Question

A 45-year-old woman is found to have an elevated thyroid-stimulating hormone (TSH) of 8 mIU/L with normal free thyroxine (fT4) on two occasions. She is asymptomatic. What is the most appropriate next step according to Canadian guidance and Choosing Wisely recommendations?

Accepted Answer

Monitor TSH periodically and consider treatment only if symptoms develop, TSH exceeds 10 mIU/L or she becomes pregnant

Answer

Start levothyroxine immediately in all patients with TSH above 5 mIU/L

Answer

Request free triiodothyronine (fT3) and thyroid uptake scan in all such patients

Answer

Order routine thyroid ultrasound to exclude malignancy

Answer

Refer urgently for thyroid surgery

Practice question

A 45-year-old woman is found to have an elevated thyroid-stimulating hormone (TSH) of 8 mIU/L with normal free thyroxine (fT4) on two occasions. She is asymptomatic. What is the most appropriate next step according to Canadian guidance and Choosing Wisely recommendations?