Unexplained Weight Loss Despite Normal Appetite: A Gastroenterology Concern

Weight Issues ~ Weight Continues to Decrease Despite Normal Diet

Hello, Doctor.
My current health status is as follows: On December 3, 2020, I underwent an upper gastrointestinal endoscopy.
The attending physician explained that I have gastritis and mild ulcers, but my esophagus is normal.
On the same day, I also had an abdominal ultrasound, which revealed two small kidney stones.
My gallbladder and spleen are normal, but I have mild fatty liver and a hepatic hemangioma.
I didn't ask how large it was at the time, but it appeared to be less than 2 cm on the screen.
I'm unsure if the screen's display is at a 1:1 ratio or not.
Regarding my pancreas, the doctor mentioned that my abdomen is too large to get a clear view.
My GOT and GPT levels are normal.
I had blood tests for Hepatitis B and C in 2018, which were negative.
I had a colonoscopy on June 29, 2020, which found two hyperplastic polyps that were removed and confirmed to be benign, along with internal hemorrhoids.
My fasting blood sugar fluctuates between 100 and 110, and my hemoglobin A1c was 5.6 (tested on November 14, 2020).
My kidney function, with creatinine levels hovering between 1.0 and 1.1, shows mild proteinuria.
In November, I also had blood tests for autoimmune issues in the rheumatology department, which came back normal.
Additionally, I have stage I papillary thyroid carcinoma and underwent a total thyroidectomy in August of last year.
I had a second iodine scan at the end of September this year, which showed no abnormalities.
Currently, I am noticing a decrease in my weight, which is concerning me.
In less than two weeks, I have lost 3 to 4 kilograms, but I do not have a lack of appetite or unusual fatigue; I just occasionally feel sleepy.
My sleep at night is normal, and I fall asleep easily.
I am wondering if the hepatic hemangioma can be evaluated with an abdominal ultrasound, or if I need a more advanced CT scan to confirm it.
Should I consider a full-body scan to check for any malignancies? I have read online that unexplained weight loss can be a sign of malignancy.
I apologize for my disorganized thoughts, and I appreciate your understanding.
Thank you, Doctor.

A Mao, 40~49 year old female. Ask Date: 2020/12/03

Dr. Chen Shidian reply Gastroenterology and Hepatology

Please discuss with the attending physician regarding the current data (hemangioma of the liver should only be monitored) and the management/consultation for weight loss.

Reply Date: 2020/12/03

More Info

Unexplained weight loss, especially when accompanied by a normal appetite, can indeed be a significant concern in gastroenterology and may warrant further investigation. In your case, the recent findings from your endoscopy and ultrasound, along with your medical history, provide important context for understanding your symptoms.

Firstly, it is essential to recognize that weight loss can occur for various reasons, including metabolic changes, gastrointestinal disorders, malignancies, or even psychological factors. Given your history of thyroid cancer and the presence of a hepatic hemangioma, it is understandable to be concerned about potential malignancies or other serious conditions.

The fact that you have experienced a weight loss of 3-4 kilograms in less than two weeks, despite having a normal appetite, is noteworthy. This could indicate an underlying issue that needs to be addressed. While you mentioned that you do not feel unusually fatigued and have normal sleep patterns, unexplained weight loss can sometimes be a sign of metabolic disturbances or chronic diseases that may not yet present with other symptoms.

Your endoscopy results indicated mild gastritis and superficial ulcers, which could contribute to gastrointestinal discomfort but are less likely to be the sole cause of significant weight loss. Chronic inflammation in the stomach can lead to malabsorption or changes in appetite, but it typically does not cause rapid weight loss unless accompanied by other complications.

The presence of a hepatic hemangioma, while generally benign, should be monitored, especially if there are any changes in size or if you begin to experience symptoms such as abdominal pain or discomfort. A follow-up with imaging studies, such as a CT scan, may be warranted to assess the hemangioma further and to rule out any other potential liver issues.

Additionally, your history of thyroid cancer raises the question of whether there could be any residual effects or complications related to your treatment. Thyroid hormone levels can influence metabolism, and any imbalances could lead to weight changes. Regular monitoring of thyroid function tests is essential to ensure that your thyroid hormone levels remain stable.

Given your concerns about potential malignancies, it is reasonable to consider further diagnostic evaluations. A comprehensive approach might include:
1. Imaging Studies: A CT scan of the abdomen could provide a more detailed view of the liver and other abdominal organs, helping to identify any abnormalities that may not have been visible on ultrasound.

2. Blood Tests: Regular monitoring of liver function tests, thyroid function tests, and possibly tumor markers could help in assessing your overall health and detecting any potential issues early.

3. Gastroenterology Follow-up: Continued follow-up with a gastroenterologist is crucial, especially to monitor your gastric condition and any potential complications from the ulcers or gastritis.

4. Nutritional Assessment: Consulting with a nutritionist may also be beneficial to ensure that you are receiving adequate nutrition, which can help mitigate weight loss and improve overall health.

In conclusion, while your weight loss is concerning, it is essential to approach this issue holistically, considering all aspects of your health history and current symptoms. Regular follow-ups with your healthcare providers, along with appropriate imaging and blood tests, will be key in determining the underlying cause of your weight loss and ensuring that any potential issues are addressed promptly. Please do not hesitate to reach out to your healthcare team with any further questions or concerns.

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