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Original Question

Team 2 Case and Questions: Complaint: “I’m so tired all the time.” History: A 50-year-old female presents to the clinical complaining of progressive weight gain of 25 pounds in the last year, fatigue, postural dizziness, slow speech, dry skin, constipation and cold intolerance. Physical Exam: Vital signs: T-98.6, HR-58 bpm, BP-150/100 General: Moderately obese female who speaks slowly and has a puffy face. Integumentary: pale, cool, dry skin Neck: No thyromegaly. Neuro: DTRs are delayed Laboratory Studies: CBC with differential is normal. TSH is 23.0 and serum T4 is 3.8 micrograms/dl (range 4.5-12.5) Cholesterol: 255mg/dl Questions: What is the likely diagnosis? Why? What other aspects of the patient’s history and physical examination would be helpful for diagnosis? What additional tests would help confirm the diagnosis, if any?What treatment would you recommend? Provide a rationale for your recommended treatment. What are some of the cardiac risk factors present in this patient? How does that affect therapy?

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