A 24-year-old man reports progressive asthenia for at least 6 months, hoarse voice, slow speech, drowsiness and swelling of the hands, feet and face. Examination: pulse at 52 beats per minute, abotarada face and dry and pale skin. CBC: mild anemia, cholesterol 385 mg/dL (normal <220), creatinine 1.3 mg/dL (normal: 0.5-1.1), negative proteinuria, TSH 187μIU/mL (normal 0.35-5.5) and Free T4 0.2 ng/dL (normal 0.85-1.86). What strategy do you think is most appropriate?
This is severe primary hypothyroidism. Treatment is with thyroxine. If there is no nodule, neither echo nor FNA is indicated.
Perform a thyroid ultrasound before starting treatment.
Determine free T3 and perform a pituitary MRI.
Treat with L-triiodothyronine and a statin.
Treat with L-Tyroxine and determine antithyroid antibodies.
Perform thyroid cytology prior to treatment.
If there is no nodule, neither echo nor FNA is indicated.
This is severe primary hypothyroidism. Treatment is with thyroxine.
If there is no nodule, neither echo nor FNA is indicated.