Get Answer: Year Evaluated Amenorrhea Question Guide

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Original Question

An 18-year-old is evaluated for amenorrhea of 5 months duration. A review of the systems is positive for cold intolerance, dizziness, fatigue, hair loss, nausea, and constipation. Medical history is unremarkable. She takes no medications and denies using alcohol, illicit drugs, or tobacco. She is not sexually active. The patient is in her first year of college and reports stress from her course load and being on the volleyball team. She has been trying to lose weight to increase her jumping ability. Her vitals are temperature 95.9 °F (35.5 °C), blood pressure 84/52 mm Hg, heart rate 36 bpm and regular, respiratory rate 16 breaths/min, oxygen saturation 95% on ambient air, and body mass index 16.5 kg/m². Physical examination reveals a thin woman in no acute distress. There is fine hair over her neck and back. Heart rate is slow without murmurs or skipped beats. Lungs are clear to auscultation. The abdomen is scaphoid and nontender. An electrocardiogram reveals sinus bradycardia. Urine beta-hCG is negative. Results of laboratory studies are notable for macrocytic anemia and TSH of 0.7 mIU/L with free T4 of 0.6 ng/dL. CMP is normal. Which of the following findings is most concerning in this patient? A. Amenorrhea B. Cold intolerance C. EKG D. TSH and free T4

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