Family Nurse Practitioner Exam

What is the best treatment plan for a patient with elevated TSH and low free T4, who is symptomatic for hypothyroidism?

1. Advise the patient that she does not have a thyroid problem

2. Start on levothyroxine (Synthroid) 0.25 mcg PO daily

3. Start the patient on Armour thyroid

4. Refer to an endocrinologist

The correct answer is: Start on levothyroxine (Synthroid) 0.25 mcg PO daily

The best treatment plan for a patient with elevated TSH and low free T4, along with symptoms of hypothyroidism, is to initiate therapy with levothyroxine, commonly known as Synthroid. This option is appropriate because the patient's laboratory findings indicate primary hypothyroidism, characterized by elevated TSH (thyroid-stimulating hormone) due to a lack of adequate thyroid hormone (T4) production by the thyroid gland. Starting levothyroxine therapy directly addresses the underlying deficiency of thyroid hormone by providing the body with a synthetic form of T4. This treatment works to normalize TSH and T4 levels, alleviating symptoms associated with hypothyroidism, such as fatigue, weight gain, and cold intolerance. It is crucial to start treatment to improve the patient's quality of life and metabolic function. The administration of levothyroxine is supported by guidelines and clinical practice for treating hypothyroidism, with dosages typically starting at 1.6 mcg/kg/day, although the exact dose can be adjusted based on the patient's response and subsequent laboratory results. In contrast to suggesting that the patient does not have a thyroid problem – which disregards the evident lab results and symptoms – initiating treatment directly addresses the diagnosis. While Armour thyroid