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. She has a one month history of increased nervousness associated with a short temper, crying easily, and tremor. In addition she states she has lost 25 pounds without dieting, and is always hot. Her eyes protrude and feel dry.