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A 62-year-old woman presented with a 6-month history of hair thinning, itchy scalp, and cold sensitivity. She reported no fatigue, depression, memory problems, dry skin, or constipation. She had hyperlipidemia for which she took fish oil and red yeast rice extract. Heart rate was 80/min and body mass index was 31 (calculated as weight in kilograms divided by height in meters squared). Physical examination demonstrated a thyroid gland of normal size and consistency without palpable nodules. Deep tendon reflexes were normal. Her laboratory values are reported in the Table.
Papaleontiou M, Cappola AR. Thyroid-Stimulating Hormone in the Evaluation of Subclinical Hypothyroidism. JAMA. 2016;316(15):1592-1593. doi:10.1001/jama.2016.9534