Question

A 42-year-old woman presents with fatigue, weight gain and constipation. Examination shows dry skin and periorbital puffiness. TSH is 19 mIU/L (normal 0.4-4.5) and free T4 is low. Which is the most appropriate initial management?

Accepted Answer

Start levothyroxine at a full replacement dose and recheck TSH in 6-8 weeks

Answer

Start liothyronine (T3) monotherapy

Answer

Reassure and repeat thyroid function tests in one year

Answer

Start empiric iodine supplementation

Answer

Order thyroid ultrasound before starting any treatment

Practice question

A 42-year-old woman presents with fatigue, weight gain and constipation. Examination shows dry skin and periorbital puffiness. TSH is 19 mIU/L (normal 0.4-4.5) and free T4 is low. Which is the most appropriate initial management?