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Hypothyroidism — MCCQE Part 1 MCQ

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ModerateFatigueHypothyroidismMCCQE Part 1

46-year-old woman presents with fatigue, cold intolerance and weight gain. She has dry skin, delayed reflex relaxation and TSH is elevated with low free T4. Which of the following is the most appropriate next step?

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Correct answer: A — Start levothyroxine and monitor TSH response

Start levothyroxine and monitor TSH response is best because primary hypothyroidism explains the symptoms and biochemistry. Discharge with reassurance and routine follow-up only is suboptimal because it underestimates acute or progressive risk; Treat symptomatically and defer definitive assessment is suboptimal because symptom control alone does not address the likely underlying diagnosis; Arrange non-urgent outpatient imaging in several months is suboptimal because delayed imaging is unsafe when the presentation has red flags; Start long-term corticosteroids without confirming the diagnosis is suboptimal because empiric steroids can obscure infection, malignancy or other diagnoses. Dose cautiously in older patients or those with ischaemic heart disease.

Reference: Choosing Wisely Canada endocrine guidance