History and Physical Exam

History

A 40-year-old woman presents with a 6-month history of increasing fatigue. For the past three months she had suffered recurrent upper respiratory infections, poor appetite, abdominal cramps and diarrhea. During this time, she lost 25 lb. She had also noted joint pains, muscle weakness, a dizzy spells following exercise, and she had not menstruated for the past 3 months.

Physical Exam

She was 5'4" tall and weighed 102 lb. Her heart rate was 86 and the blood pressure was 120/65 when she was supine. After one minute of quiet standing, the heart rate was 120, the blood pressure was 90/58, and she became dizzy. Her thyroid gland was diffusely enlarged and the bowel sounds were hyperactive.

Questions

  1. What can you say about the patient's problems so far?
  2. What laboratory tests would you order to evaluate this patient?