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Lost weight. Tests indicated Hyperthyroid. On steroid. Repeated tests indicated hypo. Suggested silent Thyroiditis. Guide?

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Answered by

General & Family Physician
Practicing since : 2006
Answered : 567 Questions
Hi Doctor,

I want to know what kind of thyroid disease I suffer from ? I consulted 2 different Endocrinologists in the recent past and they both had different diagnosis. My Thyroid problem started when I was 18 in the year 2003 , at that time I lost 15 kgs of weight in few months. Few tests were done that time like 99MTC Thyroid Scan , Thyroid Profile , Thyroid Antibodies. Thyroid Antibodies was high and TSH levels indicated Hyperthyroid.

I was immediately put on a steroid that time by the treating physician for nearly a month after which the Thyroid profile was repeated , Thyroid profile came normal after which Wysolone was stopped. From 2003 to 2010 XXXXXXX . Thyroid Profile(t3,t4,tsh) was repeated every 4-5 months and they always came normal , also I did not see any thyroid related illness symptoms. I was not on any kind of Thyroid medication for 7 years.

In 2010 March, when the Thyroid profile was done it showed my TSH Level mildly towards Hyper and then the tests were repeated in next 7-10 days after which it showed towards Hypo. Same test was repeated a couple of times in the next few weeks and the values started shooting up towards Hypo.

This was shown to an Endocrinologist and they said possibly it can be Silent Thyroiditis Post Hypothyroid attack and the other Endocrinologist said possibly this can be Autoimmune Hashimoto's Hypothyroid.In 2010 itself Thyroid Antibodies test was repeated which was high.

Well none of them have a clear diagnosis and answer why my Thyroid reports were normal for 7 years. I am taking 75-100Mg Thyroxin since 2010 till current under Endocrinologist supervision. My TSH levels are currently normal.

I want to know what kind of thyroid problem I suffer from ? is it curable or treatable which will require lifelong medication as my Endocrinologist does not have a clear ans. I don't fear taking medicine lifelong provided there is a satisfactory diagnosis.

Other medical problems I suffer from is Acne , Eye Floaters. Eye floaters may not have anything to do with Thyroid but I feel somewhere Thyroid Disease is triggering Acne in some or the other way which I should not be getting at this age of 28. My Dermatologist has tried every possible treatment to control it , but all in vain. I started getting Acne at the age of 15.

I keep in fighting fit shape with right kind of diet and exercise, my height is 6'2 with 90 kg weight. I avoid all foods which are goitrogenic.

My Thyroid report is uploaded in a PDF Format which I would suggest you to go through from bottom to top . Top being the latest report. I have recorded all the reports from the scratch since the age of 18 to 28.

Looking forward to hear back from you.


Posted Sat, 5 Oct 2013 in Thyroid Problem and Hormonal Problems
Answered by Dr. Jay Patel 3 hours later

I am Dr XXXXXXX and I will try my level best to help you understand what is going on.

Based on the information you are being diagnosed as Autoimmune Hashimoto's thyroiditis and wanting to know why initially you had a hyperthyroidism for 7 years and now suddenly it turned to a hypothyroidism. Also worried about the acne issues and having floaters in eyes. More over is the condition life long or not.

1) Here is the explanation for the Autoimmune Hashimoto's thyroiditis, its a inflammation of thyroid tissue due to auto-antibodies which produces the thyroid hormone, now as the inflammation starts building up it will destroy the cells producing thyroid hormone, which in turn releases the previous stored hormone in the blood, which in turn will show high thyroid hormone level in blood initially, for first seven years same process was repeated till all of your hormone producing cell are destroyed by the auto-antibodies.

Next phase is with our any hormone producing cell in thyroid gland, so its not possible for thyroid gland to produce the hormone giving the result as hypothyroidism.

2) The issues with acne - acne mostly tends to occur due to changes in sex hormone like testosterone, which is not related in a big way to thyroid issues you are facing, acne can be treated but vit-A derivatives, and antibiotics in case of pus formation.

3) Now question about having the hypothyroidism life long and have to take medication ? The answer is "YES" as I explained in 1st answer that your normal thyroid cell which are producing hormone are destroyed by auto-antibodies and now their is very little or no cell to make thyroid hormone in your body. To provide the required hormone needed by body you have to take the medication for refilling the required hormone from mouth as medication.

Hope it helps to shed some more light on your issues and give a clear view about the thyroid issues you are facing and what your endocrinologist are doing to help you.

Please feel free to contact me in case of any further clarifications.

Thanks for the query.

Above answer was peer-reviewed by
Follow-up: Lost weight. Tests indicated Hyperthyroid. On steroid. Repeated tests indicated hypo. Suggested silent Thyroiditis. Guide? 12 hours later
Hi Doctor

Thanks for your reply , I have few more queries which I would like to ask .

1. As you said I was hyperthyroid for 7 years , but as per the reports I was U-Thyroid for 7 years as the Thryoid profile always came normal. More over these 7 years I did not have any noticeable weight loss or weight gain. How come I was hyper thyroid if my reports were normal ?

2. I get mild tremors in my finger/hands since many years. This could be related to anxiety but I dont think this should be the reason for me. If I am Hypothyroid and my TSH levels are under control why do I get tremors ? This is usually a symptom if you are Hyper Thyroid.

3. Do you mean to say my thyroid gland has completely stopped working and my TSH values are totally dependant on Thyroxine supplement , does it mean my thyroid gland is completely inactive and is of no use to my body ? Cant a dead organ lying inside the human body be harmful in long run, should it not be removed surgically ? . Even if the gland is able to produce little Thyroxine but it is anyway being attacked by the antibodies , so why there is something not being done to protect the left over gland from the antibodies attacking it ? Is it somehow not possible to repair the gland ?

