Question

An occupational medicine physician is evaluating a masonry and sandblasting worker who reports progressive exertional breathlessness and profound lethargy worsening over the past eight months. The patient, whose career spans three decades in abrasive blasting without consistent respiratory protection, recently noticed his work boots becoming excessively tight and reports needing three pillows to sleep comfortably.

On physical examination, vital signs are within normal limits except for an oxygen saturation of $92\%$ on ambient air. The patient has prominent jugular venous distention when seated at a 45-degree angle. Auscultation reveals a prominent parasternal impulse and scattered fine crackles in both lower lung fields; no expiratory wheezing is present. Examination of the lower extremities demonstrates bilateral $2+$ pitting edema extending to the mid-calves.

A high-resolution chest radiograph displays diffuse, small, rounded opacities predominantly located in the upper lung zones, alongside enlarged hilar lymph nodes exhibiting a peripheral rim of calcification.

Recent laboratory analysis reveals the following:
Thyroid-stimulating hormone (TSH): $2.5 \text{ \mu U/mL}$ (Normal: $0.4\text{--}4.0 \text{ \mu U/mL}$)
Total Thyroxine (T4): $3.8 \text{ \mu g/dL}$ (Normal: $4.5\text{--}12.0 \text{ \mu g/dL}$)

Which of the following are appropriate next steps in the management of this patient? (Select 2)