A 26-year-old woman is in the clinic today for evaluation of weight gain and fatigue. She is 5 feet 6 inches and weighs 175 pounds. Prior to her pregnancy, she weighed 130 pounds and her maximum weight during pregnancy was 155 pounds. She is now 18 months postpartum and continuing to gain weight despite no change in diet or activity. She reports that the fatigue is getting worse even though her daughter is sleeping reliably through the night and the patient feels she is getting plenty of rest. She takes no other medications and has no significant medical history. Her vital signs today are HR 68, BP 108/60, RR 10, temperature 97° F. The nurse practitioner orders a CBC, TSH, and T4.
Discussion Questions
What sources of fatigue is the nurse practitioner evaluating with the CBC, T4, and TSH?
What other history or clinical findings would be indicative of hypothyroidism?
The patient's laboratory values show an elevated TSH and a low T4. What does this mean?
After starting the patient on thyroid hormone replacement, the nurse practitioner asks the patient to return in 8 weeks to check her TSH level.
What is the purpose of this test? What should be done if the test result is abnormal?