Q: I am a 53 years old man suffering from depression for the past 4 years. The doctor says that it is endogenous, which recovered twice and got cured through electroconvulsive therapy (ECT) but I have to take Velenfaxin 75 mg daily. I am taking Eltroxin thrice a day for hypothyroidism. The recent reports states my T-3 is 1.8 ug/ml, T-4 is 8 ug/ml and thyroid-stimulating hormone (TSH) level is 0.1 iu/ml. These results came after taking 3 tablets of 100 mcg Eltroxin. I have a severe joint pain problem and my weight is also increasing, which is 104 kg now. I take Alprocontin 5 mg daily for sound sleep. Please advise how to control weight gain and remedy for joint pains.

A:A large number of medications used in daily clinical practice have potentially detrimental effects on the skeleton (bones and joints). In your case, it is thyroxine (Eltroxine). Excessive doses of thyroid hormone can accelerate bone remodeling and result in bone loss causing joint pain. I would like to advise you to do bone marrow density (BMD) for estimating bone density and skeletal masses. The dose of Eltroxine is adjusted on the basis of TSH levels, with the goal of treatment being normal TSH, ideally in the lower half of reference values. In your case it is 0.1 iu/ml. Do consult a physician for dosage and schedule. Recently, a meta-analysis of studies performed, indicated that weight-bearing exercises prevent bone loss, beneficially effect nerve and muscles, improve co-ordination and balance and reduce the risk of falling. You don't need to worry about 104 Kg. The symptoms, which you have, are the most common ones in hypothyroidism, for which you don't need to worry or go into depression. Your intelligence is always normal, perhaps brighter than others. Do not hesitate to start walking, doing physiotherapy because of joint pain, which will again worsen your condition. A walking programme is a practical way to start reducing the weight. It keeps your nerve-muscle junction strong, and thus preventing direct load on weight bearing joints, relieving your joint pains. Strong muscle = Strong Joint = Reduced Pain If you find it initially difficult to walk, you will benefit from swimming and water exercises. I would advise you to take all the medications as of now, and in addition have T. Osteofos 70 microgram in a glass of water once a week in early morning, empty stomach and not to lie for 30 minutes after the tablet along with T. Citromacalvit 2 tab a day (Day and night). The safest painkiller will be Crocin 1 gm at the time of pain.