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History and Present Illness 
Patient is a 42-year-old female that presented for a physical after three years with no medical care. She is obese, and rationalizes a 45-pound weight gain, stating that all women in her family are ‘stocky.’

She complains of ‘bumps’ on her arms, along with occasional nausea, and fatigue. The patient believes that her fatigue indicates worsening hypothyroidism, and that she needs her Synthroid dosage increased. 

Medical History 
Seasonal allergies 
Synthroid – 100 mcg qd 
OTC decongestant BID 
Vital Signs and Physical Examination 
Temperature: 98.6 
B/P: 148/84 
Height: 5’6” 
Weight: 280 
Alert and oriented x3 
Patient has multiple solid yellow lesions on her upper arms and chest. She states that she noticed them approximately four months ago. She exhibits slight edema in both feet. 

Social History 
Patient lives alone, and works in the fast-food industry.  

What leads you to believe that your patient has very high triglycerides?  

What labs would you order for this patient, based on the patient’s weight gain, and her elevated blood pressure? 

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