Clinical course showing changes in thyroid function and treatment adjustments from initial evaluation to hospitalization. The lines represent free T4 levels, and changes in TSH levels over time. The shaded areas indicate levothyroxine and liothyronine dosage adjustments. Treatment administration routes are denoted by arrows: solid arrows indicate periods of oral administration and outlined arrows represent periods of rectal administration. TSH and free T4 measurements demonstrate persistent thyroid dysfunction despite progressive medication adjustments, ultimately leading to diagnostic admission.