Question

A 25-year-old woman presents with fatigue, weight gain, constipation and cold intolerance. Examination reveals dry skin and delayed ankle reflex relaxation. TSH is 15 mIU/L (reference 0.4-4.0), and free T4 is low. There is no pregnancy. Which is the most appropriate initial management?

Accepted Answer

Start levothyroxine at a full replacement dose of approximately 1.6 µg/kg/day

Answer

Observe and repeat thyroid function tests in 6 months

Answer

Start levothyroxine at 25 µg daily and titrate slowly over 12 months

Answer

Treat symptomatically without thyroid hormone and consider antidepressants

Answer

Refer for thyroidectomy as first-line therapy

Practice question

A 25-year-old woman presents with fatigue, weight gain, constipation and cold intolerance. Examination reveals dry skin and delayed ankle reflex relaxation. TSH is 15 mIU/L (reference 0.4-4.0), and free T4 is low. There is no pregnancy. Which is the most appropriate initial management?