An 18-year-old with low TSH of 0.27, normal free T3 and free T4, heavy menstrual bleeding, and irregular cycles. Other history of eczema and depression. Suggestions on how to follow up?

Dr. Amy Nett: Well, because of the menstrual issues, I would think about getting hormone testing. I’d probably start with Precision Analytical. I would do a complete hormone profile. You want adrenal information in there as well because, remember, there’s the hypothalamic-pituitary-adrenal-thyroid-gonadal axis, so cortisol can also affect thyroid. Do the 24-hour collection. If you don’t have a good answer there in terms of what’s going on hormonally, they also have cycle mapping, where patients are collecting urine samples throughout the month and you get a better idea of the estrogen-to-progesterone ratio.