A 52-year-old man presents to his primary care physician with a 3-month history of progressive fatigue, weight gain of 8 kg, and cold intolerance. He denies palpitations, anxiety, or heat intolerance. Physical examination reveals bradycardia (heart rate 58 bpm), dry skin, delayed relaxation phase of deep tendon reflexes, and a firm, non-tender thyroid gland without nodules. Laboratory studies show: TSH: 18 mIU/L (normal 0.5–5.0) Free T4: 0.8 ng/dL (normal 0.8–1.8) Thyroid peroxidase (TPO) antibodies: Negative Thyroglobulin antibodies: Negative Which of the following is the most appropriate initial management?
- A)Levothyroxine 75–100 mcg daily with TSH rechecked in 6–8 weeks
- B)Levothyroxine 25–50 mcg daily with TSH rechecked in 6–8 weeksGABARITO
- C)Levothyroxine plus liothyronine (T3) combination therapy to provide both thyroid hormones
- D)Observation for 3 months without pharmacologic intervention, given borderline low-normal free T4
- E)Propranolol 40 mg twice daily to manage bradycardia and constitutional symptoms
Explicação
This patient has overt hypothyroidism with elevated TSH (18 mIU/L) and free T4 at the lower limit of normal (0.8 ng/dL). The clinical presentation—fatigue, weight gain, cold intolerance, bradycardia, delayed reflexes, and dry skin—is classic for hypothyroidism... Ver explicação completa e trilha adaptativa →