A 65-year-old female presents to the clinic feeling tired and fatigued all the
time. She has also noticed an increasing problem with constipation despite
adequate fiber intake. She is frequently cold when others are hot. Her skin has
become dry, and she has noticed a swelling sensation in her neck area. On
examination she is afebrile with a pulse of 60 beats per minute. She is in no
acute distress and appears in good health. She has an enlarged, nontender thy-
roid noted on her neck. Her reflexes are diminished, and her skin is dry to the
What is the most likely diagnosis?
What laboratory test would you need to confirm the diagnosis?
What is the treatment of choice?