ABSTRACT
A 62-year-old woman presented to her GP worried that she has become increasingly fatigued over the last 18 months and recently her appetite has been poor. She put this down to stress and difficulty coping at home since her retirement. However, her daughter is anxious that she seems to be looking more yellow over the past few weeks. The woman also complains of an itchy sensation making her scratch all the time. She finds she has to drink more water because of a dry mouth. She has not had any abdominal pains, malaena, change in bowel habit or loss of weight. She has hypothyroidism and takes thyroxine replacement, and her sister also has thyroid disease. She does not smoke or drink alcohol. She takes no treatment other than thyroxine.
