Rapid Review: Hypothyroidism

Reviewed February 2024

Hypothyroidism

• Sx: generalized weakness, fatigue, facial swelling, constipation, cold intolerance, and weight gain
• PE: periorbital edema, dry skin, and coarse brittle hair
• Labs: high TSH and low free T4
• Most commonly caused by Hashimoto thyroiditis
  • Dx: antithyroid peroxidase and antithyroglobulin autoantibodies
• Tx: levothyroxine
  • Takes about 6 weeks to see treatment effects
  • Monitor TSH
• Hashimoto: risk factor for non-Hodgkin lymphoma

Sample Question:

A 30-year-old woman presents to the clinic with hair loss, fatigue, weight gain, and constipation. She also reports symptoms of arthralgia. Her heart rate is 50 bpm. Physical examination reveals cool, rough, dry skin, periorbital puffiness, and pallor. A beta-hCG test shows a negative result. Which of the following is the first line of treatment for this patient’s most likely condition?