A 35-year-old female presents to the GP with complaints of fatigue, weight gain, and cold intolerance over the past six months. She reports feeling depressed and has difficulty concentrating. She has no significant medical history, and her family history is notable for autoimmune disorders (her mother has Hashimoto's thyroiditis). Physical Exam Findings: General: Overweight female appearing tired Vital signs: BP 120/75 mmHg, HR 68 bpm Skin: Dry and coarse Neck: Mildly enlarged thyroid gland (goiter) Initial Investigations: TSH: 8.5 mIU/L (high) Free T4: 0.7 ng/dL (low) Thyroid peroxidase (TPO) antibodies: Positive MCQs: What is the first-line treatment for this patient? A) Levothyroxine B) Liothyronine C) Methimazole D) Radioactive iodine How often should the patient’s TSH levels be monitored after starting treatment? A) Every 3-4 weeks until stable, then every 6-12 months B) Every month indefinitely C) Only at the next annual check-up D) Every 2 weeks for the first 6 months What lifestyle advice should be given regarding medication? A) Take the medication with food B) Take the medication on an empty stomach C) Discontinue medication if feeling well D) Adjust the dose as needed based on symptoms Answers with Explanations: Answer: A) Levothyroxine Explanation: Levothyroxine is the standard treatment for hypothyroidism to normalize TSH and T4 levels. Answer: A) Every 3-4 weeks until stable, then every 6-12 months Explanation: TSH levels should be monitored frequently after starting treatment to ensure the dosage is effective and to avoid overtreatment. Answer: B) Take the medication on an empty stomach Explanation: Levothyroxine should be taken on an empty stomach, ideally in the morning, to enhance absorption. Overview of the Topic: Hypothyroidism Management Hypothyroidism is characterized by elevated TSH and low T4 levels. The mainstay of treatment is levothyroxine, with regular monitoring of TSH to ensure adequate management. Patient education on medication adherence and timing is essential for effective treatment. Key Learning Points: Early diagnosis and treatment are crucial for preventing complications of hypothyroidism. Regular monitoring and patient education are vital for long-term management.
