Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
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        Weight Loss of Undetermined Cause, an Outline
      

Weight loss of unknown etiology

  • Unintended weight loss and weight gain are two common problems for medical evaluation. Careful history and physical examinations must be combined with lab tests to get to the bottom of the diagnosis. 
  • Nutritional status: lab testing
  • In Older/Elderly Patients:
    1. with good, full appetite and feel fine after meal:
      • diabetic.
      • hyperthyroidism in the elderly: a great masquerader, and even severe, life-threatening & can easily be missed in patients older than 60 years & due to Graves disease, toxic multinodular goiter, solitary toxic adenoma, transient hyperthyroidism of subacute thyroiditis, and iodine-induced hyperthyroidism (Jod-Basedow disease) may be caused by increased iodine uptake from sources such as mucolytics or contrast media. Symptoms often atypical instead of classic and may mimic other common diseases in this age group & may be absent, subtle, or may be obscured by coexisting diseases & cardiac complications are the most common manifestation: atrial arrhythmias (commonly atrial fibrillation with slow ventricular rates, as compared with high rates in young patients); congestive heart failure (usually high output heart failure) and angina pectoris. The classic tremors seen frequently in younger patients are rarely seen in the elderly and if present at all are often coarse, not fine, as noted earlier in life. Rather than increased appetite, weight loss with anorexia may be present. Diarrhea is common in young hyperthyroid patients; elderly patients may note a correction of preexisting constipation but will rarely complain of loose stools. Elderly patients can present with only one symptom of hyperthyroidism (such as myopathy...muscle weakness), sometimes referred to as monosymptomatic hyperthyroidism. Neuromuscular symptoms such as decreased patient activity with fatigue, weakness, lethargy, agitation, confusion, and dementia are common. Elderly patients may present with an apathetic form of hyperthyroidism with placid apathetic facies. Lab DX: Elevated levels of total or free thyroxine and low levels of TSH confirm the diagnosis of primary hyperthyroidism, though in a minority of patients even with low TSH level, thyroxine level may be normal. In these cases, the serum T3 should be measured to rule out T3 toxicosis. It is important to remember that TSH level may be low in some normal elderly individuals as well as patients receiving glucocorticoid therapy and patients with nonthyroidal illness.
      • chronic anxiety.
      • GI hypermotility.
    2. with good, full appetite and feel faint after meal: chronic borderline to low blood volume & it is cured if drink a glass of water before meal and plenty of liquids during meal.
    3. neutral/disinterested to decreased appetite:
      • polypharmacy.
      • hyperthyroidism in the elderly.
      • depression.
      • "frailty syndrome": muscle weakness, lack of stamina, weight loss (possibly in assoc. with mutliple health problems).
      • midbrain strokes...dementia.
      • Alzheimers may begin to manifest as unintended weight loss.
  • In Adults:
    1. good appetite:
      • hyperthyroidism
      • chronic anxiety
      • GI hypermotility
      • bulemia
    2. neutral/disinterested to decreased appetite:
      • diabetes mellitus or insipidus
      • adrenal insufficiency
      • cancer
      • drug abuse
      • chronic infections
      • occult renal, pulmonary, hepatic, or cardiac disease
      • anorexia nervosa
      • depression
      • polypharmacy
  • In Children: [search "failure to thrive"]
    1. celiac disease
(posted Dec 2001; latest addition 15 April 2007)

 
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