4. Has there been cases where Auto Immune Hashimoto Thyroditis got reversed on its own and the gland started working normally because I have seen few people where they have been dependant on Thyroxine supplment for many years but then they somehow recovered from the Thyroid illness and they reports were coming normal without the supplement. Of Course I have no intention of any experiment by stopping the supplement as their illness could be of different kind. Will request you to put some light over it as well.

Answered by Dr. Jay Patel 9 hours later

Welcome back.

Let me answer your queries in order of appearance

1) The level of thyroid hormone does fluctuate from higher to normal during the first stage of Auto Immune Hashimoto Thyroditis, and is some case it appears to be euthyroid for long time, I explained the pathology how the normal cell are destroyed by the auto-antibodies, and if the amount of cell destroyed may release the more or normal amount of thyroid hormone, the report only shows the level present at that point in time only.

2) Mild tremor in hands are mainly caused by low-calcium in blood which relates to parathyroid hormone issues. Para-thyroid glands are glands besides the thyroid. More over an fluctuation in the thyroid hormone may some time seen as a cause of such problems.

3) The thyroid gland seems to be inactive, gland has many cells and only few of them are indulging in the process of making hormone, now to answer you question is thyroid tissue dead, answer is no, not the supporting cell only the hormone forming cell are destroyed by auto-antibodies. Hence the function of making thyroid hormone producing cells are seizing as the day goes.

Now about the TSH- its a chemical release by brain trying to send a message to thyroid gland that the hormone is low and produce more amount of thyroid hormone by increasing the TSH into blood. Brain do not distinguish between the thyroid hormone produced by thyroid gland or the medication. As long as the amount of thyroxine (thyroid hormone) level is normal brain will not produce the TSH, in high fashion.

Low TSH means the higher thyroid hormone circulation in blood, where as high TSH means Low thyroid hormone in blood. TSH is indirect measure of thyroid gland activity.

4) Auto immune diseases has a varied, course it the reason of body forming auto-antibody is mysterious and medical science do not have answer how that will take course. The assumption that person need to take the thyroid supplement is based on the statistical outcome from the past history of documented cases.Their may be some unknown reason that people may get better on its own. In some cases it might be a missed diagnosed case that get better and leaves some wild results creating a false hope. Still medical science do not have answer to that question how those case got better on their own. But based on statistical analysis their are higher chances that you will have to take medication through out life.

Thanks, and feel free to contact me in case you need further clarifications.


Above answer was peer-reviewed by
Follow-up: Lost weight. Tests indicated Hyperthyroid. On steroid. Repeated tests indicated hypo. Suggested silent Thyroiditis. Guide? 17 hours later

Thanks for the reply , I am pretty satisfied with your answers for my thyroid condition. I have few more questions which I would like to address.

1.My father developed diabetes after crossing age 55 and Hypothyroid after crossing age 40 . I believe the reason for my father's Type 2 Diabetes could be poor eating habits and consumption of high sugary foods as he is not health conscious. I believe it would be difficult to say whether his diabetes would be a genetic problem which I will develop too or not.

But what precautions can I take to avoid diabetes in the near future no matter whether it is genetic or not as I have the same genes.

2.I am currently unmarried, but would sometime marry and have kids. How can I avoid passing my Thyroid problem to the next generation.

3.I avoid fats/dairy(possible reason for calcium deficiency) ,sugar,fried/spicy/oily food as I feel these trigger acne. Medical science says these things don't have affect acne but with my personal experience I feel it does.

The medical problems I suffer from is Acne,Constipation,Hypothyroid,Eye Floaters.

Eye floaters may or may not go . I am not worried about it as I don't have a pathological condition and there are ways to deal with it which I can explore later when I am over with my other medical issues.

For Acne I am consulting a Dermatologist and I am applying the topical's being given by him. I think he's trying his best to help me with my acne condition.

I would like to engage your skills for management of my constipation(15 yrs old problem) & hypothyroid.

I take good diet with common sense , sleep well and do rigorous exercise. As I told you earlier I keep myself in fighting fit shape.

When I was a teenager I used to be usually constipated and those days it was not so severe and was manageable with diet and exercise. Someone advised me a herbal purgative which I started using and gave me instant relief, I continued using it for 2-3 years at a stretch after which it stopped working and I did not have any medicine which would work after that. I consulted a Gastroentrologist and he was able to somehow manage it for a couple of years after which it became so worse that he gave up, I still have constipation, currently I don't consult any Gastroentrologist but in the past my Gastroentrologist has done all kinds of investigation like Colonoscopy,Berium Meal follow Through,Rectos-copy but no pathological condition was identified.

But fortunately I got an Alternative Healer(Yoga) who brought me in a span of 2-3 years at a level where today I am just dependent on Softovac SF and occasional Lactose Solution to manage my constipation from the past 2-3 years. I know I can get rid of this problem if I get the right intervention.

I would like to engage your skills in regular continuation for managing my Constipation & Thyroid disorder. Let me know what do I need to do to identify if I have calcium deficiency related to parathyroid gland .Also I forgot to mention that I get occasional palpitations prior.


Answered by Dr. Jay Patel 10 hours later

Let me answer you question in order of appearance.

1) Type -2 diabetes is mostly inherent , but a person share only 1/2 of the genetic material from father, so your chances are about 50% both ways.

