We are excited to see so many of you join our FMEP courses. Several of you have requested we continue to post more practice SAMPs, so here you go!

SAMP

A 55-year-old woman presents with fatigue, weight gain, and constipation. TSH is 12 mIU/L, free T4 low-normal. (8 points)

1. Most likely diagnosis? (1 point)
   1. Subclinical hypothyroidism
   2. Overt hypothyroidism
   3. Hyperthyroidism
   4. Euthyroid sick syndrome
   5. Thyroid nodule

   Answer: B

2. Best initial management? (1 point)
   1. Observation only
   2. Start levothyroxine
   3. Methimazole
   4. Radioactive iodine
   5. High-dose iodine supplementation

   Answer: B

3. Which factor increases levothyroxine requirements? (1 point)
   1. Pregnancy
   2. Sedentary lifestyle
   3. Vitamin D supplementation
   4. Aging
   5. High-fibre diet

   Answer: A

4. Which medications interfere with levothyroxine absorption? Select all that apply. (4 points)
   1. Calcium
   2. Iron
   3. Bisphosphonates
   4. Proton pump inhibitors
   5. Metformin

   Answer: A, B, C, D

5. Target TSH after treatment? (1 point)
   1. <0.1 mIU/L
   2. Within normal range for age
   3. >10 mIU/L
   4. Suppressed below normal
   5. No need to monitor

   Answer: B