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Metabolic Diagnosis

A 43-y.o. female presents with the complaint of weight gain and fatigue over the past 4 mo. She states that she is always cold and just can’t get warm. She states that she is sleeping really well through the night but does not wake feeling refreshed. She denies shortness of breath, chest pain, or dyspnea on exertion.

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  1. What additional questions should you ask the patient and why?
  2. What should be included in the physical examination at this visit?
  3. What are the possible differential diagnoses at this time?
  4. What tests should you order and why?

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