Here is what you could do to live a healthy life if your do have an diabetes as an inherited form, as nothing can be done to stop it coming on, as it is programmed in your genes at the time of birth.

a) keep your diet habits healthy like eating, green vegetables, and little less fruits then normally you consume.
b) daily exercise about 30 min which can make you sweat is good to kill the sugar in your blood (best method)
c) keep checking your blood sugar Hba1c every 6 months after age of 45, if precentage goes above 6% go to physician and get your self checked and if needed start taking medicines. As diabetes is a systemic disease and will damage the brain, eyes, nerves and every other organ in body in a long run if blood sugar is not better controlled.

2) The auto immune disorder do not have a very clear mode of inheritance so we are not certain that a person will pass on the autoimmune disorder, but they are definitely have a predisposing factors in them that makes it more likely for next generation to have it but not cent percent sure.

Choosing a life partner with out any thyroid problems will reduced passing of disease by 50% as discussed earlier. More over as i said earlier mode of inheritance for auto immune disease are not yet clear nothing can be said for sure for next 50 %. Hope it explains how difficult for any one is to guess an outcome as every thing is linked to the minute DNA molecules.

3) Now about the dairy products are good for calcium and you need to keep taking them as it will help for your issues with constipation as calcium is important ion for the stimulation of muscle that make you go (stool/poop). Even indian medicine system ayurveda says milk is nectar for skin diseases. So please take milk.

Now about " sugar,fried/spicy/oily food" I agree they do have role in "ACNE" and its best to avoid them as much as you can. I do have similar experience like for spicy food and acne relation so I can understand what you are saying.

Its good to know that yoga helps to control constipation, but please keep drinking milk to increase the calcium content and will help your intestine to push the stool better, which in turn will help in constipation . Yoga is to balance the body to its normal status and I am glad you do it.

Now about palpitations were the influx of changing thyroid hormone which i explained in earlier section.

Hope iT helps too as previous answers to satisfy you need and feel free to contact me in case of any other need or concern.

Thanks again

Above answer was peer-reviewed by
Follow-up: Lost weight. Tests indicated Hyperthyroid. On steroid. Repeated tests indicated hypo. Suggested silent Thyroiditis. Guide? 16 days later

Thanks for the reply prior.As per your advice I increased my dairy product(Milk) intake but I am not able to see any noticeable difference in my constipation. I am frequently constipated and I take Softovac Sugar Free for it but I dont feel a comfortable evacuation of stools in the morning even after taking it. If the condition worsens and if I am continuously constipated for more than 7-8 days I take half packet of Peglec(Colonoscopy Solution) to clear my stomach which surely works. After that Softovac SF starts working normally for next couple of days. This cycle continues on and off with this permutation and combination.

I am following a very sound diet program given by a Nutritionist as I exercise and make sure I don't lack anywhere through diet which I could result in constipation. As I said prior no pathological condition was found for constipation when the investigations were done years back.

Also tremors in hands and palpitation are still continuing with no reduction which could have some relation with my Hashimoto Thyroid(HypoThyroid) diagnosed by you. I am currently taking 75 MG Thyroxin. All my Thyroid reports are attached with the topmost being the latest.

Please advice how to deal with this constipation, tremors and palpitations

Answered by Dr. Jay Patel 5 hours later

Welcome back, here is what I would like you to do next, I need like you to check a "serum parathyroid hormone level" along with "serum calcium" with next blood report, as I explained before that calcium ion in body is need to get to go to "loo/poop". So you are taking the most abundant source of calcium which is milk still you are having issues for going, some times lack of parathyroid hormone may result decrease absorption of calcium from diet, which in turn will show up as constipation.

Please get your "serum calcium level" along with "parathyroid hormone level" to determine if their is something wrong with it or not.

Now about the tremors and palpitations, its a straight side effect from thyroxin supplement you are taking. The pulsatile release of thyroxin from taking medicine is the result of it. To deal with it in best fashion is to take "2 doses of 40 mg or 1dose 40mg sustained release" instead of 75mg straight in one dose. Talk to your doctor if its available in india yet, we do have it here in USA and NZ does have it too.

Dealing with constipation is to check with parathyroid hormone, if every thing about calcium level and parathyroid is normal. Contact me once you have a lab report about it and we move forward after that, mean while, taking stool softener (Softovac SF) is best way to go.

Thanks again for putting faith in me.

As always feel free to contact me.
Above answer was peer-reviewed by
Follow-up: Lost weight. Tests indicated Hyperthyroid. On steroid. Repeated tests indicated hypo. Suggested silent Thyroiditis. Guide? 14 hours later

Thanks for advising the Tests , I need to know if these tests need to be done early morning in fasting or can be done anytime during day.

The Testing Lab asked me to check first with the Doctor if there are any specific instructions , also I need to know if I should be repeating Thyroid Profile as the latest report attached is nearly 3 months old.

Kindly advise.

Answered by Dr. Jay Patel 5 hours later

You can check your parathyroid hormone blood level with or without fasting.

But our purpose, take it as 8 Hrs over night FASTING (No food after 12:00 am at night and have your test done around 8-10 am in morning) . Take all medications as prescribed.

I would like you to do the thyroid hormone level as an updated report too. (If cost is not much of a concern please get the new thyroid hormone profile , as it very expensive in USA, I just do not want to burden you with extra cost if its too expensive)

Thanks again.


Above answer was peer-reviewed by
Follow-up: Lost weight. Tests indicated Hyperthyroid. On steroid. Repeated tests indicated hypo. Suggested silent Thyroiditis. Guide? 5 days later

I have uploaded the investigation reports as suggested by you with latest Thyroid Profile. I don't understand them much but I see that PTH is higher.

