Failure to gain weight on long-term parenteral nutrition attributed to tri-iodothyronine thyrotoxicosis

We describe the case of a 49-y-old female patient on long-term parenteral nutrition after abdominal surgery who failed to gain weight despite nutritional provision in excess of theoretical requirements. On investigation, she was found to have a negative nitrogen balance (−5.9 g) and to have a tri-io...

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Bibliographic Details
Published in:Nutrition (Burbank, Los Angeles County, Calif.) Los Angeles County, Calif.), 2004-11, Vol.20 (11), p.1018-1021
Main Authors: Livingstone, Callum, Phillips, Mary, Davis, Joy, Marvin, Vanessa, Stebbing, John F.
Format: Article
Language:English
Subjects:
Abdomen
Biological and medical sciences
clinical nutrition
Diagnosis, Differential
diagnostic techniques
Feeding. Feeding behavior
Female
Fundamental and applied biological sciences. Psychology
gaining weight
Humans
hypercalcemia
hyperthyroidism
hysterectomy
liver function
Liver Function Tests
long term effects
Middle Aged
Nitrogen balance
nutrient excess
Nutrition
Parenteral nutrition
Parenteral Nutrition - adverse effects
patient care
patients
Thyroid
thyroid function
Thyroid gland
Thyrotoxicosis
Thyrotoxicosis - blood
Thyrotoxicosis - diagnosis
total parenteral nutrition
Treatment Outcome
triiodothyronine
Triiodothyronine - blood
Vertebrates: anatomy and physiology, studies on body, several organs or systems
Weight Gain
weight loss
women
Wound healing
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Summary:We describe the case of a 49-y-old female patient on long-term parenteral nutrition after abdominal surgery who failed to gain weight despite nutritional provision in excess of theoretical requirements. On investigation, she was found to have a negative nitrogen balance (−5.9 g) and to have a tri-iodothyronine thyrotoxicosis but without many of the typical clinical features of hyperthyroidism. The patient also had mild hypercalcemia and hyperphosphatemia, which resolved fully after mobilization and treatment of the thyrotoxicosis. A derangement of the liver function tests was observed, which worsened progressively during parenteral nutrition but resolved promptly at its discontinuation. This case illustrates the importance of carrying out appropriate investigations including all thyroid function tests on patients who fail to gain weight on nutritional support.
ISSN:0899-9007
1873-1244
DOI:10.1016/j.nut.2004.08.012