Jackie O. comes to the clinic today concerned of fatigue, weight gain and abnormal periods. She has no previous past medical history of any chronic illnesses. She does have family history of hypothyroidism in her mother. You perform a physical exam which is normal. You then order laboratory tests with results as follow. CBC – normal CMP – normal Vit D – normal TSH – 15 microunits/ml – high (normal range is 0.4-4 microunits/ml) Free T4 – 0.8 mcg/dI – low (normal range is 0.9-2.4 mcg/dl) You determine she is hypothyroid. Your next course of action is to: O Begin or her on oral starting dose of Synthroid (levothyroxine/synthetic T4) 75mcg daily and follow up in 6-8 weeks for recheck, sooner if any problems or concerning symptoms. • Nothing needs to be done, patient should recheck her labs in 1 year. O Begin her on oral starting dose Cytomel (liothyronine/synthetic T3) 5mcg daily and follow up in 6-8 weeks for recheck, sooner if any problems or concerning symptoms. • Begin her on both oral Cytomel (liothyronine/synthetic T3) and Synthroid (levothyroxine/synthetic T4) at entry doses daily and follow up in 6-8 weeks for recheck, sooner if any problems or concerning symptoms.
