Rapid Review: Hypothyroidism

Hypothyroidism

• Patient will be complaining of generalized weakness, fatigue, facial swelling, constipation, cold intolerance, and weight gain
• PE will show periorbital edema, dry skin, and coarse brittle hair
• Labs will show high TSH and low free T4, antithyroid peroxidase, and antithyroglobulin autoantibodies
• Most commonly caused by Hashimoto’s thyroiditis
• Treatment is levothyroxine
• Comments: Takes about 6 weeks to see treatment effects. Monitor TSH
• Hashimoto’s: Risk factor for non-Hodgkin lymphoma

Sample Question: A 55-year-old woman presents to your office with complaints of fatigue, dry skin, constipation and weight gain. Physical exam results include a heart rate of 58 bpm and diminished deep tendon reflexes. Laboratory testing reveals an elevated TSH. Which of the following is the most appropriate next step in management?