A 45-year-old G2P2 woman presents for annual examination. She reports regular menstrual cycles lasting 3 to 5 days. She exercises five times per week and reports no difficulty sleeping. Her weight is stable at 140 lb and she is 5 ft 8 in tall. Physical examination is unremarkable. Lab studies are normal with the exception of a TSH value of 6.6 mU/L (normal 0.4-4.0 mU/L). Free T4 is normal. Which of the following represents the best option for management of this patient’s elevated TSH?
A. Repeat TSH in 3 months and reassess for signs of hypothyroidismIn this patient with a TSH below 10 mU/L and no symptoms of hypothyroidism, the diagnosis is subclinical hypothyroidism. Recommendations include checking a free thyroxine level (it should be normal in subclinical hypothyroidism) and repeating the TSH in 3 months to monitor for progression toward overt hypothyroidism. The patient should be informed about the symptoms of hypothyroidism. Thyroxine therapy is not currently recommended for asymptomatic patients in whom the TSH level is below 10 mU/L. Although an abnormal TPO Ab increases the risk of progression to overt hypothyroidism, it does not affect your present management. Thyroid uptake scan may be useful in the diagnosis of hyperthyroidism, but not in possible hypothyroidism. Iodide deficiency is not seen in the United States because of dietary iodide supplementation.