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A 28-year-old woman has been seeing a psychologist for the past 18 months for depression. The psychologist is concerned about her increasing lethargy and intolerance for cold and asks the patient to see her primary care physician. She reports fatigue and anhedonia. She has experienced a 6.8-kg (15-lb) weight gain over the past year, which the patient attributes to her antidepressant. She does not exercise regularly because she doesn't like the winter air. She sleeps about 12 hours per night. She reports constipation, and frequently uses laxatives. She says that her periods have been quite heavy for the past year. Her temperature is 36.8°C (98.2°F), pulse is 56/min, respirations are 12/min, and blood pressure is 126/88 mm Hg. She is notably slow of speech. Abdominal examination shows slightly decreased bowel sounds and mild diffuse tenderness. Her deep tendon reflexes show a delayed relaxation phase. Which of the following is the most appropriate next step in diagnosis?
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