How should I treat a patient who has signs and symptoms of hypothyroidism but normal lab values? The 36-year-old woman has mitral valve prolapse, menorrhagia, headache, fatigue, brittle nails, hair loss, central weight gain, and cold intolerance but no slowing of responses or decreased deep tendon reflexes.
—Jerry Shaw, PA, Memphis

Your patient’s symptoms are nonspecific, and with normal lab values, she is by definition euthyroid. Given the menorrhagia, fatigue, and brittle nails, start by making sure she is not iron-deficient. Assess her for depression and life stressors, which may be affecting her sense of well-being. Finally, I would encourage a well-balanced diet, regular moderate exercise, and an adequate amount of sleep to help with her weight gain, improve her overall health status in the long term, and help her feel better.
—Susan Kashaf, MD, MPH (108-13)

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