MSFinals-1151

MSFinals-1151

A 67-year-old woman visits her GP with complaints of constipation that has been ongoing for a month. She requests medication to alleviate the symptoms. The patient reports feeling more fatigued than usual and has noticed recent weight gain. During the examination, the GP observes dry scaly skin. The patient’s medical history indicates recent consultation with an endocrinologist.
What would lead to elevated thyroid-stimulating hormone (TSH) levels and normal T4 in this case?