Subclinical Hypothyroidism: ABFM practice questions

4 board-style questions on subclinical hypothyroidism in the PulseMD family medicine question bank — physician-reviewed, written against current guidelines with the reference cited on each question. Two free samples below; the full set with answers, explanations, and spaced review is free to start.

Sample question 1

A 28-year-old woman at 8 weeks gestation is found to have a TSH of 5.8 mIU/L (trimester-specific reference range 0.1–2.5 mIU/L) with a normal free T4 level. Thyroid peroxidase (TPO) antibodies are positive. She is otherwise asymptomatic. What is the most appropriate management?

1. Order a thyroid ultrasound and defer treatment pending results
2. Start methimazole to lower TSH
3. Recheck TSH in 4 weeks without initiating treatment
4. Start levothyroxine replacement therapy

Sample question 2

A 38-year-old woman presents with fatigue and difficulty concentrating. She and her husband have been trying to conceive for the past 3 months. Labs: TSH 8.2 mU/L (normal 0.4-4.0), free T4 1.1 ng/dL (normal 0.8-1.8), anti-TPO antibodies positive. Pregnancy test is negative. What is the most appropriate management?

1. Recheck TSH in 3 months without treatment since free T4 is normal
2. Start liothyronine (T3) replacement therapy
3. Refer for radioactive iodine ablation of the thyroid
4. Start levothyroxine replacement therapy

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