Pituitary Disorders USMLE Step 1 Practice Question
A 45-year-old woman presents with progressive cold intolerance, weight gain, hair loss, and fatigue over 6 months. Vital signs show HR 52 bpm, BP 128/82 mmHg, temperature 36.2°C. Laboratory studies reveal elevated TSH 18 mIU/L (normal 0.4-4.0), low free T4 0.5 ng/dL (normal 0.8-1.8), and positive TPO antibodies. Thyroid ultrasound shows normal gland size without nodules. She denies recent medication changes. Which of the following is the most appropriate initial management?
Answer choices
- AObservation without treatment
- BThyroid-stimulating immunoglobulin antagonists
- CAntithyroid medications (PTU or methimazole)
- DLevothyroxine replacement therapyCorrect answer
- EPropranolol for symptom control
- FIodine supplementation with potassium iodide
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