A 50-year-old housewife complains of progressive weight gain of 20 pounds in a year, in addition to fatigue, postural dizziness, loss of memory, slow speech, deepening of her voice, dry skin, constipation, and cold intolerance. Physical examination Temperature-96.8 o F Pulse -58/min and regular BP -110/60 mmHg She is moderately obese and speaks slowly and has a puffy face, pale, cool, dry, and thick skin. The thyroid gland is not palpable. The deep tendon reflex time is delayed.
Laboratory studies CBC – Normal. Serum T4 – 3.8 ug/dl (N=4.6-12 ug/dl Serum TSH –1 uU/ml (N= 0.5-6 uU/ml) Serum cholesterol – 255 mg/dl (N<200 mg/dl) *This case challenge is from the Editorial team of Docplexus and is meant for educational purposes only.
