Approach to hypothyroidism Quiz: Ace Your Exams
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A 42-year-old woman presents to the primary care office for evaluation of fatigue, weight gain, and constipation. She has also been noticing hair loss over the last month and has had daily headaches. She states that when she is driving, it seems harder than usual to see other cars coming up on either side of her. Past medical history is otherwise unremarkable. Temperature is 37.0°C (98.6°F), pulse is 62/min, respirations are 16/min, and blood pressure is 118/78 mmHg. On exam, she appears tired with slight pallor and dry skin. Testing of the visual fields by confrontation reveals a loss of peripheral vision bilaterally. Abdomen is soft and nontender with no masses palpated. Initial laboratory evaluation reveals a TSH of 0.35 mIU/L and a serum-free T4 of 0.68 ng/dL. Hemoglobin is 12.6 g/dL. Which of the following is the most likely cause of this patient’s condition?
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