History: A 50 year old housewife complains of progressive weight gain of 20 pounds in 1 year, fatigue, slight memory loss, and constipation. The patient has had diabetes for 15 years being treated with an oral hypoglycemic agent.

Physical examination: Vital signs include a temperature 96.8^oF, pulse 82/minute and regular, BP 170/100. She is moderately obese and speaks slowly and has a puffy face with pale, cool skin, 3+ leg edema and no increased jugular venous pressure. The thyroid gland is not palpable. The deep tendon reflex time is normal.

Laboratory studies: CBC and differential WBC are normal. The serum T4 concentration is 3.8 ug/dl, the serum TSH is 1 uU/ml, and the serum cholesterol is 255 mg/dl (N<200).

1. What is the likely diagnosis?  Answer

3. What additional aspects of the history and physical examination could provide relevant information to help in the diagnosis?   Answer

4. What additional tests would help confirm the diagnosis?  Answer

5. What are the treatment options?  Answer