Question

A 49-year-old woman is found to have TSH 8.5 mU/L (reference 0.4-4.0) with normal free T4 on two occasions 3 months apart. She has mild fatigue but no goitre, normal lipids and is not pregnant. According to Canadian guidance, what is the most appropriate next step?

Accepted Answer

Repeat TSH in 6-12 months without starting therapy

Answer

Start levothyroxine immediately

Answer

Order thyroid ultrasound and fine-needle aspiration

Answer

Start combination T3/T4 therapy

Answer

Refer urgently to endocrinology for radioactive iodine treatment

Practice question

A 49-year-old woman is found to have TSH 8.5 mU/L (reference 0.4-4.0) with normal free T4 on two occasions 3 months apart. She has mild fatigue but no goitre, normal lipids and is not pregnant. According to Canadian guidance, what is the most appropriate next step?