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23rd April 2024
A 40-year-old lady presents with a 5-month history of fatigue. She explains she just has no energy
A 40-year-old lady presents with a 5-month history of fatigue. She explains she just has no energy whatsoever. She has also noticed a new itch over the past few weeks. She does not have any abdominal pain and has not noticed any fevers or weight loss. Her observations are normal. On examination, she is very slightly jaundiced and there is evidence of truncal scratch marks.
Investigations show the following:
| Haemoglobin | 120 g/L |
| White Cell Count | 7×10⁹/l |
| Platelets | 350 10⁹/l |
| ESR | 30mm/h |
| Creatinine | 60 μmmol/ |
| TSH | 3 mu/l (ref 0.5-5.5 mu/l) |
| Bilirubin | 55 μmmol/ |
| Alkaline Phosphatase | 500 μmmol/ |
| ALT | 50 iu/l |
| AST | 70 iu/l |
| Antimitochondrial Antibody | Positive |
| Antinuclear antibody | Positive |
Abdominal ultrasound is unremarkable.
What is the most appropriate initial management plan?
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