CONTINUING MEDICAL EDUCATION

A 51-year-old lady was referred to the outpatient endocrine clinic by her general practitioner because of raised TSH of 52.9 mU/L (0.35–5.50 mU/L) while on levothyroxine (LT-4) 75 mg/day. She was diagnosed with hypothyroidism due to Hashimoto’s thyroiditis 10 years previously. She had a goitre with compression symptoms (mild dysphagia and hoarseness of voice). She was known with depression and took amitriptyline 20 mg nocturnal. She did not report any cardiovascular history, diabetes or recent change of medications. She was a smoker, unemployed and had no allergies. Her sister also had a history of thyroid disease.