Scenario:A 42-year-old woman who is an established patient comes to an appointment complaining of sudden and unexpected weight gain, fatigue, and heavy menses for the past 3 months. The woman has a history of allergies, Guillain-Barré syndrome at age 18, depression, and some difficulty getting pregnant in the past. Her maternal grandmother had a history of thyroid problems, but no specific information was available.    

    1. What additional subjective and objective assessments should be included in the patient examination?
    2. Explain whether this patient should have had a routine screening of thyroid function prior to today’s visit.
    3. Which testing is needed to diagnose hypothyroidism?
    4. Why is the measurement of free T4 always preferred over the total T4?
    5. Under what circumstances should this patient be referred to an endocrinologist for treatment?
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