A Recently Married 27-Year-Old With Hot Flashes, Amenorrhea

George T. Griffing, MD


September 02, 2022

Physical Examination

Upon examination, she appears normal with no dysmorphic features. Vital signs are normal except for mild, symptomatic orthostasis; blood pressure and heart rate are 90/60 mm Hg and 72 beats/min (lying), respectively, and > 70/50 mm Hg and 90 beats/min (standing), respectively. Body weight, height, and proportions are normal. She has Tanner stage 5 breast and pubic hair development, no excessive body hair, and no galactorrhea. Her uterus is normal to palpation. The patient is found to have a diffuse and nontender thyroid swelling.

General laboratory studies, including a comprehensive metabolic panel, urinalysis, and complete blood count (CBC), are remarkable only for a slightly elevated serum potassium level of 5.1 mEq/L (reference range, 3.5-5 mEq/L) and absolute eosinophil count of 0.61 x 109/L (reference range, 0.05-0.50 x 109/L). Specialized laboratory tests show an elevated thyroid-stimulating hormone (TSH) level of 8.2 mIU/L (reference range, 0.3-5 mIU/L), an antithyroid peroxidase (anti-TPO) antibody level of over 1000 IU/mL (reference range, <9 IU/mL), and a follicle-stimulating hormone (FSH) level of 68 IU/L (follicular phase reference range, 3.9-8.8 IU/L). Prolactin, testosterone and free thyroxin levels are normal. Pregnancy test result is negative.


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