Q: I am a hypothyroid patient. About 11 years ago I was diagnosed to have osteomalacia as my alkaline phosphatase levels were extremely high. I was put on Shelcal 500 - 2 tabs daily and a sachet of Vitamin D. Three years later I was put on Eltroxin which is continuing even today. Nine years back my weight was 47 kgs which increased to 58 kgs and now it is 70 kgs. My height is 155cms. My weight remains between 65-70 kgs despite my best efforts and despite taking 150 mcgs Thyronorm. My latest readings (a month ago) were TSH-7.0 (range 0.3-4.0 mU/L) and T4-160 (range 52-167 n mol/L) which nine months back were TSH-8.0 and T4-150 while I was on Thyronorm 100 mcg. Since last month the dose has been increased to 150 mcgs. I get cramps in my legs almost everday. I am very regular with my medicine.

A:Weight gain can be due to several causes, but the most common is an imbalance between dietary intake and output (basal metabolism + exercise). Both the T4 values were high-normal while TSH was only borderline raised, so for practical purposes you are not hypothyroid and thus your being overweight is unlikely to be because of hypothyroidism. Without a history and physical examination, it is difficult for me to specifically advise you about cramps/ osteomalacia/ overweight. However, I can give you some general information. Losing weight requires long term commitment on your part, but gives tremendous returns in the form of lower risk of diabetes, BP, high lipids, osteoarthritis, and many other health problems. Under the guidance of your doctor, you will benefit from: 1. Exercising regularly. The best way is to start by walking 15-20 minutes and increasing it to about 40-50 minutes per day. This can be in one stretch, or divided into 2-5 parts of 10-20 min each, depending on general health, weight, condition of knees etc. Later, you should add some weight bearing upper body arm exercises also. 2. Eating regularly: NO missed meals, especially breakfast: missing meals reduces basal metabolism and can increase weight gain 3. Eating sensibly by: a) making sure you are taking sufficient amounts of LOW FAT milk in the form of milk or milk products. This is especially important for you in view of the past osteomalacia; b) taking enough fruits and salads, c) reducing excess fat intake in your diet, in the form of oily vegetable cooking, parathas, ghee on chapatis, fried snacks eg pakoras, namkeens, mixture, murku, etc. In addition, you may be advised to 1. Get your BP checked. 2. Get blood sugar (both fasting and post-breakfast), cholesterol and other lipid levels tested. 3. Get your serum calcium, phosphorus and alkaline phosphatase checked regularly, and make sure you are not overdoing (or underdoing) the calcium and Vitamin D supplements. Please stay in regular follow-up with a good physician/endocrinologist for proper treatment.