Review Question - QID 104391

This patient has symptoms suggestive of hypothyroidism and associated myopathy. Evaluation of TSH and free T4 are the first step in evaluating for clinical hypothyroidism.

Myopathy can be caused by hypothyroidism. Because it is not an inflammatory-mediated myopathy, ESR should be normal, but CK will be elevated. Typically, other symptoms of hypothyroidism are present, such as fatigue, weight gain, and constipation. Other causes of myopathy include infectious myopathies, inflammatory myopathies such as dermatomyositis, inclusion body myopathies, and polymyositis, and drug induced myopathies (especially from statins).

Incorrect Answers:
Answer 1: Specialty referral in the setting of hypothyroidism may include referral to an endocrinologist, but this is not appropriate at this time.
Answer 3: Rheumatoid Factor is a screening test for rheumatoid arthritis, but this patient's signs and symptoms are more indicative of hypothyroidism.
Answer 4: ANA is a high sensitivity, low specificity test for Lupus.
Answer 5: Morning cortisol would be appropriate if you suspected Cushing's Disease, but the history is more suggestive of hypothyroidism, which is also much more common among the general population.