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diagnosed Hypothyroid and taking Synthroid. Having weight loss. Sugar, lipid, HDL, LDL is normal. Root cause?

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Ayurveda Specialist
Practicing since : 2003
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Attached is my Symptoms and Test Results;
Symptoms have been existing for the past 15 years but the intensity and frequency is increasing.
The weight loss is high; from 156lbs to 139lbs.
MRI and CT Scan also came normal. I am diagnosed Hypothyroid and taking Synthroid 75mg daily.
Thyroid, sugar, lipid, HDL, LDL is normal.
What other tests can be performed to identify the root cause?
Posted Sat, 20 Jul 2013 in Ayurveda
 
 
Answered by Dr. Munish Sood 1 hour later
Dear XXXXX,
Thanks for contacting Ayurveda with your concern and going by your history following points needs clarification before proceeding for further work up and management.
1.     You said you were diagnosed hypothyroid and in the next line thyroid profile is normal,so point which is to be clarified: IS or WAS? Because weight loss can also result for over treating an under active thyroid?
2.     Weight loss suggests some underlying disease and as low grade fever, and other associated features are there, make sure suitable X-ray along with Ultrasongraphy of Abdomen is done to rule out any Lung or Intestinal disease.
3.     You haven’t mentioned about the bowel habits i.e. whether constipation or loose stool is there to rule out any Inflammatory Bowel Disease which can be a cause of weight loss and blood in stool.
4.     Were you treated with Avloclor for Amoebiasis whose side effect are the symptoms which you have already mentioned and moreover it is a parasitic infection of intestine resulting in blood mucus stool and weight loss.
5.     Pain is in right abdomen so best option is to consult a Gastroenterologist who will either go with Endoscopy or Colonoscopy.
6.     Please revert back with your views regarding the same,will be duly looked upon.
Dr. Munish Sood
MD. (Ayu.) Kayachikitsa
Consultant & Physician
Naimittika Clinic.
Above answer was peer-reviewed by
 
Follow-up: diagnosed Hypothyroid and taking Synthroid. Having weight loss. Sugar, lipid, HDL, LDL is normal. Root cause? 8 hours later
Dr. Sood,

1. You said you were diagnosed hypothyroid and in the next line thyroid profile is normal,so point which is to be clarified: IS or WAS? Because weight loss can also result for over treating an under active thyroid?
> I was diagnosed Hypo and am taking Synthroid 50mg so recent blood test is normal

2. Weight loss suggests some underlying disease and as low grade fever, and other associated features are there, make sure suitable X-ray along with Ultrasongraphy of Abdomen is done to rule out any Lung or Intestinal disease.
> CT-scan of abodmen is normal.

3. You haven’t mentioned about the bowel habits i.e. whether constipation or loose stool is there to rule out any Inflammatory Bowel Disease which can be a cause of weight loss and blood in stool.
> Usually normal wel formed; sometimes hard with mucous; sometimes mucous only and sometimes loose; I do see blood stains sometimes.

4. Were you treated with Avloclor for Amoebiasis whose side effect are the symptoms which you have already mentioned and moreover it is a parasitic infection of intestine resulting in blood mucus stool and weight loss.
> I was treated for amoebiasis twice about 15 years back;

5. Pain is in right abdomen so best option is to consult a Gastroenterologist who will either go with Endoscopy or Colonoscopy.
> Yes I have attached the endoscopy / biopsy results

Thanks,
XXXXX
 
 
Answered by Dr. Munish Sood 5 hours later
Dear XXXXX

1.     What is your assessment of weight loss: whether it is lost grossly or it is a small weight loss? And what is the relationship of APPETITE with Weight loss i.e. is appetite increased or decreased with weight loss???
2.     Any history of addiction to alcohol or drugs,malabsorption syndromes?
3.     Examine for Hb%,WBC,ESR,FBS & Urine Routine.
4.     Though CT-Abdomen came out normal (i.e. Malignancy with chronic amoebic hepatitis can be excluded), go with Chest X-ray to rule out any lung pathology.
5.     Are you free from Amoebiasis now? Go for Sigmoidoscopy to rule out Amoebic ulcer in Intestine, also presence of mucus in stool is/can be due to Ulcerative colitis, IBS, Malabsorption syndrome
6.     If you see occasional blood streak go for stool test for occult blood.
7.     Endoscopy/biopsy attached reports are still not in the Query section, so unable to comment anything, make sure you have done the needful, regarding the same.