Current Medication:
Thyroid: 75 Mg Thyroxin(Early Morning)

Constipation: Softovac SF-2 TeaSpoons , Looz Syrup(Lactulose)occasionally at bed time

Acne Rosacia : Combination of Topical s prescribed by Dermatologist which don't seem to help.

Eye Floaters: None.

Tests are anyway expensive in India too but I consider myself fortunate as I can afford them.

For your action now.

Answered by Dr. Jay Patel 13 hours later

i need you to have your parathyroid hormone level treated i have current issues with my internet i will explain you other things in next question
Above answer was peer-reviewed by
Follow-up: Lost weight. Tests indicated Hyperthyroid. On steroid. Repeated tests indicated hypo. Suggested silent Thyroiditis. Guide? 5 hours later
Hi Dr.

How this should be treated and for how long. Is it due to vit d deficiencies as I have very little exposure to sun...please advise.

Answered by Dr. Jay Patel 1 hour later

First of all I am extremely sorry for the short answer before, my internet connection kept on dropping on me so I was having very short window to sent you the message. More over I had not answer the query you might loose me and some other physician would be assigned to your question automatically. Thanks for understanding.


Now about your "high Parathyroid hormone"
Their are two cause for the high parathyroid hormone
1) Low vitamin-D3 (which is active form of vitamin D and it is activated by UV rays from sun hence its said that vitamin d is available from sunlight)
2) Parathyroid gland might be acting rapidly / calcium deficiency in blood.

Now as you said you do not have exposure to sunlight this explains what might be going on.

Let me explain how calcium, vitamin D and parathyroid hormone are related.

For absorption calcium from food vitamin D is needed in active state (UV rays activated vitamin D3 ), If their is not enough calcium in blood then the PARATHYROID hormone comes to play. It stats dissolving calcium from bone to maintain blood calcium level. So if you have high parathyroid hormone with normal calcium in blood means their is deficiency of ACTIVATED VITAMIN d3 in body.

Now if you have chance please take some sunlight at morning or evening, if nothing is possible then VITAMIN D3 supplement will be available in the market.

I need you to take vitamin D3 available from market for 2 months and at he end of two months I need you to repeat the parathyroid hormone level and check to see if it came normal. Mean while you are taking milk as I advised will help to built calcium .


Now about the symptoms of High Parathyroid hormone are mentioned below please let me know if you are having any of other symptoms (except constipation which I know. )
1) Muscle weakness
2) fatigue and an increased need for sleep
3) feelings of depression
4) aches and pains in bones and joints

more severe SYMPTOMS
1) loss of appetite
2) nausea
3) vomiting
4) constipation
5) confusion or impaired thinking and memory
6) increased thirst and urination.



1) Mostly you constipation is due to high parathyroid hormone.
2) It will come back to normal once the parathyroid hormone come back to normal.
3) Mean while please continue taking-- Softovac SF-2 TeaSpoons , Looz Syrup(Lactulose)occasionally at bed time



Constipation do cause acne, more over the high parathyroid hormone in blood does have some effect in "acne".

Now had your Dermatologist ever asked you about checking "testosterone level "? If yes please upload the report. If no then let me know and I might ask you to have it done in next blood report in 2 months when we will check para thyroid hormone level again.

Mean while here is some thing you can do at home, try to see if it helps.

1) Take a medicated cotton from market deep it in XXXXXXX water (gulab jal) available and put it every night, it will help to absorb excess of heat from the acne area, (if irritation is felt stop using it.)

2) Stop applying any kind of cream like moisturizers, aftershaves or any chemicals .

3) try avoiding:- hot beverages, hot showers ( warm water is ok ), extreme wind, polluted air, humid air, spicy or fried food.

Mostly the issue of acne will go down along with para thyroid hormone issue. We will drive deeper if ever other things are resolved and acne still persist.


Please let me know if you need more details.

Thanks again


Above answer was peer-reviewed by
Follow-up: Lost weight. Tests indicated Hyperthyroid. On steroid. Repeated tests indicated hypo. Suggested silent Thyroiditis. Guide? 5 hours later

In reply with your elaborate explanation and queries :

Symptoms which I suffer from :

1) Muscle weakness : NO, but occasional due to intense workout.

2) fatigue and an increased need for sleep : No, but occasional due to intensive workout which involves weights and cardio under supervision.

3) feelings of depression : Yes , but the reason of depression is mostly due to the medical problem I suffer from, specially Acne. Rest day to day life issues I am able to handle very well.

4) Aches and pains in bones and joints : No

More severe SYMPTOMS

1) loss of appetite : No , also I take a healthy diet under Nutritionist supervision.
2) nausea : Cough/cold yes it keeps coming and going.
3) vomiting :No
4) constipation :Yes, daily
5) confusion or impaired thinking and memory : Yes I feel so but not sure , also I have a sharp memory and I don't forget things.
6) increased thirst and urination. : No

I reduced my Thyroxin from 100 mg to 75 mg around 3 months back to see if I experience any difference in my palpation and tremors but it did not make much difference. Though I feel its not as frequent like before.

I have not been tested yet for Testosterone , though I have acne from nearly 14 years and from the same time itself I have constipation. Thyroid condition was diagnosed later though.

I can repeat the test as and when required.

T3,T4,TSH came to be normal this time as well. Should I continue with the same dosage of 75 MG ? I know I should not have reduced the dosage without consent of endocrinologist but he was not open to diagnose and give clear explanation on my tremors and palpation so I just wanted to see if reducing dosage helps.

