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What Causes Lost Appetite, Nausea, Diarrhea, Anxiety, Panic Attacks And Weight Loss?

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Posted on Mon, 20 Jul 2015
Question: Since about 8 months, I was suffering from loss of appetite, nausea and some bouts of diarrhea, great anxiety, panic attacks and weight loss (about 20 kilograms). At the beginning, I was treated for about 3 months from IBS. I went to another doctor and during investigations and blood tests I discovered that I have mild hyperthyroidism. He prescribed me Inderal 10 mg for about 1 month. Then after a month the symptoms increased and I was prescribed neomercazole 3 tablets daily, but my condition worsened. The tablets were increased to 6 daily for 6 weeks and a partial improvement was seen in fatigue and sleep after several weeks. I made a blood test on 25/5/2015 (attached) and the doctor told me that this is a strong dose and I neeed to decrease the dose from 6 to 4 pills starting from this date. I made another test after 17 days on 13/6/2015 to check the levels (attached) and the doctor told me to keep the same dose. I noticed that at the end of the second week after decreasing the dose I had some bouts of diarrhea, then symptoms began to worsen again this week which is the third after decreasing the dose. I have some pulsations in my head again, dry mouth, dehydration, more weight loss, can not eat all, can not sleep well, severe anxiety, some shakiness (athough I was still suffering from nausea and anxiety while taking the 6 pills). I am afraid because I won't be able to contact my doctor now and after making the next blood test. I increased the dose from 4 to 5 pills since last Sunday (2 at 6 am, 2 at 2 pm and I increased one at 9 pm) because I feel again that my symptoms are not controlled. I am even afraid that there is a setback as some of the symptoms which had already gone returned and the dose needs further increase despite the normal lab results. Despite increasing the dose by 1 pill since last Sunday, I am still feeling unwell. I heard before that it is ideal to gradually decrease the dose. Was it wrong to cut the dose by 2 pills at once and why did the symptoms worsened after some partial improvement in the last period.
doctor
Answered by Dr. Noble Zachariah (12 hours later)
Brief Answer:
Your hyperthyroidism is under control but anxiety is not

Detailed Answer:
Hello,

Welcome and thanks for your query.
I understand your concern.
Both the results you have uploaded show normal Thyroid Functions. Please upload the results by which you were diagnosed to have Hyperthyroidism.
The symptoms of anxiety and hyperthyroidism are very similar and overlap.
The cause of your present symptoms with normal TFT is anxiety.
If you are off Inderal, you should restart Inderal at 10 mg twice a day and step it up depending on your heart rate. Your symptoms are likely to get better. If not at a satisfactory level, you would require to be on anxiolytics which are prescription medicines and it would be better to see a psychiatrist in addition.
There is nothing to worry about the medicines. In addition you require to have a healthy life style eating wholesome food, avoid alcohol and caffeinated beverages, exercise a minimum of 30 minutes of moderate exercise a day and practise stress relieving measures like yoga, meditation and relaxation techniques.
Above all you should have a positive attitude and a firm belief that you will get well inspite of the present set back.
Do get back to me if you have more queries.
Best wishes,
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Noble Zachariah (11 hours later)
I stopped Inderal because my blood pressure sometimes get low 90/60 and 100/70. What is increasing my anxiety is the feeling of being nauseated even before discovering my hyperthyroidism and the fear of entering into a bout of vomiting and diarrhea and my continuous weight loss. What is worrying me is that I am following with 2 doctors one for my IBS and the other for my thyroid and the doctor f my IBS told me that 6 tablets of neomercazole is a strong dose for me and I should lower to 4 so I did. When I went to my thyroid doctor even after the results were better after 6 weeks he asked me to keep the same dose, then after 2 weeks he asked me to reduce to 5. I already reduced to 4 for a whole month because I was afraid of my colon and to turn hypo and since last Sunday I increased to 5 since my symptoms worsened. So I am perplexed and do not know what to do. People around me advised me to follow the instructions of the thyroid doctor even though the doctor of my IBS is also specialized in other branches as diabetes and endocrinology and he is the one who discovered my hyperthyroidism. Should the dose be lowered after symptoms control or after levels get normal. At the beginning before treatment even after the blood test dated 25/3/2015, symptoms got more worse. When I turn from side to side in bed I could hear my heart pulsations, shakiness, complete fatigue and I could not eat at all so I am afraid to turn to the beginning. I am attaching the earlier tests before treatment.

