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What Causes Severe Fatigue And Sudden Weight Gain While Treating Crohn's Disease?

Posted on Fri, 5 Feb 2016

Question: Hello Dr. Bienenfeld. I have BPD and Crohn's disease. I just had a series of blood tests and my Lithium level was 1.1 and my TSH was over 4. I had taken my Lithium 4 hours before the test, which could have been a contributing factor to these numbers. I also take Entecort, Librax and Linzess for my Crohn's (as I have had several surgeries and risks of obstruction). My symptoms are extreme fatigue and some rapid weight gain (which I needed, quite frankly). I could not tolerate the hypothyroid medicine the last time this happened. What do you suggest? My magnesium level is a bit high, and my creatine level seems off. I run my own business, and I literally cannot move from the fatigue.

Answered by Dr. Chintan Solanki (2 hours later)

Brief Answer:
lamotrigine will be better option than lithium

Detailed Answer:
Hello,

Thanks for writing to us.

I am Dr. Chintan Solanki , MD- Psychiatrist, and I used to face such problems in my clinical practice with patients of BPD.

Lithium 1.1 after 4 hours is still normal so it is fine. TSH 4 is also normal according to most of the laboratories reference value; however for clarification it is better to upload the report or write down the report with reference range and unit. If it is confirmed that your hypothyroid was side effect of lithium and you are not able to tolerate hypothyroid medicine, I recommend switching to other mood stabilizer like lamotrigine instead of lithium.

considering history of Crohn's disease I also recommend going for serum Vitamin B12 level as it is common problem with this disease and responsible for fatigue symptoms. If B12 comes low, supplements in form of injections will be helpful.

Let me know more information.

- What dose of lithium is going on and since when?

- Since when do you have hypothyroid and how much micro gram of synthyroid are you taking?

- Have you tried any other mood stabilizer medicine in past, if yes please provide details.

- Upload the reports if feasible.

I will be happy to help you further after your response.

Regards,
Dr.Chintan Solanki.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Chintan Solanki (4 hours later)

My PDOC has just reduced my Lithium from 675mg. to 450mg. I am on 200 mg. of Limictal. I have been on both medications for 6 years. There has never been any correlation between the dosage of Lithium I am taking and my Lithium serum level, which is very strange (as I have taken upward of 900 mg. of Lithium and my serum level has tested at .4). I only took synthryoid one time, and it made me ill, so I stopped it. My PDOC has never been worried about my TSH level until now, which is why he is reducing the Lithium. I have taken every SSRI, MAOI, and anti-psychotic on the market, and did not respond well. Only Lithium and Limictal have worked for me. I refuse to take any medication in any of those three categories. In the latest panels taken this week, my magnesium was high (which no one can explain). I can try to send all the lab results as soon as I can.

Answered by Dr. Chintan Solanki (3 hours later)

Brief Answer:
lamicatal can be increased

Detailed Answer:
Hi,

Thanks for information. It is good that you are on lamictal(lamotrigine) and tolerating it well. Even after stopping the lithium, there is chance to increase lamictal dose for your BPD if needed.

Yes your lithium level and dose correlation is really unpredictable. Ideally lithium level should be done after 12 hours of taking dose. If feasible go for retesting. If level is less than 0.35, it is not at all useful.

Your TSH level if at all in slight higher limit after stopping the lithium it can come to normal.

I can comment further after seeing the detail reports.

Take care.

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar