A 45 year old woman with a 10 year history of hypothyroidism presents for follow up care. She's been taking levothyroxine 100 micrograms per day with excellent adherence. Stating "I take the medicine every morning on an empty stomach with a big glass of water.” She states she's generally feeling well, but notices increased fatigue over the past four months, which she attributes to the stress of starting her graduate studies while working full time. The results of today's laboratory testing include the following:

TSH is 2.3, the norm being .4 to 4, pre T4 15 with norm being 10 to 27.

The next step in her care is to:

A. continue on the same levothyroxine dose and obtain a repeat TSH in one year.

B. increase the levothyroxine dose by 25 micrograms per day and repeated TSH in one month.

C. increase the levothyroxine dose by 25 micrograms per day and repeated TSH in two months.

D. Repeat the TSH and free T4 today and provide counseling about taking the medication with breakfast.
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