Thyroid Case: 52-year-old Woman with Weight Gain, Fatigue and Poor Concentration

00:01 A 52 year old woman comes to see you for follow up of her thyroid tests.

00:06 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.

00:21 Skin was dry and coarse, and her deep tendon reflexes demonstrated a delayed relaxation phase.

00:29 You ordered a TSH level which is elevated at 24 microunits per mL and subsequently a free T4 which was low.

00:38 Her TPO antibody level is positive.

00:42 What is the next step for today's visit? So let's go through this patient's presentation.

00:49 Signs and symptoms point towards clinical hypothyroidism Remarkably as well, she has elevated TSH.

00:57 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.