31-year-old woman with nausea and increased thirst

• Medical history: Primary hyperthyroidism due to Graves disease treated with radioactive iodine 6 years prior with subsequent hypothyroidism; depression 5 years prior that resolved with medication and counseling; no other psychiatric disorder. No known diabetes, pulmonary, or renal disease.


• Surgical history: None


• Medications: Levothyroxine 125 mcg daily, vitamin D 800 U daily.


• Allergies: No known drug allergies.


• Family history: Mother has type 2 diabetes mellitus and primary hypothyroidism.


• Social history: Patient is married and has been a homemaker since the birth of her daughter 2 years ago. She used to work in an office. She is a nonsmoker, has no alcohol intake, and denies taking any recreational drugs. Her diet is healthy and balanced. She eats a moderate amount of dairy products, lean meat, fruit, and vegetables. She last traveled abroad 6 months ago to Portugal. She has not had any recent contact with anyone with febrile illness or GI symptoms.