I keep sun exposure minimal as I suffer from excessive sweating and I have a very fair skin due to which it gets red easily , also it aggravates acne. Also the kind of lifestyle I have it does not push me to stay outdoors for more than 10-15 mins only while driving that too with tinted glasses in the car. My Gym , social activities , office work everything remains indoors under controlled climate , so Vit D3 deficiency can make sense to me.

I would need to depend on oral intake of Vitamin D3 , please elaborate the dosage which I require and when to be taken and how to be taken. Do I need to take it daily or on some specific days after an interval.
Also if it has to be taken in fasting or at bed time.


Answered by Dr. Jay Patel 10 hours later

Welcome back, thanks for replying, it does has important information.

Now you need to take VITAMIN D3- 2000 IU Per day, which ever time you want with water will be fine. If forget to take some days its fine " do NOT double dose it" You may take it at any time in fasting / any time of day.

VITAMIN -D 3 is also helpful in acne treatment in recent studies.


Now about exercising to heavily does cause a increase in acne, I need you to reduce your daily exercise time to half then normal, please take some "glucon-D" like a spoon full in water after exercise to replace essential salt lost in sweat.


About the tremors I need you to have "thyroxin 40 mg sustain release twice a day" dose for the smooth operation as the does will help you maintain average thyroid hormone along with reducing the palpitations and tremors by almost near zero incidence, except when you are nervous. For this please discuss it with you endocrinologist before making change by your own. Still if your endocrinologist is not open then you may try it on you own. Its a great way because as I explained that high thyroid hormone will cause such symptoms,breaking its dose will smooth the way. Since every thing is fine as per new report and you are taking only 75 mg that explains that you need only 75 mg to maintain normal function. Their is nothing wrong in having 75 mg if not having any trouble, and the second option as i MENTIONED above 2 dose of 40 mg will be fine too. I want you to be comfortable and safe.


I will let you know when to get testosterone level checked mostly after 2 months when will check for following parameters.

1) Serum thyroid PROFILE
2) Serum parathyroid profile
3) Serum, testosterone level.
4) Serum , vitamin -d level -d2 and d3 included.
5) Lever enzyme profile ( just for checking every thing/ its not needed but if you can do it, its great)

All after 2 months once we are done having with the necessary changes.

Thanks and keep in touch in case for any concerns.

Above answer was peer-reviewed by
Follow-up: Lost weight. Tests indicated Hyperthyroid. On steroid. Repeated tests indicated hypo. Suggested silent Thyroiditis. Guide? 13 days later

Just to brief you what all I am taking.

Constipation : Softovac sf- 2 teaspoons @ bedtime.

Acne : Topicals - Clindamycin gel-morning, Mupirocin Ointment mixed with Metrogel-night . Oral - Ranbaxy Sodox( Kind of Multivitamin which has anti-aging effects as well) all prescribed by Derm.

Eye floaters : Eye doc suggest to try Vit c 500 MG daily for 3 months and see , but not yet started. I doubt if Vit C can help with floaters, but would still like to try. Suggest if this can be taken with Vit D3 ? If yes then is gap required or I can take them together.

Hypothyroid : 75 MG Thyroxin ( did not split the doses to 40-40 mg as I am not getting palpitations at the moment) and I am not noticing tremors since I am taking Vit D3.

Vit D3 2000 IU as advised since 2 weeks in the last communication.


2 weeks down the line I can see noticeable improvement in my acne tendency and Constipation . I am getting bowel urge on its own and skin is improving but there is a catch here.

New Issue :

I have a history of catching cough-cold very easily and for long duration. But this time its back after quite sometime.I had a climate change in the last few weeks due to travel by air and land on cold areas.

I am having sore throat-Cough with Sputum approx from the past 2 weeks.

I get running nose in the morning when I wake up but once i clean it the nose remains dry through out the day and it is not blocked & I breath normally. I tried some home remedies along with gargle with salt water , and tried benadryl cough syrup for a couple of days but its not helping. Condition is the same , its not worsening nor the cough is going and sputum formation is not reducing.

I do have a history of catching cough-cold very easily and for long duration. But this time its back after quite sometime.

Please advise how to cope up with this and fix this as I would not like to see a local physician for it as he may get mixed up with my ailments.

Answered by Dr. Jay Patel 2 hours later
Brief Answer:
Don't worry I try to have it fixed fast.

Detailed Answer:

The treatment mention is pretty much on spot.

Now about the vitamin C, you can take vitamin c with D but, I will may not give you any relief from floaters.

Let me explain what are the floaters are- Basically the eye is like a ball filled with transparent gel, so that it can behave like a lense of camera (you may have come across the lager manual camera nikon , mostly used by photographers) Now if the pictures have some redness it can only be fixed via software on pc right, some similar is happening in the eyes in case of floaters. Floaters are thickened older gel which will take some time for body to reabsorb. Nothing will help reducing it (my wife is ophthalmologist and I did consult her for the same and her answer is the same). You may try any things but it will take sometime for body to reabsorb it.


Now about the cough and catching cold. ( well I do am very sensitive to it too, it because of under active immunity.)

This is what helps me.
1) Take turmeric (haldi) with warm water gargle.( haldi/turmeric is a natural drug which is antibiotic as well as anti-inflamatory drug, if possible swallow the powder.)

2)Take some ginger in every day use like ( tea with some ginger juice in it) ginger will create boost in immunity and will help you in long run to avoid catching cough easily, ginger will help cleanse the body too.

3) Mean while I would like you to take "certizine" 10 mg made by "zydus-cadila" twice a day till things have cough.

