A 32-year-old woman worries about her ability to care for hi

[madhurima]

A 32-year-old woman comes to the physician because of lethargy and boredom since the birth of her son 5 months ago. She worries about her ability to care for him and has had frequent palpitations. She is unable to fall back asleep after nighttime feedings. She stopped breast-feeding 1 month ago. Her son is healthy, and growth and development are normal for his age. Her blood pressure is 122/80 mm Hg, pulse is 58/min, and respirations are 18/min. Physical examination shows no abnormalities. She remembers one out of three objects after 5 minutes. Her serum cholesterol level is 265 mg/dL. The most appropriate next step in diagnosis is measurement of which of the following serum levels?

A) Cortisol

B) Estrogen

C) Progesterone

D) Prolactin

E) Thyroid-stimulating hormone

[madhurima]

hypopitutarism may be caused by sheehan's syndrome. increased levels of cholesterol suggests secondary hypothyroidism so I suggest TSH.

[megha]

It is Option E. As zzetegn explained bang on, this is post-partum lymphocytic thyroiditis. Do a TSH; this is hypothyroidism (the patient is depressed, pulse is 58 [<60], and is lethargic, with a raised serum cholesterol).