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Taking thyrox. Experiencing dry mouth, weight gain, fatigue, ED and low libido. Required treatment?

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General & Family Physician
Practicing since : 1986
Answered : 458 Questions
I'm a 35-year-old male. I am 5 Feet 10 Inches tall and I weigh about 92 kilograms. I am not a diabetic, but I'm on Thyroxine Sodium (Thyrox) since July 2007, and the current dosage is 125 MCG.

Since the year 2000, I was experiencing 'dry mouth' symptoms, which I mentioned to the doctor who put me on Thyrox. However, this condition was not prominently discussed with the doctor. Other conditions such as weight gain, fatigue, dry skin, etc. were mentioned and the doctor prescribed Thyrox after the TSH test. With the intake of Thyrox, my general health improved.

The 'dry mouth' problem persisted. In December 2011, there was an attack of pain in all the joints simultaneously. I rushed to an orthopedic who referred me to a rheumatologist. The rheumatologist connected the 'dry mouth' and the joint-pain, and diagnosed that I have Sjogren's Syndrome. I was put on HCQS 200 MG thrice a day. The joint-pains ceased. However, the 'dry mouth' persists. The rheumatologist told me that the drugs that may reduce 'dry mouth' has adverse side-effects. One side-effect he mentioned was that my off-spring might be born with some disorder. I am married male but have no issue yet.

The other problems I have are:

1. Erectile Dysfunction,
2. Low Libido,
3. Irritability, Mixed-Anxiety-Depression Syndrome, and OCD, and
4. Fatigue

Before Thyrox treatment started, dry skin, fatigue, irritability, etc. were more severe than these are now. Yet, the problems still persist.

What course of treatment should I take now?
Posted Sat, 11 May 2013 in General Health
Answered by Dr. Nirmala P 6 hours later

Thanks for asking in XXXXXXX

Only symptomatic treatment is given in Sjogren's as it is an autosomal disorder. Since salivation is needed for proper mastication (munching) and swallowing, dry mouth will be a problem interfering in day today activities.

Cholinergics like Pilocarpine and Cevimeline are preferred in the treatment of xerostomia (dry mouth) associated with Sjogren's syndrome. Steroids and immunosuppressants like Cyclosporine given in this condition can cause long term side effects but not the cholinergics.

Pilocarpine is nonspecific but Cevimeline will act specifically on salivary and lacrimal gland and hence has fewer side effects. Also Cevimeline has long standing sialogogic action (increased salivary secretion) given at 30 mg thrice daily. Since the action is more specific on salivary and lacrimal glands it will not result in any side effects in your offspring. Your treating doctor will know about these drugs.

Your fatigue may be due to HCQ (Hydroxy chloroquine). It occurs when HCQ is given for a long period and is reversible on stopping the drug. But do not stop the medications without consulting your physician. Thyroxine may reduce symptoms like dry skin and muscle pain but does not completely abolish tiredness and fatigue.

I hope this helps.
Above answer was peer-reviewed by
Follow-up: Taking thyrox. Experiencing dry mouth, weight gain, fatigue, ED and low libido. Required treatment? 17 minutes later
1. Is Cevimeline 30 MG thrice a day free from serious side effects? What are the minor side effects, if any?

2. How safe is the Aqwet oral spray?

3. Does Sjogren's Syndrome also cause ED? How should I get treated for the same?

4. If HCQ causes fatigue, then what is the alternative? In case I need to continue HCQ, then is there any supplement that I can take to reduce/eliminate fatigue?
Answered by Dr. Nirmala P 1 hour later
Welcome back.

You have asked very specific questions related to drugs mainly and I am happy to note that you have read my suggestions properly.

No drug is devoid of side effects and a drug is usually prescribed depending upon the benefit risk ratio (more benefit than expected side effects). And also the extent of side effects varies in each individual. Therefore never take or stop any drug without your treating doctor's advice

1. Cevimeline can result in mild side effects like increased sweating and tears. Major side effects are frequent urination, abdominal pain and even heart problems. The dose can be reduced if there are minimal side effects. In case of severe side effects, the drug should be stopped.

2. Aqwet is Carboxy methyl cellulose. It is a salivary substitute and a oral moisturiser. It lubricates mouth. It will work in mild dryness. But if the dryness is severe, then you will need salivary stimulant like Cevimeline. Since Aqwet is a oral spray, only minimal amount is absorbed and so does not result in side effects.

3. Erection is an autonomic system (parasympathetic) related function. Sjogren's may or may not be related, but bipolar (mixed anxiety depression) depression can also be the reason for ED and fatigue. Although no reports are available about Cevimeline and ED, this drug acts on M3 receptors responsible for erection and so it may be useful to you.