4) If the cough turns to little bit thick , yellowish/greenish- that means its infection and you will need antibiotic, 500 mg ampilicin 2 times a day for 5 days is routine dose, things will be fine in 3 days but keep on moving with dose and complete it please. If even after taking the medicine for 3 days no change contact me and i will change the antibiotic.

Please use ginger and haldi/turmeric it helps me and surely will help you its basically a natural drug and don't think it as tradition stuff its very much scientific and advantageous. Please take advantage of this ever day herbs so that we can stay away from medications.

Thanks again.

Above answer was peer-reviewed by
Follow-up: Lost weight. Tests indicated Hyperthyroid. On steroid. Repeated tests indicated hypo. Suggested silent Thyroiditis. Guide? 9 days later

Problems reported in my last communication :

Cough with Sputum , sore throat from 31st July
-Tried home remedies and self medication for nearly 14 days without much success.

You prescribed :

1.Cetrizine- Took twice in a day for 5-6 days.
2.500 mg Ampilicin: Took twice in a day for 5 days.

I used to take both of these medicines together after breakfast and dinner. Last dosage was taken nearly 40 hours ago last morning.

Symptoms have gone down by nearly 60-70%. Occasional cough and mild irritation in the throat is still there. Sputum looks transparent , if I look it very carefully it looks mildly yellowish. I am not able to distinguish clearly whether its grey or yellow.

I feel sluggish when I wake up in the morning , throat has irritation and I need to cough a couple of times to clear it...I feel better after gargling with Listerine mouth wash as it reduces my irritation to some extent. For a couple of hours I feel normal after gargling , pain and cough returns after 2-3 hours in the office and continues through out the day which is mild in nature. In the evening before hitting bed when I gargle again with Listerine I feel better and I am able to sleep without much irritation in the throat

I don't have running nose and I can breath normally also in the morning.

--As mentioned in the last communication by you, I should try ginger which I did not as I read somewhere it should be avoided if you are Hypothyroid as it has Goiter-gens.

--Though I did not avoid Listerine which has Fluoride again that should be avoided if you are Hypothyroid. I even use a non-fluoride toothpaste.

--I read them somewhere, not sure if I should be following them or it's a myth.

--I totally avoid raw Goiter-gen vegetables as suggested by Nutritionist/Dietitian or if I take them , they are well cooked.But I totally avoid Soya-Products in raw or cooked form.

Please give me your inputs on the same if I am doing the right thing ?

Also let me know what I am supposed to do next for the problem reported in the current communication for which your prescribed two medicines in the last communication as mentioned above.

Answered by Dr. Jay Patel 2 hours later
Brief Answer:
Hey doing good so far.

Detailed Answer:

Let me start explaining why I asked you to have ginger even through the research papers lists is as goiterogenic. (I appreciate you did research of it.)

Goiter is basically a swelling of thyroid gland. Now it occurs with deficiency of iodine. Now in case of normal thyroid gland it will make sense that it will get enlarge if you do not have enough iodine absorb in blood for intestine. The thyroid gland enlarges as its trying to make more thyroxine will lack of iodine only true in case of normal thyroid gland.

In your case the gland is already destroyed by the antibodies as i explained you earlier, so it not function properly now hence you need thyroxine for out side. As long as body detects enough thyroxin in blood no pressure is given to thyroid gland by brain. So no chance of thyroid reaction to less iodine supply form blood. So what difference will it make if you have enough iodine absorbed in blood or not.

Goiterogenic means , interferes with absorption of Iodine for food into blood. I would like you to ask you dietitian to explain you they told you to avoid goiterogenic (as they asked you to avoid vegetable and soy stuff). Its may be true for other case but as them how it will help in your case.
My opinion is you should be free of all dietary restrictions put on by you diet planner, as long they are concern about you thyroid issue. LET THEM WORK FOR YOU WEIGH GAIN/ OTHER ISSUE. BUT ASK THEM TO FREE YOU FROM RESTRICTIONS BASED ON THYROID/GOITER FEVER)

It's always good to ask question and understand the reason about the ongoing process. Please feel free to ask any question to me, even feel free to criticize me in case I made some mistake.


Now about the soar throat, I would feel that now you body will take over the remaining issues of residual infection if any, as we supported the immune system in point of most need of help with antibiotics.

I would advice you to take one spoon turmeric (haldi) and mix it in water and drink ever night, which is known antibiotic for centuries and being an herbal produce we have no fear of sides effects. I will help to cover residual infection.

In case if you think your condition get bit worst then contact me I may need to advice a another different antibiotic course. I don't see the need for another antibiotic for now. Things sound with in accepted results limit.

If in need continue taking cetrizine if you have runny nose. other wise stop it too.

Keep gargling with listerine if you feel good, do it till you feel ok. And if to much worried about fluorine try to collect some data from local water supply to figure out fluorine content in water an send me the data. I will let you know if you should keep using listerine for long time or not.


Above answer was peer-reviewed by
Follow-up: Lost weight. Tests indicated Hyperthyroid. On steroid. Repeated tests indicated hypo. Suggested silent Thyroiditis. Guide? 22 hours later

Thanks for the reply and giving me authorization to criticize you. Well I will not criticize you but as I take time to understand things may be I will put the same questions more or less in an another way to understand them better.


As per our prior discussion , I asked you what's the need of my thyroid gland if its already damaged and if I am already taking Thyroxin Supplement. On that you said that only a part of the gland is damaged and it still performs many other important functions.
Before I proceed further let me summarize few things:

In 2003 I was initially diagnosed with some thyroid issue which was taken care of by Wysolone Steriod , due to lack of right medical guidance I forgot it then and there and just did regular T3,T4,TSH tests which always came normal from 2004-2009.

