Soru

A 29-year-old G2P2 is evaluated in the outpatient setting for secondary amenorrhea that has persisted for 9 months. Her last pregnancy concluded 14 months prior via a spontaneous vaginal delivery, which was immediately complicated by significant uterine atony. This resulted in a massive obstetric hemorrhage necessitating a 4-unit packed red blood cell transfusion. In the postpartum period, the patient noted a complete inability to breastfeed her newborn. Over the most recent six-month interval, she has developed worsening fatigue, an inability to tolerate cold temperatures, and an unintended weight loss of 4 kg (8.8 lb). Before her last pregnancy, her menstrual cycles were highly predictable, occurring every 28 days. Vital signs today show a blood pressure of 92/58 mm Hg and a heart rate of 58/min. Physical examination is remarkable for dry, cool skin and a noticeable delay in the relaxation phase of her deep tendon reflexes. A urine beta-hCG assay is negative. Which of the following laboratory test result patterns is most likely to be present in this patient?