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Central hypothyroidism — SCE Endocrinology MCQ

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HardThyroidCentral hypothyroidismSCE Endocrinology

A 40-year-old woman has low free T4 at 7 pmol/L with TSH 1.1 mU/L. She also reports amenorrhoea and headaches. Prolactin is mildly raised. What is the most appropriate next investigation?

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Correct answer: D — Pituitary MRI and assessment of other pituitary axes

Low free T4 with an inappropriately normal TSH suggests central hypothyroidism, especially with headaches and amenorrhoea. Primary thyroid disease usually gives an appropriately high TSH. Other pituitary axes must be assessed before thyroid replacement, particularly cortisol reserve.

Reference: Society for Endocrinology Pituitary Guidance; NICE NG145