Now FYI :

During that time I started taking lot of Soya products to XXXXXXX my Protein requirement that I required for bodybuilding. I did not know the fact that Soya is Goiter genic or its doing any kind of damage to my Thyroid gland.

Only in 2010 when my Thyroid issue clearly relapsed , I started avoiding all kinds of Goitergenic foods as advised by the Nutritionist and continued the practice til date.

My Throat looks completely normal and I don't see any kind of external swelling or throat lagging forward at all.

I am 5 kgs overweight and BMI is near to normal. my ideal body weight should be 85 KGS for 6'2 height but I don't look overweight at all due to the muscular physique. My current weight is 90-91 kgs

Questions for you

1. Is it advisable to reduce my body weight further to 85 kgs to avoid any kind of further health risks ? but that will make me look skinny , anyhow if thats advisable I can train that ways.

2. Does Goitergenic food items support Antibodies to attack Thyroid gland ?
If yes will that not be XXXXXXX for my residual Thyroid gland which still functions to some extent ?
3. If the Iodine/Thyroxin level is normal in the blood through the supplement , does it mean the brain does not bother the Thyroid gland to produce more thyroxin ?
4. So that means if I consume Goitergenic food items now , it will not stop absorption of Thyroxin/Iodine in the body ?

But why ? how does the Goitergenic food items know that whether the Thyroxin is being produced by Thyroid gland or being consumed externally ?

Its job seems to interfere in absorption of the same in either cases right ?
5.I had been gar-gelling with listerine only due to my current sore throat issue else I avoid it.

But I did not understand why would you need a report of my local water supply and how does it relate to Listerine ?

Well getting such a report in India is not possible from the water authorities.
6. Is Listerine(Fluroide) anyway even a minor threat to my Thyroid condition if used on regular basis ?


Answered by Dr. Jay Patel 6 hours later
Brief Answer:
let me clarify

Detailed Answer:

Ok let me clarify first the missunderstanding about thyroid gland, the antibody will attack the "normal thyroid hormone producing cells" only their are other cell what works for other reasons. Now in your case some or more of normal cell are destroyed by antibodies, exact number is impossible to calculate.

Now relation between the brain and thyroid gland works in this fashion. Brain do not know how much iodine in their in body it only has sensors for thyroxine -(T3 and T4). As long it detects the level of required T3/T4 its fine, it do not care where it came from either from thyroid gland or from external pill. It will not impose any issue to thyroid to regulate ( its like income tax, consider brain as IRS and thyroid like taxpayer, IRS do not come to harasses tax payer as long IRS receive the money taxpayer owes, like wether its taxpayer's income or money he may have stolen )


Now to answer your question in sequence.
1) As PER BMI- your weight should be around 80 kg +/- 3 kgs. Its optimum for body to work without excess of wastage, like in case of car, you don't need SUV's to travel in city area, it will consume more fuel then regular car. In case for car you are wasting money and fuel in case of heavy body you are trading, healthy long life and disease free life. I would like to recommend you to loose around 10 kg but do it very gradually like 2 kg on year bases if you need more info talk to me. Let me give you example of how big body adversely effect health in very long run. Heart is a pump which need to pump the blood to each and very part of body now with increase surface area of body will require heart to work that much more to get the blood supplied in entire region.

2) No Goitergenic food items do not have any thing to deal with antibodies.
3) YES i Explained the reason in introduction para.
4) Goitergenic food items are known only to decrease absorption of iodine no relation to thyroxine which is finished product has yet been discovered.
5) You may do like use it till you need then just drop it.

The amount of fluorine in water can be measured and water dept will know how much fluorine is present in water near you. Nothing to worry. leave it out of your site.
6) Iodine and fluorine both are halides as per chemistry so it may interchange to some extend. We just as a human race do not know how much it may effect. So just on a safe side avoid using extra fluorine makes a sense.

Above answer was peer-reviewed by
Follow-up: Lost weight. Tests indicated Hyperthyroid. On steroid. Repeated tests indicated hypo. Suggested silent Thyroiditis. Guide? 3 days later

The cough and sore throat symptoms are nearly back. When I take Turmeric in the night , I feel better for a couple of hours but from morning on-wards same symptoms come back and increase in the day. It's happening from the past 2 days. Listerine , saltwater gargles only suppress the symptoms for a while.

I don't have running nose at all.

Please let me know how to deal with this as you had some plans to prescribe a different medicine.

I am taking Vit D3 supplement and I have stopped the multivitamin Sod-ox prescribed by Dermatologist after consuming it for the prescribed duration. Though the Multivitamin never made any changes to my skin condition but I feel Vit D is making some improvement. But due to a bit of diet fluctuation/mismanagement and stress there is a slight relapse of active acne .Topical s don't help much.

Can you prescribe me a medicine which can work together for Cough/cold/Acne together for now.

Just to let you know I have tried other antibiotics in the past like AZITHROMYCIN/Doxycycline/Minoz...they have very little effect on cough or Skin.

Answered by Dr. Jay Patel 9 hours later
Brief Answer:
let us try the other antibiotic.

Detailed Answer:

The other antibiotic is AZITHROMYCIN here is how you take it.
its available in two forms one is "immediate release" and other is " sustained release"

Make sure you read on the medication specifically is it for sustained release or immediate release as I dont know which will be available in near by pharmacy.

(1) Immediate-release: 500 mg orally once a day for 3 days ____dosage
(2) Extended/sustained -release suspension: 2 g orally as a single dose.

"You may need prescription from local doctor to buy antibiotics."

