今CASE42 迟钝 A 44-year-old woman presents to the office because of fatigue. She has felt sluggish for months and thinks she may be anemic. She has started taking iron pills but isn't feeling any better. She has been sleeping well and doesn't feel depressed. She has no- ticed some thinning of her hair and feels as if her skin is dry. She takes a multivitamin and iron supplement, otherwise no medications. She has smoked a pack of cigarettes a day for about 20 years, occasionally drinks alcohol, and doesn't exercise. Her mother takes some kind of thyroid pill and has diabetes. On examination, her blood pressure and pulse are normal. Her hair is thinned but there are no focal patches of alopecia"or scarringof the scalp. Her skin is diffusely dry. Her thyroid gland feels diffusely en larged,is nontender", and has no nodules. The remainder of her exam is unremark able. Lab tests show a normal complete blood count(CBC), glucose, and electro- lytes. Her thyroid-stimulating hormone( TSH) level is elevated, and T, level is re- duced. You diagnose her with hypothyroidismand start her on oral levothyroxineso- dium迟钝 触痛