Question

A 24-year-old woman presents with tiredness, weight gain and cold intolerance. Her TSH is 18 mIU/L (reference 0.4-4.0) and free T4 is below the reference range. She is not pregnant and has no cardiac disease. What is the most appropriate initial management?

Accepted Answer

Start levothyroxine at a full replacement dose (about 1.6 micrograms/kg/day)

Answer

Reassure and repeat thyroid function tests in 6 months

Answer

Start liothyronine (T3) therapy

Answer

Start levothyroxine at very low dose (12.5 micrograms daily)

Answer

Refer immediately for thyroidectomy

Practice question

A 24-year-old woman presents with tiredness, weight gain and cold intolerance. Her TSH is 18 mIU/L (reference 0.4-4.0) and free T4 is below the reference range. She is not pregnant and has no cardiac disease. What is the most appropriate initial management?