Approach to hypothyroidism Quiz: Ace Your Exams

A 60-year-old woman was brought to the emergency department by EMS in the winter after a bystander noticed her on the ground and called 911. A friend at the scene reported that the patient is currently undomiciled. Records from prior clinic visits indicate that the patient takes levothyroxine and atorvastatin. She is responsive only to painful stimuli. Shallow, labored breathing is observed. Temperature is 34.9°C (94.8°F), pulse is 41/min and weak, respirations are 10/min, and blood pressure is 82 systolic. Reflexes are globally diminished.  Non pitting edema is present over the hands and face. While the patient is being stabilized, urgent labs are sent and show a TSH of 94.2 mIU/L (reference range: 0.5-5 mIU/L) , serum free T4 of 0.18 ng/dL (reference range: 0.9-2.3 ng/dL), sodium of 132 mmol/L (reference range: 136-146 mmol/L), and glucose of 60 mg/dL (70-110 mg/dL). In addition to supportive measures, which of the following is the most appropriate next step in management?