Question

A 45-year-old man is seen for follow-up evaluation for depression and to review the results of laboratory testing. He was seen 1 month ago for a 6-month history of depressed mood, difficulty sleeping, decreased appetite, 2.3-kg (5-lb) weight loss, and fatigue. Major depressive disorder was diagnosed, and escitalopram was prescribed. Today the patient reports a significant improvement in his mood, appetite, and the quality of his sleep since starting treatment. On physical examination, vital signs and physical examination are normal. Screening laboratory studies from 1 month ago show a thyroid-stimulating hormone (TSH) level of 7 µU/mL (7 mU/L) and a free thyroxine (T4) level of 1.0 ng/dL (12.9 pmol/L). Which of the following is the most appropriate management? a. Measure thyroid peroxidase antibodies b. Measure thyrotropin receptor antibodies c. Measure serum triiodothyronine (T3) level d. Prescribe levothyroxine e. Repeat serum TSH testing in 2 months"

Answer 1

For a patient with depression showing improvement on escitalopram and having an elevated TSH with normal T4, the best step is to recheck TSH in 2 months to assess thyroid function.

Step-by-step explanation:

The most appropriate management for the 45-year-old man with depression and a higher-than-normal thyroid-stimulating hormone (TSH) level and normal free thyroxine (T4) level is e. Repeat serum TSH testing in 2 months. Since the patient has shown significant improvement in symptoms with escitalopram and his T4 level is normal, it is possible that the elevated TSH level is a lab anomaly or caused by transient thyroiditis.

Monitoring the TSH level after some time allows for assessment of whether the thyroid function is normalized or if further intervention is needed.

A deficiency in thyroid-stimulating hormone (TSH) can lead to weight gain and fatigue in individuals like Terry. TSH is responsible for stimulating the thyroid gland to produce thyroxine, which regulates metabolism. When there is a deficiency in TSH, the thyroid gland does not produce enough thyroxine, causing a decrease in metabolism. This decrease in metabolism can result in weight gain, while the lack of sufficient thyroxine can cause fatigue.