Family Nurse Practitioner Exam

In evaluating hypothyroidism, what is the next step after finding an elevated TSH of 10 mU/L?

1. Check the total T3 and T4 levels

2. Check for antithyroid peroxidase antibodies

3. Check the thyroid profile

4. Recheck the TSH in 4 to 6 months

The correct answer is: Check the thyroid profile

In the context of evaluating hypothyroidism, finding an elevated thyrotropin (TSH) level, such as 10 mU/L, indicates that the thyroid gland may not be producing sufficient thyroid hormones (T4 and T3). It is essential to confirm the diagnosis of hypothyroidism by measuring the associated thyroid hormone levels. The thyroid profile generally includes both free T4 and total T3 levels. By measuring these hormones, you can determine whether the elevated TSH is due to primary hypothyroidism (where both TSH is elevated and T4 is low) or another condition. This step is crucial because it helps in establishing the diagnosis and determining the appropriate management plan for the patient. Checking for antithyroid peroxidase antibodies may be important in evaluating autoimmune thyroid conditions, such as Hashimoto's thyroiditis, but it is not the immediate next step after identifying elevated TSH. Similarly, while rechecking TSH in 4 to 6 months could be considered in certain scenarios, it is not appropriate here as the elevated TSH indicates an immediate need for further evaluation of thyroid function. Therefore, obtaining a complete thyroid profile is the most logical next step after discovering an elevated TSH.