You are evaluating a 13-year-old girl who complains of malaise, fatigue, and occasional abdominal discomfort. You diagnosed hypothyroidism due to chronic lymphocytic thyroiditis (Hashimoto thyroiditis) 6 years ago. She has normal serum immunoglobulin A concentrations. A tissue transglutaminase antibody study was negative 1 month before this visit, and free thyroxine and thyroid-stimulating hormone (TSH) values were normal at that time. She has normal menses. She reports that she has been eating poorly and has lost 5 lb since you saw her at the beginning of the summer, but she obviously has had a good summer and has a tan.
Of the following, the MOST important laboratory studies to obtain at this time are
A. complete blood count and erythrocyte sedimentation rate
B. duodenal biopsy for cryptic celiac disease
C. measurement of cortisol and adrenocorticotropic hormone
D. measurement of free thyroxine and TSH
E. mononucleosis spot test and liver function study
ANSWER ON FRIDAY 10 AM
D
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