A 75-Year-Old Woman With Unexplained Weight Loss

Kenneth D. Burman, MD

Disclosures

April 08, 2003

In This Article

Case Presentation

A 75-year-old woman with a height of 5'2" has had unexplained weight loss for the previous 3-6 months. She now weighs 110 pounds. She has had increased nervousness and anxiety as well as a fine hand tremor and muscle weakness. She does not have neck discomfort or dysphagia. She has noted palpitations without chest pain. There is no history of radiation to her neck, but she had a chest computed tomography (CT) scan with contrast about 1 month ago for the evaluation of dyspnea. She has not experienced burning or itching of her eyes, double vision, or decreased visual acuity. The remainder of her history is unremarkable.

The patient's blood pressure is 145/85, and her pulse is 110 and irregular. She has a mild hand tremor, general muscle wasting, normal eye findings, and a normal skin examination. Her thyroid gland weighs about 25 grams (10-20 g is normal). The thyroid gland does not have significant nodularity, but the gland is firm and irregular. Heart examination reveals a soft systolic murmur. Pulmonary and abdominal examinations are normal.

Free T4: 4.2 ng/dL (normal: 0.8-1.8 ng/dL)
Total T3: 424 ng/dL (normal: 80-180 ng/dL)
Thyroid-stimulating hormone (TSH): < .01 mIU/mL
Complete blood count: normal
Complete metabolic panel: normal
EKG: Shows atrial fibrillation

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