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Subclinical hypothyroidism — RACGP Fellowship MCQ

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HardChronic disease managementSubclinical hypothyroidismRACGP Fellowship

A 57‑year‑old woman reports fatigue, weight gain and low mood. TSH is 7.2 mIU/L, free T4 is normal and thyroid peroxidase antibodies are positive. She has no goitre and no pregnancy plans. Repeat TSH in eight weeks is 6.8 mIU/L. What is the most appropriate management?

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Reveal the answer and explanation

Correct answer: E — Discuss subclinical hypothyroidism, monitor thyroid function and individualise treatment

Explanation lettering: E = shown as C · C = shown as D · D = shown as E

Option D aligns with current Australian (RACGP) guidance. For persistent TSH 5–10 mIU/L and positive TPO antibodies, monitoring with shared decision-making is an acceptable alternative to immediate thyroxine (RACGP 2012). The patient’s TSH is stable, symptoms are non‑specific, and there is no goitre or other risk factor. Options A, B, C and E are inappropriate—carbimazole treats hyperthyroidism; thyroidectomy or iodine therapy are unsupported; antibodies indicate disease, not exclusion.

Reference: RACGP: Hypothyroidism – Investigation and management (2012); RACGP: First Do No Harm – Management of subclinical hypothyroidism (circa 2022). https://www.racgp.org.au/afp/2012/august/hypothyroidism