4. Sjogren's is an auto immune (immunological) condition. HCQ is also an immunosuppressant and its side effects are much less severe compared to other immunosuppressants used in Sjogren's. There is no specific supplement that can reduce fatigue. Vitamin supplements may help to reduce fatigue to a certain extent.

I hope my answers are satisfactory. Please feel free to contact me for further clarifications and I will be happy to assist you.

Above answer was peer-reviewed by
Follow-up: Taking thyrox. Experiencing dry mouth, weight gain, fatigue, ED and low libido. Required treatment? 12 hours later
I am very happy with the in-detail advice, especially the explanation of the usefulness of Cevimeline in treatment of ED. I can see a XXXXXXX of hope, literally.

I know that it is difficult for a doctor to prescribe medications without examination of the patient or without review of the medical records, yet I would request you to clarify the following based upon the medical history that I have already written earlier & reiterated below:

1. I'm a male of 5 Feet 10 Inches weighing 92 kgs. I'm a social drinker. I have quit smoking recently. I was a mild-to-moderate smoker in the past. I'm not a diabetic. I do not have any heart condition though my cholesterol and triglyceride levels are on the higher side;

2. I'm on Thyrox 125 MCG and HCQS 200 MG (thrice daily).

So, can I start Cevimeline 30 MG thrice daily?

Can I continue to take HCQS 200 MG thrice daily?

I have read that Low Testosterone also causes ED, fatigue, irritability, bipolar disorders, etc. So, should I get the Testosterone levels checked?

I want to continue consultation with you because you have given me a holistic picture which, frankly, my doctor has not. So, please suggest me clinical tests that I have to undergo to screen all my problems and I'll upload all those for a more accurate advice.

Answered by Dr. Nirmala P 1 hour later

Thanks for coming back again.

You should definitely continue taking HCQS until the period specified by your Doctor as it will suppress the immunological trigger of sjogren's.

Yes. Deficiency of testosterone causes ED, fatigue and depression (but not Bipolar). Your blood testosterone levels will give an indication about the extent of testosterone deficiency. Testosterone secretion is pulsatile and diurnal (peaks twice) highest at around 8 AM and lowest around 8 PM. So you should check for its level in the morning.

You can take Cevimeline only after your treating doctor's advice. Because Cevimeline is to be used with caution in case of depression due to bipolar disorder. Only your treating Dr can assess the level of the depression as it needs personal examination. If it is minimal, then Cevimeline can be taken.

Testosterone is not given to treat ED. Drugs like Alprostadil are specific for the treatment of ED. Please discuss with your Dr about these drugs.

I hope, I have answered your queries.

Best wishes.
Above answer was peer-reviewed by
Follow-up: Taking thyrox. Experiencing dry mouth, weight gain, fatigue, ED and low libido. Required treatment? 3 days later

What is the brand name of Cevimeline in India? I could not get Cevimeline in a couple of leading pharmacists in Bangalore.

In case Cevimeline is not available, then what is the next best alternative? Does it produce major side-effects? And what will its optimum dosage be?
Answered by Dr. Nirmala P 9 hours later
Good Morning. Welcome back to Healthcare Magic.

Cevimeline is not over the counter drug. You need your Doctor's prescription. Ranbaxy Inc. is marketing it in US under the trade name Exovac. It is not available in India.

However, Ranbaxy Inc and Apotex Inc have plans of launching Generic version of Exovac (Cevimeline hydrochloride) in India. You can get the details from their dealers.

I hope this is useful to you.
Good day. Regards.
Above answer was peer-reviewed by
Follow-up: Taking thyrox. Experiencing dry mouth, weight gain, fatigue, ED and low libido. Required treatment? 43 minutes later
Then, is Pilocarpine the next best alternative? Are there serious side-effects? What is the optimum, as well as maximum, daily dosage for a male weighing 92 kgs?
Answered by Dr. Nirmala P 3 hours later
Hi and welcome back.

Pilocarpine does not act specifically on salivary glands and so is not a suitable drug for you.

Availability of various treatment options does not necessarily mean that it would suit every individual. Unfortunately Sjogren's is an autoimmune condition and so the extent of the disease determines the outcome of the treatment.

I am sorry to say that if the salivary glands are immunologically affected (too much of lymphocytic infiltration), then even Cevimeline would be ineffective.

Starting any drug on your own when you are have an auto immune problem is unwise. Only your treating physician would know the severity and the extent of Sjogren's in you, so please let him decide about your drugs.

I sincerely request you not to ignore this advice.
Good Luck.
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