A 23 year old asymptomatic woman attends her family physician for thyroid function testing as her mother has recently been commenced on levothyroxine. Thyroid functiontests (TFTs) show TSH 6miU/L, and free
T4 of 12.4 pmoi/L (0.96 ng/dL). Her serum thyroid peroxidase antibodies are strongly positive. What is the most appropriate management plan?
Check thyroglobulin antibodies
Arrange a scintigraphy scan
Reassure and discharge
Repeat TFT s in 4-6 months
This woman has subclinical hypothyroidism. There is no benefit in checking thyroglobulin antibodies as it does not change her diagnosis or management. With positive thyroid peroxidase antibodies she has a higher risk of progression to overt thyroid failure. A trial of thyroxine replacement would be advocated if her TSH was > 1 0 miU/L or she developed symptoms suggestive of progression to clinical disease. Reviewing her biochemistry and symptomatology is therefore necessary.