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Hi again
I have been taking Budesonide 9mg and Mesavant 2400mg since November. My symptoms did seem to improve but over the last week or so I have been having episodes of severe pain leading up to a BM and also extreme urgency... when I gotta go I gotta go :) My GP did some blood tests last week and found my Thyroxine dose needs to be increased for the 1st time in 4yrs. Has anyone else found steroids have affected their Hypothyroidism like this?
steroids affecting hypothyroidism?
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Hi Becky,
I'm sorry to hear that you've been having problems. A poll among the members here show that we are 7 times as likely to have thyroid issues as anyone in the general population. That suggests that microscopic colitis is very strongly associated with thyroid issues, even before any medications are considered. Another thing to consider is the fact that as time goes on, hypothyroidism usually becomes worse, not better, so a need to increase the dosage rate of thyroid supplement is often a normal development. I've never taken a corticosteroid, but I had to start taking a thyroid supplement several years after my MC symptoms began, and I had to increase the dosage, after a while.
Many drugs can affect the results of the tests commonly used for diagnosing and monitoring thyroid problems. This includes drugs such as estrogen-containing birth control pills, heroin, androgens, anabolic steroids, nicotine, and glucocorticoids, (such as prednisone or budesonide), (and there are many other drugs that can cause problems, as well). That doesn't necessarily mean that a higher dosage rate of thyroid supplement is needed - it may mean that the test results are flawed, because of certain medications.
IOW, for example, your doctor should be using Free T4 tests, (not total T4, as is commonly used). If you took an aspirin, (or any other NSAID), before your thyroid test, for example, it would probably distort your test results. However, if you happen to be taking certain drugs, (such as phenytoin or carbamazepine), Free T4 results would be corrupt, and could not be relied upon. The research article at the following link describes in detail the problems with drug interactions and thyroid disease.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1070767/
Regarding your recent problems with increased pain and urgency prior to BMs, IMO, that is probably due to your developing an intolerance for the Mezavant. For many of us, NSAIDs can trigger an MC reaction, and anyone who is sensitive to NSAIDs, is also very likely to be sensitive to mesalamine, since it is a derivative of salicylic acid, similar to NSAIDs. For such individuals, the mesalamine, (Mezavant is a brand of mesalamine), causes the production of leukotrienes, resulting in increased inflammation, which causes the symptoms that you describe. Here is a reference on that:
http://www.nejm.org/doi/full/10.1056/NE ... 3263381320
IMO, doctors who prescribe budesonide together with mesalamine don't understand microscopic colitis very well, and they don't understand the risks of using those two drugs together. The point is, if the budesonide works, then the mesalalmine is totally unnecessary. The problem with using them together is that if the patient reacts to NSAIDs, then, the mesalamine will overcome the ability of the budesonide to maintain remission, and the symptoms will relapse.
I'm not a doctor, so I can't advise you to stop taking the Mezavant, but if I were in your shoes, that's what I would do. If the Mezavant is the problem, then you should be doing much better, a few days or so after you stop taking it.
Good luck with this.
Tex
I'm sorry to hear that you've been having problems. A poll among the members here show that we are 7 times as likely to have thyroid issues as anyone in the general population. That suggests that microscopic colitis is very strongly associated with thyroid issues, even before any medications are considered. Another thing to consider is the fact that as time goes on, hypothyroidism usually becomes worse, not better, so a need to increase the dosage rate of thyroid supplement is often a normal development. I've never taken a corticosteroid, but I had to start taking a thyroid supplement several years after my MC symptoms began, and I had to increase the dosage, after a while.
Many drugs can affect the results of the tests commonly used for diagnosing and monitoring thyroid problems. This includes drugs such as estrogen-containing birth control pills, heroin, androgens, anabolic steroids, nicotine, and glucocorticoids, (such as prednisone or budesonide), (and there are many other drugs that can cause problems, as well). That doesn't necessarily mean that a higher dosage rate of thyroid supplement is needed - it may mean that the test results are flawed, because of certain medications.
