20th August 2020

A 55-year old woman underwent a blood test after presenting to her GP with fatigue and generalised joint pains

A 55-year old woman underwent a blood test after presenting to her GP with mild fatigue and generalised joint pains. The results are below:

• Hb: 120 (115-165g/L)
• WCC: 5.2×10⁹ (3.6-11.0×10⁹/L)
• Platelets: 144×10⁹ (140-400×10⁹/L)
• Na: 135 (133-146mmol/L)
• K: 4.2 (3.5-5.3mmol/L)
• Ca (adjusted): 2.4 (2.2-2.6mmol/L)
• Urea: 7.2 (2.5-7.8mmol/L)
• Creatinine: 48 (45-84μmol/L)
• HbA1c: 35 (<42mmol/mol)
• Vitamin B12: 650 (180-1000pg/ml)
• Folate: 5.3 (>4.0 ng/ml)
• Transferrin saturation: 62 (25-45%)
• Serum ferritin: 182 (15-200ug/L)
• TSH: 2.3 (0.4-4.0mU/L)
• Free T4: 12 (9-24pmol/L)
• Free T3: 4.8 (3.5-7.8pmol/L)
• Cortisol (random): 338 (137-429 nmol/L)

What is the next step in her management?

Select the SINGLE most appropriate option from the list below. Select ONE option only.