A 52 year old woman comes to see you
for follow up of her thyroid tests.
When you last saw her two weeks ago, she complained
of weight gain, fatigue and poor concentration
On exam, she had a body mass index of
33, a heart rate of 55 beats per minute
and her thyroid exam was unremarkable.
Skin was dry and coarse,
and her deep tendon reflexes
demonstrated a delayed relaxation phase.
You ordered a TSH level which is
elevated at 24 microunits per mL
and subsequently a free T4 which was low.
Her TPO antibody level is positive.
What is the next step for today's visit?
So let's go through this
Signs and symptoms point towards
Remarkably as well, she has
The normal range for TSH is
0.4 to 4 microunits per mL
In conjunction with this, she also
has free T4 level which is low
and a thyroid peroxidase
antibody level which is positive
Putting this all together, it gives the picture of primary
hypothyroidism likely due to Hashimoto's thyroiditis
and in this appointment, we will commence
her on levothyroxine thyroid replacement
We made the diagnosis of Hashimoto's thyroiditis
in this patient and on today's visit,
the discussion should revolve around
thyroid hormone replacement initiation
The presence of TPO antibodies has suggested
that Hashimoto's thyroiditis is the cause
Thyroid imaging is not indicated here unless
there is a concern for a nodule on physical exam
which is suspicious for a malignancy.