HomeAnswersInternal Medicinefatigue syndromeI have general weakness with sudden weight loss. What is the reason?

I have general weakness with sudden weight loss. What is the reason?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

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Published At February 10, 2018
Reviewed AtOctober 27, 2022

Patient's Query

Hello doctor,

I have frequent fatigue with recent weight loss. In the past one year, I have been facing quite a few health issues. It all started late last year when I first experienced frequent chest pain, followed by an episode of sinus tachycardia. My 2D echo, stress test, troponin-I (1.5 ng/L) and CP-MB (14) levels were normal at the time. The doctor put me on Nebicard SM 2.5 mg just to keep my palpitations under control. This year mid, I was diagnosed with GERD with ulcers in the esophagus and a small sliding hiatus hernia. I followed a strict diet which reduced the acid reflux substantially. But, last month, I was diagnosed with mild appendicitis. The doctor put me on antibiotics and probiotics when they found out giardiasis in blood tests. The appendicitis seems to have improved as I do not have any symptoms now. But during investigations, my ECG showed ST-T changes. The doctor said these are nonspecific changes and the ECG is normal. I still went ahead and asked a cardiologist. He asked me to do troponin-I and CP-MB. The results were again normal (troponin-I 1.5 ng/L and CP-MB 5).

My concern is, despite all the tests showing normal outcomes, I do not feel healthy. I feel fatigued most of the times. My brain becomes foggy. I have become a lot more forgetful. I have lost five kg in the last three to four months. The chest pain still exists. I go through a lot of mood swings. I cannot concentrate well. There is regular muscle pain in my neck, shoulders, upper/middle back, breast bones, etc. I need to know why such drastic change in health has occurred.

Thank you.

Hello,

Welcome to icliniq.com.

I understand your concerns. I have checked all the reports you attached (attachment removed to protect patient identity) and all are within the normal range except a hiatus hernia and GERD II, but you should not worry, as you can improve with the medications. From what you mentioned, I suggest that you need psychiatric evaluation as you may have generalized anxiety disorder, chronic fatigue syndrome, mid-life crisis or atypical depression. Moreover, we have to exclude hyperactive thyroid by testing for TSH (thyroid-stimulating hormone), free T3, T4 (cause palpitations). All these conditions may cause fatigue, muscle pains and/ or weight loss.

You have to answer these questions in order to reach an appropriate diagnosis:

  1. Do you have changes in bowel habits, eating habits, or sleeping pattern?
  2. Do you live a stressful life?
  3. Do you feel anxious about minor issues?
  4. Have you faced a traumatic event like the loss of a loved one recently?
  5. Do you have tremors and/ or heat intolerance?

I suggest the following:

  1. Continue your medications.
  2. Provide me more details by answering my questions and sending me TSH, T3, and T4 lab results.

Thank you.

Patient's Query

Hello doctor,

Thank you for your reply. I will go with the same sequence for answering the questions:

1. I do experience changes in bowel habits. Sometimes I have to empty my bowels just once a day, sometimes it becomes thrice a day. The consistency of the stools varies a bit too. I have been eating less in the past few months due to acid reflux. Because if I eat more, pain and heaviness start to build in my ribs. It stays for less than an hour and then fades away. However, I do experience random muscle pains across the chest, back and neck/shoulders. My sleeping pattern has not changed much. Sometimes, my sleep does get disrupted due to acid reflux but nothing more.

2. Yes, I do live a stressful life, although most of the stress elevates when I experience those symptoms.

3. Yes. Honestly speaking, I do have this strange fear that I might have a heart attack soon. Maybe that is why I have been seeking constant reassurances from various cardiologists. Overall, I have become very sensitive to my surroundings. I definitely intend to get better but right now I feel I need some external help.

4. Yes, my mother passed away four years ago. Her demise did not affect me much initially, but I feel it is affecting me now in distorted ways.

5. No. I do not have tremors or heat intolerance.

I will do all the thyroid tests soon and show you the results.

Thank you.

Hello,

Welcome back to icliniq.com.

From what you mentioned, I would like to reassure you completely that you do not have any cardiac condition that you should worry about. Regarding your other complaints, most probably you have chronic fatigue syndrome which will require one medication along with some lifestyle modifications.

As these symptoms do not disturb your sleep, it is more likely to be psychiatric than organic. I suggest the following.

1. Sertraline (Zoloft) 50 mg per day initially then 75 mg per day after one week then maintenance 100 mg per day after another week. Consult your specialist doctor, discuss with him or her and start taking the medicines with their consent.

2. You should involve in daily exercise.

3. Regular massage, yoga, and acupuncture all could help.

4. Stay away from stress as much as possible, and try to develop relaxing techniques.

Follow up after six weeks.

Please note that the medication takes four to six weeks to show a significant effect.

Please provide me with the results of the thyroid test in order to exclude any thyroid disease.

Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Mahmoud Ahmed Abdelrahman Abouibrahim
Dr. Mahmoud Ahmed Abdelrahman Abouibrahim

Internal Medicine

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