Case Study: Young Woman with Abnormal Thyroid Function TestsAmit Akirov, MDA 36-year-old woman with a past medical history of fibromyalgia presented to her general physician for a regular check-up. The patient reported that her mother was recently diagnosed with hypothyroidism and requested that her scheduled blood work include thyroid function tests. The patient said she has been well; even her symptoms related to fibromyalgia had been under control. Her only complaint was some hair loss, but it had slightly improved since she began using over-the-counter supplements 3 months before her appointment.On physical examination, the patient appeared to be healthy: her vital signs were normal, there was no evidence of thyroid eye disease, tremor, or tachycardia; and her thyroid gland was not enlarged. Blood work completed the same day revealed normal complete blood count and liver and kidney function tests, but thyroid-stimulating hormone (TSH) was low, measuring 0.02 µIU/mL (reference range, 0.4-4.6 mIU/L). Free thyroxine (T4) was measured at 24 pmol/L (reference range, 10-19 pmol/L), and free triiodothyronine (T3) was measured at 7.1 pmol/L (reference range, 3.5-6.5 pmol/L). After review of her previous laboratory tests, it was found that her thyroid function tests, including TSH and free T4 levels, were previously normal on several occasions.In a follow-up visit, the patient denied recent pregnancy, iodine exposure, neck pain or fever, recent acute illness, and symptoms of thyrotoxicosis. In addition, she denied receiving any new medication, specifically amiodarone or lithium.Questions to consider:What was the patient's concern when she met the doctor?What were the results of the patient's physical exam and blood work?What are at least 3 key statements made by the patient about herself?What are the findings of the thyroid function tests? Were the findings consistent with her previous thyroid tests?What is the name of the disease is the patient referring to when she said her mother had hypothyroidism?What do you think is the appropriate next step; explain your answer?Schedule a thyroid scan and a neck ultrasoundStart treatment for Grave's disease with metoprololStop all supplements and repeat thyroid function tests in a week.