How do you counsel patients with elevated Thyroglobulin Peroxidase antibody levels, diffuse thyroiditis features on ultrasound, non-specific symptoms of fatigue, but normal biochemical thyroid function labs?

How do you counsel patients with elevated Thyroglobulin Peroxidase antibody levels, diffuse thyroiditis features on ultrasound, non-specific symptoms of fatigue, but normal biochemical thyroid function labs?

• I advise patient that her fatigue symptom is unrelated to the thyroiditis but explain her risk of developing hypothyroidism and the need for periodic TSH monitoring
• If the patient has associated weight loss, orthostatic drop in BP or nausea, I screen for autoimmune AI
• If the patient has no CVD risk factors, I offer a short trial of thyroid hormone replacement
• Other