She has no history of heart disease. She has recently noticed increasing fatigue, but otherwise has no complaints. Physical exam reveals a thin woman who is somewhat short of breath. The pulse is irregular at a rate of 135 beats per minute. Hair and skin are thin.
Eyes are normal.
Reflexes have a normal return phase. She was a good student who had grown normally until the age of seven. The patient and her parent denied any symptoms of hypothyroidism. Physical exam revealed a child at the fifth percentile for height and the 90th percentile for weight. Her skin was dry and thick.