I am attaching earlier tests before treatment
doctor
Answered by Dr. Noble Zachariah (1 hour later)
Brief Answer:
Mildly hyperthyroid to start with

Detailed Answer:
I have reviewed all your results. Your hyperthyroidism is only mild and is related to a thyroiditis. You don't require such a high dose.
There is nothing to worry about a BP of 90/60 if you are not symptomatic. My BP is the same.
You restart Inderal 10 mg twice a day and see the difference.
After you feel better, reduce the neomercazole.
I can even monitor you remotely if you want.
Start the stress management methods I had suggested and enjoy better health and better life.
Best wishes,
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Noble Zachariah (46 hours later)
I made sometests (attached). The dose of neomercazole needs to be reduced and I do not know my doctor will agree or not. What worries me a lot is the cortisol 9 am level. Is this level dangerous. I will not be able to see my doctor until next Friday.
doctor
Answered by Dr. Noble Zachariah (35 minutes later)
Brief Answer:
TFT is suggests Neomercazole dose more than required.

Detailed Answer:
Your latest results show the TSH in the hypothyroid range, showing that you are going into hypothyroidism from the overuse of Neomercazole. It is an indication that you should reduce your dose like I had suggested before.
If you are fasting Ramadan or your sleep pattern is disturbed you should not be attaching much value to the cortisol result. If you are fasting, the morning is like the normal evening and cortisol levels are lower in the evenings.
There is nothing to worry unless you have postural hypotension.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Noble Zachariah (9 minutes later)
Should the dose be reduced from 5 to 3 because I remained for 4 weeks on 4 tablets and I think these are the results of this month then increased to 5 since last Sunday. I am afraid my doctor won't agree to reduce the dose because he insisted before on 5 tablets eventhough I told him I am afraid of turning hypo. Also I heard that the dose should be gradually reduced, but now I should reduce from 5 to 3. Can this make me hyper again or aggravate my symptoms because the dose should be gradually reduced. I am not fasting because I am taking the medication every 8 hours , but I am afraid of the cortisol test result especially that it was 4.7 (4.3-22.4) on 13- 6 - 2015 then dropped to 3.6 yesterday in the same month.
doctor
Answered by Dr. Noble Zachariah (26 minutes later)
Brief Answer:
Suggestions follow

Detailed Answer:
Reduce to 4 tablets now and then to 3 after 3 days. Continue your Inderal.
Repeat the Cortisol both am and pm after a month. Don't worry as you have no symptoms of Addison's disease.
Wish you a good day
Note: For further follow up on digestive issues share your reports here and Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Noble Zachariah

Internal Medicine Specialist

Practicing since :1974

Answered : 2319 Questions

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What Causes Lost Appetite, Nausea, Diarrhea, Anxiety, Panic Attacks And Weight Loss?

Brief Answer: Your hyperthyroidism is under control but anxiety is not Detailed Answer: Hello, Welcome and thanks for your query. I understand your concern. Both the results you have uploaded show normal Thyroid Functions. Please upload the results by which you were diagnosed to have Hyperthyroidism. The symptoms of anxiety and hyperthyroidism are very similar and overlap. The cause of your present symptoms with normal TFT is anxiety. If you are off Inderal, you should restart Inderal at 10 mg twice a day and step it up depending on your heart rate. Your symptoms are likely to get better. If not at a satisfactory level, you would require to be on anxiolytics which are prescription medicines and it would be better to see a psychiatrist in addition. There is nothing to worry about the medicines. In addition you require to have a healthy life style eating wholesome food, avoid alcohol and caffeinated beverages, exercise a minimum of 30 minutes of moderate exercise a day and practise stress relieving measures like yoga, meditation and relaxation techniques. Above all you should have a positive attitude and a firm belief that you will get well inspite of the present set back. Do get back to me if you have more queries. Best wishes,