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

The best treatment plan for a patient with elevated TSH and low free T4 is to start levothyroxine (Synthroid) at an appropriate dose. This clinical picture is indicative of primary hypothyroidism, where insufficient levels of thyroid hormones (T4) stimulate the pituitary gland to produce more TSH (thyroid-stimulating hormone).

Levothyroxine is a synthetic form of thyroxine (T4), and starting the patient on this medication addresses the hormone deficiency effectively. The dose of 0.25 mcg daily is a standard initial dose that can be adjusted based on subsequent lab results and the patient's response to treatment. Regular monitoring of TSH and free T4 levels is essential to titrate the dosage effectively and achieve optimal thyroid hormone levels.

In contrast, simply advising the patient that the thyroid problem is resolved does not address the underlying hypothyroidism. Moreover, starting Armour thyroid, which contains a combination of T3 and T4, is typically not the first choice for treatment, as levothyroxine is preferred in most cases due to its stability and predictability. Referring the patient to an endocrinologist may be warranted in complex cases, but for straightforward primary hypothyroidism management, initiating lev