Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 54-year-old man is evaluated because of fatigue. He also notes constipation and cold intolerance. Medical history is significant for tonsillar squamous cell carcinoma treated with radiation 3 years ago. There is no family history of thyroid disorders.
On physical examination, the skin is dry. Mild periorbital edema is present. The thyroid is of normal size and without nodules. Reflexes are delayed.
Laboratory studies show a hemoglobin level of 11 g/dL (110 g/L), a serum sodium level of 129 mEq/L (129 mmol/L), and a serum thyroid-stimulating hormone (TSH) level of 1.4 µU/mL (1.4 mU/L).
Which of the following is the most appropriate next step in management?
A: Free thyroxine (T4) measurement
B: Repeat TSH measurement in 4 weeks
C: Thyroid scintigraphy
D: Thyroid ultrasound
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