Still keep using turmeric as long you can take it will help to detoxify you body in long run and will help acne too but its very slow process. In summer reduce the dose in half. (e.g if you are taking 1 spoon on turmeric now in summer starting march 2014 make it to half a spoon, again come back up to 1 spoon in august).
(A) Question do you feel like you are having some post nasal dripping ? (sensation of fluid going back from your nose) ?

(B) Do you feel heart burn or like food coming out once you eat? Just little bit as if food is coming up to you mouth like regurgitation ?

If you have any of above symptoms contact me otherwise continue with the azithromycin oral dose.

You may need prescription from local doctor to buy antibiotics.


Now about "acne" the medication which I asked you to have above is some what helpful, but how effective it will be is not certain. More over the acne will be managed only by reliving stress, as even asked you to have some XXXXXXX water and prickle over it at night which will take some heat out of the acne. Their is also a sand called "MULTAN ki MITTI " applying it with cold water will help to take some heat and will allow to relive some stress.

All will work in synergy if you drop one it will not be effective antibiotics can only work in case if its infected so no medicine will work as far as best short is concern.

Their is vitamin - A - RETINOL derivative cream, available which helped some of my patient but result are variable and if you choose to use it make sure use it only during night and clean wipe you face in morning, it have various issues with sunlight so please please be careful. Or you will have photosensitivity issues if sunlight falls on the applied cream region with out washing.



Above answer was peer-reviewed by
Follow-up: Lost weight. Tests indicated Hyperthyroid. On steroid. Repeated tests indicated hypo. Suggested silent Thyroiditis. Guide? 18 days later

As advised by you I took Azithromycin for nearly 5 days but it did not settle down my cough n sore throat. I still have it , it does not increase nor it decreases. Its more in the morning , becomes less in the day. Turmeric,Salt water gargle gives a suppressing effect.

I still have mild sore throat with cough , it did not get worse. No running nose and I breath normally.

As I indicated earlier in the last communication itself I get little relief from Azithromycin.

But if I take Benadryl , I get relief only short term for a couple of hours..I just took it twice , thrice as I did not want to play with my body without knowing whats wrong and the effects of this medicine.

Also constipation is out of control , I had been badly constipated from the past many days.

For my constipation I was taking taking : Softovac SF, when it stopped working alone I added : Looz Syrup 45 -60 ML but when this also was not giving much releif , I added : Dulcolax 2 Tabs BD SOS. All at bed time with half n hour gap. I got relief for some days but then my system became all the more sluggish and the stool evacuation was not happening , In the mean time acne also increased due to aggravated constipation. I feel very bloated when I am constipated.

I had to stop : Looz Syrup and Dulcolax which I took SOS and jump to alternative medicine.

So I took 6 Tabs of Triphala Vati and Softovac SF at bed time. Fortunately this combination is working from the past 3-4 days but I am sure it will stop working sometime soon as anything I take is habit forming and stops working after a while.

I exercise ,eat right food , enough water, sufficient rest . Tired of taking laxatives from the past 13-14 years,

Also for Acne , I am tired of applying Topicals, I am continuing with the same combination of Tbact ointment and Metrogel at night with clindamycin in morning. Nothing else suits my skin for now and makes it red and irritable. Also I am so damm tired of applying topicals from the past 10-11 years and its hard to explain how bad it feels. I wish my body could just stop producing acne rather than applying topical s every day.

I cant take Isotretnoin again though it helped me with acne and it went away but left me with a bigger problem that is eye floaters. I am sure this is the medicine through which I got eye floaters. I am not concerned about floaters if other problems go as its easy to find a solution and address a single problem.

Any how I am trying to keep my coping skills on but it affects me psychologically.

I am continuing with Vit D3 and its been 1.5 months. I am due to get the tests done again at this month end.

Sorry for not putting my concerns in a query format today.


Answered by Dr. Jay Patel 13 hours later
Brief Answer:
It seems like air pollution may be a problem.

Detailed Answer:

Now about your cough we did try to treat it with antibiotics guessing it may be due to infection of some sort but you still have the cough, it means their are the remaining cause to dealt with.

I mostly think you are having a huge air pollution and that seem like one off the major environmental factor causing your allergy. I would like you to take a break and visit near by hill station and spend about 2 weeks and try and see if your cough does changes. The constant cough does relate with environmental pollution. BENADRYL - is ANTI-ALLERGIC medication which works so it gives a strong suspicion about allergy.

Means while its better to rule out for the TB- Best test are an X-RAY Chest and a sputum test. The best and gold standard test is "QuantiFERON®-TB test " I would advice you to have it so that we can put that probability to side ways. I do not think you have TB still you live in a very populated city so their are few chances that you may be affected.


Now about the constipation, its some thing you have to live with since you have very long history about 14 years of constipation. All the remedies you are trying are good to try, each different remedies will work for sometime, so keep changing the remedies and come back to previously stopped remedy and keep on using alternatively. We do have drugs under clinical trial for reliving the chronic constipation which will act on nerves and will relive the constipation via stimulation the nerves to make a bowel movement. But it will take some time and I don't know how long it will take to come to market. If you want to try them you need to see local gastroenterologist and ask them if they have any means to help you in attaining that clinical trial drugs.

Magnesium (400 mg)- per day does make some difference in some patients of chronic constipation, if you want just give it a try.

Either way I advice your to see near by gastroenterologist to make sure every thing else is ok, and we are only dealing with constipation issues.


Your acne issues will exacerbate with constipation so, the improvement will only be seen if the constipation comes under control. Isotretnoin is a vit-a derivative and it will work for acne but you feel like you are having floaters due to it then its fine, not to use it any more.


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