Bile acid malabsorption and weight gain?

[g0courtney]

I've been treated for an overactive thyroid (graves disease) since 2016 but I always had atypical symptoms - dramatic weight gain pre diagnosis and then worse once being treated. And no - this was not due to an increased appetite. Through private blood tests I found I was deficient in B12 and Vitamin D but this was of little interest to my doctor, was was the weight gain I've experienced. This is ongoing weight gain that doesn't drop, regardless of gym, diet, etc (I've made changes to go gluten free over recent months)

As of December my thyroid normalised and I am still on 2.5mg of carbimazole a day. However I still suffered with weight gain and diarrhoea. I asked to be reffered for a test for BAM and it came back positive. For the last 2 months I have been on 4mg sachets of Colestyramine daily.

Has anyone taken this medication and had side effects? My follow up is not until July and I'm having serious bloating and I believe I'm still gaining weight. I have gained nearly 15 kgs since 2016 as a result of these issues and it shows no sign of stopping. You would think now I am being treated/normalised my weight would drop but I have no idea what to do.

[g0courtney]

I am a 22 year old female for reference

[jimh111]

It might be an idea to put this question on the thyroid forum.

Do you have results from your thyroid tests? If not I would ask for copies. If you have a copy please post any results you have for TSH, fT3, fT4 and antibodies TPO, TBG and TRAb. TRAb is really needed to confirm Graves' disease. Endocrinologists are not very good at diagnosing thyroid disorders, most specialise in diabetes and have a poor understanding of thyroid.

Your signs and symptoms suggest hypothyroidism rather than hyperthyroidism. Some doctors refer to Graves' when they mean hyperthyroidism. Graves' is when antibodies stimulate the TSH receptors in the thyroid. These antibodies are called 'thyroid stimulating antibodies' (TSI), the usual one being TRAb. Patients with autoimmune hypothyroidism have elevated TPO or TBG antibodies which attack and destroy the thyroid. During this process thyroid hormone can be released from the thyroid in spurts creating a short period of hyperthyroidism. Thus, we need to know your hormone levels and the levels of any antibodies that were measured. It's quite possible you were misdiagnosed with Graves'. Vitamin D and B12 deficiency is very common in hypothyroidism, again suggesting the diagnosis may be wrong.

A futher complication is that when patients are hyperthyroid (with or without Graves') the high hormone levels supress the TSH. If this goes on for some time the TSH response to low thyroid hormone (fT3, fT4) can be inadequate. It can take six months for the TSH to recover, if it does. Consequently if the doctor tries to titrate treatment according to TSH they will get it all wrong. In this patient group they must monitor fT4 instead of TSH. Don't expect all endocrinologists to get this right, quite a few are not very good.

Diarrhoea is a sign of hyperthyroidism but as you have bile malabsorption it may be due to the malabsorption and not hyperthyroidism and hence misleading the thyroid diagnosis. Post your results here if you have them. When you next see your specialist I would take someone along with you for support and make sure they pay attention to your signs and symtoms, giving them more emphasis than the blood tests.

Please note I am a patient who had IBS and hypothyroidism, I am not a doctor.

[Whitesugar]

You say sachets. Are you taking more than 1 per day? I take 1 sachet of Questran daily at 6pm. It has stopped my diarrhoea for 9 months now and I have had no side effects. You may need to play about with the dose (you can split the sachet) and time of day you take it. I can't comment on your other problems. Best wishes

[sweetsusie]

I take Colestipol (4 tablets a day - 2 twice a day). Totally cured my chronic diarrhea. Also, Welchol is a good choice, but much more expensive here in the US. Have your doctor switch you to one of those instead.