A 45-year-old woman has TSH 14 mU/L and low free T4, with fatigue and weight gain. What is the appropriate treatment?
Answer and explanation
Correct answer: D. Levothyroxine, with TSH monitored about every 3 months until stable
- Step 1: A high TSH with low T4 is overt primary hypothyroidism.
- Step 2: Levothyroxine replaces the deficiency and the dose is titrated by TSH, which NICE NG145 advises measuring about every 3 months until it is stable.
Answer
Levothyroxine, with TSH monitored about every 3 months until stable.
Why not the others: Watchful waiting for one year, then repeat thyroid function tests before deciding: Overt hypothyroidism should be treated. Carbimazole 40 mg daily with weekly thyroid function tests for the first month: Carbimazole treats hyperthyroidism. Radioactive iodine treatment arranged through the nuclear medicine department: Radioiodine treats hyperthyroidism.
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