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Hypothyroidism overreplacement — USMLE Step 3 MCQ

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EasyInternal Medicine (chronic management)Hypothyroidism overreplacementUSMLE Step 3

A 67-year-old woman treated for hypothyroidism reports palpitations and tremor. She takes levothyroxine 125 mcg daily. TSH is 0.05 mIU/L and free T4 is mildly elevated. ECG shows sinus tachycardia. Which of the following is the most appropriate next step in management?

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Correct answer: C — Reduce the levothyroxine dose and recheck thyroid function

Suppressed TSH and elevated free T4 on replacement therapy indicate overreplacement; dose reduction is appropriate.

Reference: American Thyroid Association hypothyroidism guidance