A 63-year-old woman is brought in to the healthcare center by her neighbor who has been worried that she looks increasingly unwell. On direct questioning, she says that she has felt increasingly tired for around 2 years. She was diagnosed with hypothyroidism 8 years ago and has been on thyroxine replacement but has not had her blood tests checked for a few years. Her other complaints are of itching for 2–3 months , but she has not noticed any rash. She says that her mouth has been dry and, on direct questioning, thinks her eyes have also felt dry .
There has been no disturbance of her bowels or urine although she thinks that her urine has been rather ‘strong’ lately. Examination Her sclerae look a little yellow and she has xanthelasmata around the eyes. There are some excoriated marks from scratching over her back and upper arms. The pulse is 74/min and regular, blood pressure is 128/76…
