Q: Whenever my doctor has me get lab work, it seems that they take a ton of blood. How likely is it for a person to get anemic from getting frequent blood drawings?

A: Outside a hospital setting, it's pretty unlikely for anyone to develop anemia just from having periodic blood draws. While those tubes may seem like a lot, the average amount of blood collected per tube is only about 5 or 6cc - or about a teaspoon of blood per tube.

On the other hand, frequent blood collection in hospitalized patients is potentially serious. Repeated blood draws over many days in the hospital, particularly from a very sick patient whose bone marrow isn't working well enough to replace lost red blood cells, can lead to anemia or a worsening of preexisting anemia. This is of particular importance in folks who have an underlying cardiac condition, such as a recent heart attack or congestive heart failure, where providing adequate oxygenation to injured heart tissue is critical. Anemia can stress the body, and that's not a good thing.

To prevent this from happening, doctors should be more judicious in ordering daily blood work for hospitalized patients. Also, switching to smaller pediatric blood-collection tubes will cut the amount of blood removed in half.