She had noticed a decrease in energy for about two years. Recently she had to close her business because of the inability to keep up with the work load. In addition she had noticed cold intolerance. Review of systems revealed a history of frontal headaches for about the last six months. The patient s last menstrual period was about seven months ago.
Physical exam reveals a pale, slender woman in no acute distress.
Visual field assessment shows homonymous hemianopsia. The skin is dry and axial and pubic hair reduced. This may be viewed as a situation where a damaged thyroid gland is able to meet the needs of the body only with excess stimulation from the pituitary gland. These patients usually do not have symptoms of hypothyroidism and do not feel better after being treated. The thyroid gland is often normal to palpation but goiters may be present.