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Karen Kryspers is 36-year-old woman with a past medical history of fibromyalgia. She presented to her general physician for a regular check-up. The patient reported that her mother was recently diagnosed with hypothyroidism and requested that her scheduled blood work include thyroid function tests. The patient said she has been well; even her symptoms related to fibromyalgia had been under control. Her only complaint was some hair loss, but it had slightly improved since she began using over-the-counter supplements 3 months before her appointment.
On physical examination, the patient appeared to be healthy: her vital signs were normal, there was no evidence of thyroid eye disease, tremor, or tachycardia; and her thyroid gland was not enlarged. Blood work completed the same day revealed normal complete blood count and liver and kidney function tests, but thyroid-stimulating hormone (TSH) was low, measuring 0.2 microunits/mL. Free thyroxine (T4) was measured at 3.0 micrograms/dL and free triiodothyronine (also known as T3) was measured at 70 nanograms/dL. After review of her previous laboratory tests, it was found that her thyroid function tests, including TSH and free T4 levels, were previously normal on several occasions.
In a follow-up visit, the patient denied recent pregnancy, iodine exposure, neck pain or fever, recent acute illness, and symptoms of thyrotoxicosis. In addition, she denied receiving any new medication, specifically amiodarone or lithium.
1. What do you think is going on with this patient?
SCIENCE
HEALTH SCIENCE
NURSING
