Signal Sprint 08: The Abnormal Finding That Isn't the Problem

Thyroid dysfunction related to the elevated TSH

A hemodynamic or volume-related cause of the lightheadedness

Attribute the symptoms to thyroid dysfunction and begin treatment based on the TSH result

Further characterize when the lightheadedness occurs and assess for contributing factors, including hydration, intake, and positional changes

Repeat the TSH immediately until it returns to the reference range

Reassure her that the symptoms are unrelated because the free T4 is normal

Orthostatic blood pressure and heart-rate changes that reproduce her usual symptoms

Which information should carry the greatest weight in explaining her intermittent lightheadedness?

Treat the thyroid result as the cause of both fatigue and lightheadedness and stop the evaluation there

Address the likely volume and orthostatic contribution to her lightheadedness while interpreting and following the thyroid abnormality on its own clinical merits

Ignore the thyroid result because another explanation for the lightheadedness has been identified

Refer immediately for neurologic evaluation because orthostatic symptoms indicate central nervous system disease