A 34-year-old woman comes to the physician because of a 3-month history of fatigue and a 4.5-kg (10-lb) weight loss despite eating more than usual. Her pulse is 115/min and blood pressure is 140/60 mm Hg. She delivered a healthy baby boy 8 months ago and has not felt the same since. She has no prior medical problems and no drug allergies. She reports that her menstrual cycles have not returned yet. The thyroid is nontender. Laboratory results show decreased serum TSH and free thyroxine (T4) levels. Which of the following is the most likely diagnosis in this patient?

Question

A 34-year-old woman comes to the physician because of a 3-month history of fatigue and a 4.5-kg (10-lb) weight loss despite eating more than usual. Her pulse is 115/min and blood pressure is 140/60 mm Hg. She delivered a healthy baby boy 8 months ago and has not felt the same since.  She has no prior medical problems and no drug allergies. She reports that her menstrual cycles have not returned yet. The thyroid is nontender.  Laboratory results show decreased serum TSH and free thyroxine (T4) levels.  Which of the following is the most likely diagnosis in this patient?

Quizplus · Accepted Answer

Eductional Objective: Central hypothyroidism is characterized by low serum TSH and thyroxine (T4) levels and is due to hypothalamic-pituitary dysfunction.  Sheehan syndrome is ischemic necrosis of the pituitary gland and is typically caused by systemic hypotension during delivery.  In addition to central hypothyroidism, patients may also develop deficiencies of other pituitary hormones (eg, ACTH, prolactin, gonadotropins).

A 34-Year-Old Woman Comes to the Physician Because of a 3-Month