Nineteen Ninety Nine arrived and I was still battling hypothyroidism.  I saw Blonde Bimbo on January 21st, 1999.  Her report for that appointment reads as follows, “Currently Widebertha is on 150 mg of Levothyroxine for the past two months.  Her previously severe myalgias have diminished markedly.  Temperature perception is normal.  Her headaches are much improved.  One menses in the interval has been normal and one has been heavy.  She still has some periorbital puffiness but no other ocular symptoms suggestive of opthalmopathy.

On examination today her blood pressure was 170/90.  Her pulse was 72 and regular.  She does have some periorbital puffiness but normal range of movement of both eyes.  The left eye is somewhat protuberant with a measurement of 20 mm; with the right eye measurement of 18 mm.  She was otherwise clinically euthyroid on exam with normal reflexes with no delay in relaxation phase.  Recent lab work shows her to have a free T4 of 16.1, TSH of 5.9 with an upper limit of normal of 3.6 on the assay.

Widebertha is still slightly under-replaced with regards to her hyperthyroidism post Iodine 131.  I have asked her to increase her levothyroxine to 175 mg daily.  She has been asked to return for review on one further occasion to evaluate the affect of this.”

Blood Test Results from August 28th, 1998 are as follows:

• TSH at 15.9 with lab normal being .46 -3.6
• Free T3 was 4.7 with lab normal being 1.5 – 5
• Free T4 – Thyroxine was 17.3 with lab normal being 9.4 – 25.9

Blood Test Results from November 2, 1998 are as follows:

• TSH was 9.7 with lab normal being .46 – 3.6
• Free T3 was 4.0 with lab normal being 1.5 – 5
• Free T4 – Thyroxine was 17.0 with lab normal being 9.4 – 25.9

Blood Test Results from January 21, 1999

• TSH was 5.9 with lab normal being .46 – 3.6
• Free T4 – Thyroxine was 16.1 with lab normal being 9.4 – 25.9