07-09-2009, 08:33 AM
A 42-year-old woman has a 1-year history of progressive fatigue without dyspnea, chest pain, or other systemic symptoms. She sleeps well at night and does not have features of sleep apnea. The patient has hypothyroidism, managed with levothyroxine, and dysmenorrhea, treated with an estrogen/progesterone combination.
On physical examination, the thyroid is slightly enlarged but nontender. Xanthomas are present on the extensor surfaces. Abdominal examination discloses mild hepatomegaly.
Laboratory Studies
Complete blood count
Normal
Serum thyroid-stimulating hormone
Normal
Serum aspartate aminotransferase
25 U/L
Serum alanine aminotransferase
32 U/L
Serum alkaline phosphatase
278 U/L
Serum total bilirubin
1.1 mg/dL (18.81 μmol/L)
In addition to a fasting serum lipid profile, which of the following studies would most likely help establish the diagnosis?
A Antimitochondrial antibody assay
B Serum 25-hydroxyvitamin D
C Endoscopic retrograde cholangiopancreatography
D Abdominal ultrasonography
On physical examination, the thyroid is slightly enlarged but nontender. Xanthomas are present on the extensor surfaces. Abdominal examination discloses mild hepatomegaly.
Laboratory Studies
Complete blood count
Normal
Serum thyroid-stimulating hormone
Normal
Serum aspartate aminotransferase
25 U/L
Serum alanine aminotransferase
32 U/L
Serum alkaline phosphatase
278 U/L
Serum total bilirubin
1.1 mg/dL (18.81 μmol/L)
In addition to a fasting serum lipid profile, which of the following studies would most likely help establish the diagnosis?
A Antimitochondrial antibody assay
B Serum 25-hydroxyvitamin D
C Endoscopic retrograde cholangiopancreatography
D Abdominal ultrasonography