PROBLEM LIST: 1. Acquired hypothyroidism. 2. Papillary carcinoma of the thyroid gland, status post total thyroidectomy in 1992. 3. Diabetes mellitus. 4. Insomnia with sleep apnea. HISTORY OF PRESENT ILLNESS: This is a return visit to the endocrine clinic for the patient with history as noted above. She is 45 years old. Her last visit was about 6 months ago. Since that time, the patient states her health has remained unchanged. Currently, primary complaint is one of fatigue that she feels throughout the day. She states, however, she is doing well with CPAP and wakes up feeling refreshed but tends to tire out later in the day. In terms of her thyroid issues, the patient states that she is not having signs or symptoms of thyroid excess or hypothyroidism. She is not reporting temperature intolerance, palpitations, muscle weakness, tremors, nausea, vomiting, constipation, hyperdefecation or diarrhea. Her weight has been stable. She is not reporting proximal muscle weakness. CURRENT MEDICATIONS: 1. Levothyroxine 125 micrograms p.o. once daily. 2. CPAP. 3. Glucotrol. 4. Avandamet. 5. Synthroid. 6. Byetta injected twice daily. REVIEW OF SYSTEMS: As stated in the HPI. She is not reporting polyuria, polydipsia or polyphagia. She is not reporting fevers, chills, sweats, visual acuity changes, nausea, vomiting, constipation or diarrhea. She is not having any lightheadedness, weakness, chest pain, shortness of breath, difficulty breathing, orthopnea or dyspnea on exertion.