A previously healthy 50-year-old male presents to your office with several new complaints. About three months earlier he had been given the diagnosis of Raynaud's phenomenon due to cold intolerance particularly affecting his hands. Over the past month, he has been fatigued and has generalized cramping and achiness. On further questioning, he also thinks he has lost some hair on his hands, has been having difficulty concentrating and has had some loss of libido. He has no constipation, abdominal discomfort, orthostasis, headaches or visual problems. He has been told that many of his symptoms are consistent with depression possibly related to the stress of being diagnosed with Raynaud's phenomenon as well as problems at work. His physical exam is unremarkable (weight is 100 kg). His CBC, metabolic panel, and sedimentation rate are all normal but his free T4 is low at 0.48 (nl 0.8 - 1.8) with a normal TSH of 1.58 (nl 0.38 - 4.70).