Daily Gastrointestinal Symptoms And Weight Loss In A Young Female Athlete

Abstract

HISTORY: 21-year-old female college ice hockey player with PMH of depression/anxiety on sertraline presents with a 3-month history of abdominal pain, nausea, vomiting, and diarrhea. This was accompanied by a 15-pound weight loss since freshman year of college. She states that she experiences emesis and diarrhea daily, however feels like she has a normal appetite and eats until she feels full. She presented to the ED, prior to our visit, for abdominal pain and vomiting, and was prescribed a PPI with no lab work at the time. At our visit, she did report feeling anxious as she had ended a 3-year long relationship which she described as being “toxic.” PHYSICAL EXAMINATION: General Appearance: Anxious appearing young Caucasian female in no acute distress with mild hand tremor Abdominal: Tenderness to palpation over the epigastric region without rebound tenderness. Prominent aortic pulse noted in abdomen. No lower quadrant or right upper quadrant tenderness to palpation. Resp: No acute respiratory distressCV: Regular rate and rhythm. No murmurs or clicks. No cyanosis of the fingers or lips. DIFFERENTIAL DIAGNOSIS: 1) Gastroesophageal reflux disease 2) Inflammatory Bowel Disease/Irritable Bowel Syndrome 3) Celiac disease4) H. Pylori TEST AND RESULTS: Fecal studies (calprotectin feces, stool culture, stool leukocytes, H Pylori stool, stool ova and parasites, FOBT) returned negative. TSH levels returned undetectable with free thyroxine levels returning elevated at 5.45. CMP returned borderline abnormal with mildly decreased CO2 and mildly increased BUN. CBC, ESR, CRP, celiac disease panel all negative. FINAL WORKING DIAGNOSIS: Thyrotoxicosis secondary to Grave’s disease TREATMENT AND OUTCOMES: The athlete was held from sporting activity due to concern for caloric deficiency as well as increased cardiac load to due hypermetabolic state. She was referred to Endocrinology where her thyrotropin receptor antibody returned positive consistent with Grave’s disease. She was initiated on atenolol for symptomatic control.