Dr. Munish Sood

Above answer was peer-reviewed by
 
Follow-up: diagnosed Hypothyroid and taking Synthroid. Having weight loss. Sugar, lipid, HDL, LDL is normal. Root cause? 8 hours later
Dr. Munish Sood,
1. What is your assessment of weight loss: whether it is lost grossly or it is a small weight loss? And what is the relationship of APPETITE with Weight loss i.e. is appetite increased or decreased with weight loss???
> Appetite is normal; Though I reduce intake when my stomach aches.

2. Any history of addiction to alcohol or drugs,malabsorption syndromes?
> No
3. Examine for Hb%,WBC,ESR,FBS & Urine Routine.
> WBC count and Urine came normal; Eosophinil count was high;
> I am not sure why you are not able to see the attached reports.
> I uploaded it again may be some defect/bug in this system.
>
4. Though CT-Abdomen came out normal (i.e. Malignancy with chronic amoebic hepatitis can be excluded), go with Chest X-ray to rule out any lung pathology.
> Check X-ray was also normal

5. Are you free from Amoebiasis now? Go for Sigmoidoscopy to rule out Amoebic ulcer in Intestine, also presence of mucus in stool is/can be due to Ulcerative colitis, IBS, Malabsorption syndrome
> I may be having chronic fungi problem; but will ask the Dr about Amoebic Ulcer test.

6. If you see occasional blood streak go for stool test for occult blood.
> Ok
7. Endoscopy/biopsy attached reports are still not in the Query section, so unable to comment anything, make sure you have done the needful, regarding the same.
> Re-uploaded it; if you cannot see it then system admins can help.

Thanks
 
 
Answered by Dr. Munish Sood 16 hours later
Dear XXXXX,

Thanks for providing additional details. My comments based on the reports are as follows:

1. Stool Examination is Negative; thus high eosinophil count due to parasitic infection is less likely.

2. History of Asthma/Bronchitis (Allergic Disorder) was in childhood. As the recent chest X-ray came normal, it is a positive sign. Consider consulting a chest physician if symptoms recur.

3. WBC count came normal - eosinophilic leukemia is less likely. It is preferable to perform H.I.V. test as routine if weight loss contiues.

4.Make sure you are not on drugs like Aspirin, Iodides, Nitrofurantoin, sulphonamides which can result in Eosinophilia

5. Consult with your Doctor and discuss about the possibilities of "Tropical Eosinophilia” (low grade fever, loss of weight, fatigue and abdominal pain are some of its symptoms)

6.“Eosinophilic esophagitis” is written in the Endoscopy report (clinicopathologically) with inactive gastritis with negative for H.Pylori infection. You are given dietary modification.

Hope this answers your query. Let me know if you need clarifications.

Dr. Munish Sood
Naimittika
Above answer was peer-reviewed by
 
Follow-up: diagnosed Hypothyroid and taking Synthroid. Having weight loss. Sugar, lipid, HDL, LDL is normal. Root cause? 44 hours later
Dr. Sood,
Thanks for your reply.

Was Tested for HIV first and negative; I could feel the heat
in my back /spine; Later the next day I had
Loose watery stool and back heat/inflammation reduced and pain got localized; I usually develop a boil and slight pus.
You mentioned about the diet modification; Can you please elaborate on it?
Usually if I am on liquid diet, my bone pain; abdomen pain gets reduced but does not get cured.

Thanks for your analysis.
 
 
Answered by Dr. Munish Sood 3 hours later
1.     Regarding esophagitis:
. AVOID: newly harvested rice,chick pea flour,white dal,horse gram, potato,brinjal,spices,tea-coffee,alcohol,junk food,day sleeping (nap is good),sesame,salt,curd,refined flour and citrus fruit.
.Take: wheat, green gram,bitter gourd,white gourd melon, well cooked green leafy vegetables (not raw),old rice,harad,garlic,honey,pomegranate,amla (indian gooseberry)
2.     Home remedy: you can take Soda bicarbonate 10gm or olive oil 10ml once a day (don’t take at once rather sip at gap of 10 minutes)
3.     Bone pain could result from deficiency of Vitamin D, apart from any other source, so make an appointment regarding the same with an Orthopaedic Surgeon.
4.     Boils themselves are not infective but the bacteria that causes it are, although your sugar came out to be normal, consult with your Doctor for any other pathology.

Dr. Munish Sood
Above answer was peer-reviewed by
 
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