Question

A 36-year-old woman presents with fatigue, weight gain, cold intolerance and constipation. Examination shows dry skin and delayed ankle reflexes. TSH is 18 mIU/L (elevated) and free T4 is low. She is not pregnant and takes no interacting medications. What is the most appropriate management?

Accepted Answer

Start levothyroxine replacement therapy.

Answer

Reassure her and repeat thyroid function tests in 6 months.

Answer

Start liothyronine (T3) replacement therapy only.

Answer

Order thyroid ultrasound and delay treatment until imaging is completed.

Answer

Treat only if TSH remains above 20 mIU/L on repeat testing.

Practice question

A 36-year-old woman presents with fatigue, weight gain, cold intolerance and constipation. Examination shows dry skin and delayed ankle reflexes. TSH is 18 mIU/L (elevated) and free T4 is low. She is not pregnant and takes no interacting medications. What is the most appropriate management?