MEDizzy - A 45-year-old G2P2 female presents for an annual

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Metabolic diseases

A 45-year-old G2P2 female presents for an annual examination. She reports regular menstrual cycles lasting 3 to 5 days. She exercises 5 times per week and reports no difficulty sleeping. Her weight is stable 140 lbs and she is 5 ft 8 in tall. Physical examination is unremarkable. Laboratory studies are normal with the exception of a TSH value of 6.6 mU/L (normal 0.4-4.0 mU/L). Which of the following represents the best option for the management of this patient’s elevated TSH?

ExplanationIn this patient with a TSH below 10 mU/L and no symptoms of hypothyroidism, the diagnosis is subclinical hypothyroidism. Recommendations include checking a free thyroxine level (it should be normal in subclinical hypothyroidism) and repeating the TSH in 3 months to monitor for progression toward overt hypothyroidism. The patient should be informed about the symptoms of hypothyroidism. Thy- roxine therapy is not currently recommended for asymptomatic patients in whom the TSH level is below 10 mU/L. Although an abnormal TPOAb increases the risk of progression to overt hypothyroidism, it does not affect your present management. Thy- roid uptake scan may be useful in the diagnosis of hyperthyroidism, but not in possible hypothyroidism. Iodide deficiency is not seen in the United States because of dietary iodide supplementation.