Table 4.
Faculty member and trainee responses to clinical scenarios
| Clinical scenario | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| Patient characteristics | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 |
| Sex | Female | Female | Female | Female | Female | Female | Female | Female | Female |
| Age (years) | 31 | 31 | 31 | 31 | 31 | 31 | 72 | 72 | 72 |
| Current TSH level (mIU/L) | 7.0 | 7.0 | 7.0 | 7.0 | 12.1 | 7.0 | 7.0 | 12.1 | 7.0 |
| Current FT4 level (ng/dL) | 1.2 | 1.2 | 1.2 | 1.2 | 1.2 | 1.2 | 1.2 | 1.2 | 1.2 |
| Prior TSH level | 3.6 | 6.8 | 6.8 | 6.8 | 10.4 | 6.8 | 6.8 | 10.4 | 6.8 |
| Desire for fertility | No | No | Yes | No | No | No | NA | NA | NA |
| Weight gain, depressed mood | No | No | No | Yes | No | No | No | No | No |
| History of HTN and obesity | No | No | No | No | No | Yes | No | No | Yes |
| Participant responses (%) | |||||||||
| No further treatment or monitoring | 5.7 | 11.4 | 2.6 | 1.6 | 2.6 | 5.8 | 18.8 | 4.1 | 8.2 |
| Monitor for symptoms, recheck TSH annually* | 26.4 | 52.8 | 19.3 | 7.3 | 12.0 | 36.6 | 61.3 | 17.1 | 48.5 |
| Re-check TSH and FT4 in 1–2 months | 51.8 | 9.3 | 11.5 | 8.8 | 8.3 | 12.6 | 7.9 | 16.1 | 11.9 |
| Check anti-TPO antibodies and start LT4 if positive | 13.0 | 18.1 | 15.1 | 15.5 | 14.6 | 17.8 | 7.3 | 10.9 | 11.3 |
| Begin treatment with LT4 | 3.1 | 8.3 | 51.6 | 66.8 | 62.5 | 27.2 | 4.7 | 51.8 | 20.1 |
*
For clinical scenario 3, response was modified to recheck TSH during first trimester of pregnancy. All TSH levels are in mIU/L. Provided reference ranges: TSH: 0.4 – 4.4 mIU/L; FT4: 0.9 – 1.7 ng/dL. Abbreviations: TSH: thyroid stimulating hormone; FT4: free T4; HTN: hypertension; TPO: thyroid peroxidase; LT4: levothyroxine.