A 42-year-old female presents with fatigue, cold intolerance, weight gain, and constipation. Laboratory evaluation reveals an elevated TSH of 14.2 mIU/L and a low free T4. What is the most appropriate initial pharmacological therapy?
Answer and explanation
Correct answer: B. Levothyroxine (T4)
- Step 1: An elevated serum TSH with a low free T4 confirms primary hypothyroidism (commonly Hashimoto's thyroiditis).
- Step 2: The standard replacement therapy is oral synthetic levothyroxine (T4), dosed to normalize serum TSH levels.
Answer
Levothyroxine (T4).
Why not the others: 'Propylthiouracil (PTU)' is an antithyroid drug used for hyperthyroidism and thyroid storm; 'Methimazole' treats hyperthyroidism; 'Radioactive iodine-131 ablation' destroys hyperactive thyroid tissue in Graves' disease.
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