A 60-year-old man has a TSH of 0.1 mIU/L (normal 0.4 to 4.0) and normal free T4 and free T3. He has no goiter and no symptoms of hyperthyroidism. What is the most appropriate next step?
- A Radioactive iodine uptake scan
- B Start methimazole
- C Repeat TSH with free T4 and free T3 in two to three months ✓
- D Start levothyroxine
Correct answer: C. Repeat TSH with free T4 and free T3 in two to three months
Explanation
Subclinical hyperthyroidism is defined by suppressed TSH with normal free T4 and T3. Before further workup, transient non-thyroidal illness or assay variation must be excluded by repeating the test in two to three months. RAIU scan or treatment is premature without persistent biochemical confirmation.
Reference: Braverman and Cooper's Werner and Ingbar's The Thyroid, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.