Central hypothyroidism

Case history

A 40-year-old woman visits her physician with a 4-month history of chronic headaches and visual problems. She has no past medical history. Review of symptoms reveals easy fatigability, cold intolerance, galactorrhea, and amenorrhea for the past 6 months. Physical exam findings include a bitemporal hemianopia, periorbital edema, normal-sized thyroid, bradycardia, galactorrhea, and vaginal atrophy.