Loose Stools, Diarrhea, and Weight Loss: Gastrointestinal Issues

Q: Loose Stools, Diarrhea, and Weight Loss: Gastrointestinal Issues

Hello： If the thyroid blood test report is normal compared to the reference values, you can continue to monitor whether your bowel habits will return to normal or if the current condition becomes a new baseline. <br>Dietary adjustments or taking probiotics may help; if there is n

Loose stools or diarrhea and weight loss?

Hello Doctor: I was diagnosed with gastroenteritis in mid-March, and since then my stools have often been loose but occasionally formed or even diarrhea (without abdominal pain).
Before the gastroenteritis, my bowel habits were irregular, sometimes having a bowel movement every two to three days, and sometimes not at all during the weekdays but having two bowel movements on weekends.
After the gastroenteritis, my bowel movements changed to once a day, typically in the morning right after waking up, and they are quick.
Since the gastroenteritis, I have lost nearly 4 kilograms.
I went to the hospital for a fecal occult blood test, and the results were normal.
This past Tuesday, I had an upper endoscopy, and the doctor said I have mild gastritis and mild gastroesophageal reflux disease.
After taking medication, the discomfort has significantly decreased.
This Thursday, I had blood tests for hyperthyroidism, with results showing T4 (thyroxine) at 9.5 and TSH (thyroid-stimulating hormone) at 2.79.
However, my bowel movements remain the same, and my weight continues to gradually decrease.
I would like to ask the doctor what possible causes there could be for my situation, and whether I should continue seeing a gastroenterologist or switch to another specialty.
Thank you.

Ms. Li, 20~29 year old female. Ask Date: 2020/05/08

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: If the thyroid blood test report is normal compared to the reference values, you can continue to monitor whether your bowel habits will return to normal or if the current condition becomes a new baseline.
Dietary adjustments or taking probiotics may help; if there is no improvement, you can consult with your physician to determine if a colonoscopy is necessary.
Changhua Hospital cares about your health.
Dr.
Tsai An-shun.

Reply Date: 2020/05/08

More Info

Based on your symptoms and the medical history you've provided, it appears that you are experiencing a complex interplay of gastrointestinal issues that may be contributing to your loose stools, diarrhea, and weight loss. Let's break down the potential causes and considerations for your situation.

Understanding Your Symptoms
1. Loose Stools and Diarrhea: The change in your bowel habits from irregularity to daily bowel movements with loose stools could be a result of the gastrointestinal inflammation caused by the gastroenteritis you were diagnosed with. Gastroenteritis can disrupt the normal flora of the gut, leading to altered bowel habits. Additionally, the presence of mild gastritis and gastroesophageal reflux disease (GERD) may also contribute to gastrointestinal discomfort and changes in stool consistency.

2. Weight Loss: The weight loss of approximately 4 kg is concerning, especially in the context of gastrointestinal symptoms. Weight loss can occur due to malabsorption, decreased appetite, or increased metabolic demands due to inflammation. Since you mentioned that your stool tests for occult blood were normal, this reduces the likelihood of significant gastrointestinal bleeding, but it does not rule out other issues such as malabsorption syndromes or chronic infections.

3. Thyroid Function: Your thyroid function tests indicate that your T4 level is elevated while TSH remains within normal limits. Hyperthyroidism can lead to increased metabolism, which may contribute to weight loss and changes in bowel habits, including diarrhea. It is essential to evaluate whether your thyroid function is contributing to your gastrointestinal symptoms.

Recommendations
1. Continue Monitoring: It is crucial to keep a close watch on your symptoms. Documenting your bowel habits, dietary intake, and any associated symptoms (like abdominal pain, nausea, or changes in appetite) can provide valuable information for your healthcare provider.

2. Follow-Up with Gastroenterology: Given your ongoing symptoms, it would be prudent to continue seeing a gastroenterologist. They may recommend further investigations, such as stool studies for pathogens, tests for malabsorption (like a D-xylose absorption test), or imaging studies if necessary.

3. Consider Dietary Adjustments: Sometimes, dietary changes can significantly impact gastrointestinal symptoms. A low-FODMAP diet or a gluten-free trial may help if you have underlying food intolerances. Consulting with a dietitian can provide personalized dietary recommendations.

4. Thyroid Evaluation: Since your thyroid levels are slightly elevated, it would be wise to follow up with an endocrinologist. They can assess whether your thyroid function is contributing to your symptoms and discuss potential treatment options if hyperthyroidism is confirmed.

5. Mental Health Considerations: Chronic gastrointestinal issues can lead to anxiety and depression, which may further exacerbate symptoms. If you are experiencing mood changes or stress related to your health, consider discussing this with your healthcare provider.

Conclusion
Your symptoms of loose stools, diarrhea, and weight loss are multifactorial and may involve gastrointestinal inflammation, potential malabsorption, and thyroid dysfunction. Continuing to work with your healthcare providers, particularly in gastroenterology and endocrinology, will be essential in identifying the underlying causes and developing an effective treatment plan. Regular follow-ups and possibly further testing will help clarify your diagnosis and guide appropriate management. Remember, it’s important to communicate openly with your healthcare team about any new or worsening symptoms.

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