IOW, for example, your doctor should be using Free T4 tests, (not total T4, as is commonly used). If you took an aspirin, (or any other NSAID), before your thyroid test, for example, it would probably distort your test results. However, if you happen to be taking certain drugs, (such as phenytoin or carbamazepine), Free T4 results would be corrupt, and could not be relied upon. The research article at the following link describes in detail the problems with drug interactions and thyroid disease.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1070767/
Regarding your recent problems with increased pain and urgency prior to BMs, IMO, that is probably due to your developing an intolerance for the Mezavant. For many of us, NSAIDs can trigger an MC reaction, and anyone who is sensitive to NSAIDs, is also very likely to be sensitive to mesalamine, since it is a derivative of salicylic acid, similar to NSAIDs. For such individuals, the mesalamine, (Mezavant is a brand of mesalamine), causes the production of leukotrienes, resulting in increased inflammation, which causes the symptoms that you describe. Here is a reference on that:
http://www.nejm.org/doi/full/10.1056/NE ... 3263381320
IMO, doctors who prescribe budesonide together with mesalamine don't understand microscopic colitis very well, and they don't understand the risks of using those two drugs together. The point is, if the budesonide works, then the mesalalmine is totally unnecessary. The problem with using them together is that if the patient reacts to NSAIDs, then, the mesalamine will overcome the ability of the budesonide to maintain remission, and the symptoms will relapse.
I'm not a doctor, so I can't advise you to stop taking the Mezavant, but if I were in your shoes, that's what I would do. If the Mezavant is the problem, then you should be doing much better, a few days or so after you stop taking it.
Good luck with this.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Hi Tex
Thanks for the link. It was a raised TSH which led to an increase in dose of Thyroxine. Looking at the table in the article the steroids should lead to a decreased TSH, so I'm confused!
I was unable to tolerate Ibuprofen, even before my LC diagnosis so I think you may have hit the nail on the head there :)
I am seeing my Gastroenterologist for follow up next month, but I don't hold out much hope there. He was very unhelpful at my last appt in November, bordering on unpleasant.
Some people really are just in it for the money aren't they?
Thanks for the link. It was a raised TSH which led to an increase in dose of Thyroxine. Looking at the table in the article the steroids should lead to a decreased TSH, so I'm confused!
I was unable to tolerate Ibuprofen, even before my LC diagnosis so I think you may have hit the nail on the head there :)
I am seeing my Gastroenterologist for follow up next month, but I don't hold out much hope there. He was very unhelpful at my last appt in November, bordering on unpleasant.
Some people really are just in it for the money aren't they?
That may mean that your need for more thyroid hormone supplement was so strong that the corticosteroid couldn't make much of a dent in it. At least this way it's pretty clear that you do need a higher dose. If your TSH had been down, instead, (because of the steroid), your doctor might have incorrectly interpreted that to mean that you might need to reduce your dosage - that would have been very unfortunate.Becky wrote:Looking at the table in the article the steroids should lead to a decreased TSH, so I'm confused!
My guess is that budesonide has only a fraction of the effect on TSH test levels that the other corticosteroids, (such as prednisone), would have. The reason I say that is because unlike the other corticosteroids, oral budesonide is encapsulated, so that it does not become activated until it reaches the lower third of the small intestine, and the colon. Because of that, tests show that less than 19% of it is absorbed into the bloodstream, whereas the absorption rate of the other steroids are relatively high. If only a small amount is absorbed into the bloodstream, then it can't have more than a correspondingly-small effect on any of the blood markers of thyroid issues. IOW, I'll bet that budesonide's effect on TSH test result levels is so small that it can be safely ignored, for all practical purposes.
Unfortunately, that seems to be true in every profession. We don't like to think that our doctors are vulnerable to such moral defects, but, of course, they are only human, so surely some of them have less than altruistic intentions.Becky wrote:Some people really are just in it for the money aren't they?
Please let us know if eliminating the mesalamine helps.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.