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Suggest treatment for IBS while on Thyroxine

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Posted on Sat, 28 Feb 2015
Question: I am hypothyroid, diagnosed in 2011,but probably started in 2009. I have had a history of IBS all my life really. I was premature and born in 1960. I developed some unusual symptoms in 2009 where I was having these intestinal attacks where I would have diarrhea and cramping with extreme pain to where the spasm continued even after my colon was through passing stool. I had numerous tests done, but no diagnosis was ever given. I had a colonoscopy in 2001 with precancerous polyps I had an endoscope at one point that showed microscopic inflammation. My stomach has always been very sensitive to everything I probably passed a gall stone in 1995
Recently I passed a kidney stone, which is most likely still in my bladder. They discovered numerous stones in both kidneys. In the CAT scan they found a fatty liver slightly enlarged, along with the kidney stones. My AST and ALT were also elevated around 2 to 3 times normal. Other labs were positive for classic kidney stone passage. I have been having problems with diastolic hypertension. I become almost short of breath if I squat down and lean forward. My colon has been very crampy, my stool greasy. My stool is still very firm as usual but on the outside is fatty looking and toilet paper residue is greasy. When stool is in my lower colon I will have spasms and cramping before during and after BM's till it passes. I started having unusual bloating in my abdomen in 2009 and it has never gone away. I frequently have a bloated balloon type abdomen. I have times of SIBO quite frequently. My abdomen itself has a number of tender areas, and if I message it with a messager the muscles contract like it did when I was pregnant in the past. I have tummy symptoms a lot. I am just recently on full medicare and my husband just retired. I can't afford a lot of medical bills. Should I just go on a gluten free diet and see what happens. I am a little concerned about non hodgekins lymphoma in my intestines my medications are Paxil bentyl levothyroxine and amitryptalline.
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Answered by Dr. Sandip Kabra (4 hours later)
Brief Answer:
Protein diet except gluten will be helpful

Detailed Answer:
Hi XXXXXXX good morning
Thanks for asking questions on HCM.

First you continue with your thyroxine with periodical serum TSH monitoring atleast once in year.

Seconds IBS, amitryptiline is good but you can take antispasmodics on as and when required basis with diet containing high fiber like cucumber cabbage or carrot etc, avoid taking carbohydrates like fructose and lactose diet which will greatly reduce your abdominal symptoms.

Protein diet except gluten will be helpful you can continue with that.

For diastolic hypertension you should start antihypertensive medication with physician consultation.
You can reduce weight if your BMI is above 30 otherwise no need to worry about fatty liver.
Kidney stones if they are less than 6 mm size then there can be chances of passing in urine for that will have to take one more drug Tab.Tamsulosin hydrochloride 0.4 mg once in night will dilate your ureter allowing passage for stone to void with urine by simultaneously drinking excess water 5 to 6 liters per day.

Non Hodgkin's lymphoma, you will have to see a gastroenterologist for further medical intervention.

I hope I have covered all your medical problems one by one,if still something you want to know then kindly let me know,
Take care
Above answer was peer-reviewed by : Dr. Shanthi.E
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Follow up: Dr. Sandip Kabra (11 hours later)
Thank you for answering my questions. Just a few more. My bottom figure is the one that is high, which I understand goes along with vessels becoming less flexible and is seen with low thyroid. My thyroid tests were borderline T4 was the only one in the range. My TSH was over 2.0 and T3 was low just out of range. I am on 75mcg per day and I take it on an empty stomach in the am. I have been very consistent with it. I take bentyl fairly regularly and have been having more intestinal colon symptoms with spasming I can put my hand on my abdomen and actually feel tightening like I could feel my uterus during times of pregnancy. I am 55 years old and had a abalation back in 2007 for heavy bleeding which may have been due to my Thyroid at the time. I was diagnosed with hypothyroid in 2011. Probably was present since 2009 when I was having severe abdominal cramping attacks that were really bad. I have been having regular night sweats, but mild as far as amount of sweating. It is strong sweat though, and during the day physical activity that is taking effort produces sweating on forehead, under breasts, and along inside of groin. I was wondering about menopause, but with abalation I stopped having periods. Should I persue confirmation of CD, and what would I look for as far as Nonhodgkins being a possibility. I really hate going to the doctor all the time etc. I have major DDD and spinal stuff and pain and energy and comfort etc. and my nerves take a toll dealing with more than I ususally do. Sorry this is long but my regular doctor is nice but he has an assembly line type of practice and is an older man so I don't talk with him about female type attitude etc. Also my liver enzymes were 2 to 3 times normal which is new in the last 6 months, ast and alt. Thanks
doctor
Answered by Dr. Sandip Kabra (37 minutes later)
Brief Answer:
continue with thyroxine and see cancer surgeon

Detailed Answer:
Hi XXXXXXX
Thank u for asking follow up question.

First if your TSH is still high then you can take thyroxine 100 and 75 alternatively, your night sweating or bowel spasm can be because of high TSH level.
Now, if you have already been suspected non- Hodgkin's lymphoma then you will have to see cancer physician ahead, I won't be able to help through online in this regard.
Now your disc problem, DDD is a degenerative disc disease due to age related changes due to loss fluid or affection to disc,you can take NSAIDs or steroids with good exercises,loosing weight or lastly orthopedic surgery.

If you have elevated liver enzymes AST and ALT,they are the markers of jaundice. Abdominal ultrasound would help further to find out liver status, Tab.Udilive 300 mg would provide supplements of liver engymes if you are asymptomatic right now.

Hope you understand my answers.
Thanks and regards,
Dr.Sandipkabra
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Dr. Sandip Kabra

General & Family Physician

Practicing since :2009

Answered : 3078 Questions

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Suggest treatment for IBS while on Thyroxine

Brief Answer: Protein diet except gluten will be helpful Detailed Answer: Hi XXXXXXX good morning Thanks for asking questions on HCM. First you continue with your thyroxine with periodical serum TSH monitoring atleast once in year. Seconds IBS, amitryptiline is good but you can take antispasmodics on as and when required basis with diet containing high fiber like cucumber cabbage or carrot etc, avoid taking carbohydrates like fructose and lactose diet which will greatly reduce your abdominal symptoms. Protein diet except gluten will be helpful you can continue with that. For diastolic hypertension you should start antihypertensive medication with physician consultation. You can reduce weight if your BMI is above 30 otherwise no need to worry about fatty liver. Kidney stones if they are less than 6 mm size then there can be chances of passing in urine for that will have to take one more drug Tab.Tamsulosin hydrochloride 0.4 mg once in night will dilate your ureter allowing passage for stone to void with urine by simultaneously drinking excess water 5 to 6 liters per day. Non Hodgkin's lymphoma, you will have to see a gastroenterologist for further medical intervention. I hope I have covered all your medical problems one by one,if still something you want to know then kindly let me know, Take care