A 7-year-old girl is found to have TSH 7.5 mIU/L (normal 0.5-5.0) on routine testing. Free T4 is normal at 1.2 ng/dL. She is asymptomatic with normal growth velocity and development. Thyroid peroxidase antibodies are negative. Physical examination is normal with no goiter. What is the most appropriate next step?
- A Start levothyroxine 25 mcg daily
- B Perform thyroid ultrasound
- C Repeat TSH and free T4 in 4-6 weeks ✓
- D Start iodine supplementation
Correct answer: C. Repeat TSH and free T4 in 4-6 weeks
Explanation
Subclinical hypothyroidism with TSH between 5-10 mIU/L in an asymptomatic child with negative antibodies and normal growth warrants observation with repeat testing in 4-6 weeks, as many cases are transient. Treatment is indicated if TSH exceeds 10 mIU/L, symptoms develop, antibodies are positive, or growth velocity declines.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.