A 30-year-old woman complaining of tiredness was seen by her physician. A serum sample was collected at 2 pm. The following results were obtained (reference ranges are given in brackets): TSH 1.3 mU/L (0.5–5) Free T4 15 pmol/L (9–22) Cortisol 220 nmol/L (>550 at 9 am) The physician has asked for advice regarding the interpretation of the results and any further investigations you would recommend. What advice would you give to the physician?
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Disorders of thyroid function are common, and screening, diagnosis, and management are often performed by primary care providers. While management of significant biochemical abnormalities is reasonably straight forward, laboratory tests only slightly outside, or even within, the normal range are becoming more difficult to appropriately manage. A large part of this increasing difficulty in appropriate management is caused by patients requesting, and even demanding, certain tests or treatments that may not be indicated. Symptoms of thyroid dysfunction are non-specific and extremely prevalent in the general population. This, along with a growing body of information available to
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