DEAR DR. ROACH: I am a male who is 58 years of age. I recently had an MRI of my cervical spine, and just this month, I had a CT scan of my whole abdomen. Since then, I have had symptoms of dry eyes, weight loss and insomnia. I wondered if the contrast dye used for the MRI or CT scan can cause hyperthyroidism, as these are common symptoms for excess thyroid hormone. Do you think I have hyperthyroidism? — G.L.

ANSWER: You are quite right that all the symptoms are commonly seen in people with excess thyroid. The weight loss is due to the increased metabolism of people with excess thyroid hormone. Insomnia is also common for similar reasons. Palpitations, tremor, anxiety, frequent bowel movements, and heat intolerance are all classical symptoms of excess thyroid hormone.

You are also right that the iodine-containing dye from CT scans can precipitate hyperthyroidism in a person who is destined to get it. However, the risk of this occurring is low. There is no increased risk of thyroid disease with MRI dye.

You could indeed have hyperthyroidism, and if you saw your doctor, you would very likely be tested. (I would certainly do so if I had a patient with these symptoms.) My experience is that these symptoms are not specific to thyroid disease, and it is probably some other cause. So, I would not be surprised if your thyroid tests were normal.

DEAR DR. ROACH: I recently got married again after being single for six years and have had five urinary tract infections (UTIs) in 14 months. My primary care doctor, a urogynecologist, and a urologist have all agreed on estradiol cream. I was basically put on this treatment for a prolapsed bladder and to build up my vaginal walls since I am sexually active again.

In reading your recent column about hormone replacement therapy (HRT) in older women, I am concerned since I underwent menopause 20 years ago (instead of under 10) and just started this treatment two months ago.

I might add that I had not had a UTI for 50 years prior, but vaginal dryness may be contributing to these UTIs. My doctor has not recommended a progestin, but I have also been introduced to taking a cranberry supplement once a day in tablet form to keep bacteria from multiplying.

Would you have recommended the same treatment knowing that I have not had a period for 20 years? — L.E.

ANSWER: The risks from estrogen replacement in postmenopausal women are from systemic estrogen, meaning estrogen that gets absorbed into the blood. This includes estrogen pills and patches.

Topical estrogen, such as vaginal creams, rings and gels, are not well-absorbed in the body and do not significantly increase the risk of heart disease, which is the major reason that I recommended caution to women who underwent menopause more than 10 years ago.

Similarly, progestins need to be used in women with a uterus when they’re taking systemic estrogen — but not topical estrogen. (Topical estrogen is absorbed slightly in women with atrophy of the vaginal lining, so it is always worth a consultation with an oncologist for women with estrogen-sensitive tumors, such as breast cancer.)

I don’t generally advise systemic HRT more than 10 years postmenopause, but there still may be some times when it’s appropriate after a thorough discussion between a woman and her doctor. In your case, however, the risk of heart disease, breast cancer or blood clots is negligible from topical estrogen.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2025 North America Syndicate Inc. All Rights Reserved.