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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