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Primary hypothyroidism — USMLE Step 3 MCQ

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EasyAmbulatory Medicine / Primary CarePrimary hypothyroidismUSMLE Step 3

A 37-year-old woman has fatigue, cold intolerance, constipation, and weight gain. TSH is 12.8 mIU/L and free T4 is low. She is not pregnant and takes no medications. Which of the following is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Start levothyroxine

Overt primary hypothyroidism is treated with levothyroxine; pituitary imaging is not needed with elevated TSH and low free T4.

Reference: American Thyroid Association hypothyroidism guidance; USMLE Step 3 Content Outline