Amy Z. is a 45-year-old female who comes to the clinic today due to fatigue and weight gain. She has noticed decreasing energy

Amy Z. is a 45-year-old female who comes to the clinic today due to fatigue and weight gain. She has noticed decreasing energy over about 6 months. She states that now she just feels tired all of the time even after a good night’s sleep. When she comes home from work she frequently falls asleep on the couch until bedtime. She has also gained 20 lb. in the past 5 months. She has also noticed some difficulty with concentration at work recently. She wonders if she could be starting menopause as her menses have been heavier than normal the past 2 months. Current medications include an OCP. Ht. 5’5″: Wt. 180. T – 97.6; P – 64; R – 16; BP 130/78. Physical exam is within normal limits. Lab today: Chem 7: Na – 138; K – 4.2; Cl – 102; HCO3 – 26; BUN – 12; Cr – 0.7; glu – 90 CBC – WNL Total cholesterol – 228 TSH – 15 uIU/ml Free T4 – 0.8 ng/dL FSH – 18.4 IU/L