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Primary hypothyroidism — MCCQE Part 1 MCQ

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ModerateFatiguePrimary hypothyroidismMCCQE Part 1

A 46-year-old woman reports weight gain, constipation, cold intolerance and heavy menses. Examination shows dry skin and delayed relaxation of ankle reflexes; TSH is high and free T4 is low. Which of the following is the most appropriate treatment?

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Correct answer: B — Start levothyroxine with follow-up TSH monitoring

The biochemistry confirms primary hypothyroidism and levothyroxine is standard replacement therapy. Methimazole and radioactive iodine treat hyperthyroidism, not hypothyroidism. TSH should be monitored after dose changes, with lower starting doses in frail older adults or those with coronary disease.

Reference: Canadian Society of Endocrinology and Metabolism resources; Choosing Wisely Canada endocrinology