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Levothyroxine over-replacement — SCE Endocrinology MCQ

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EasyThyroidLevothyroxine over-replacementSCE Endocrinology

A 39-year-old woman taking levothyroxine for primary hypothyroidism has persistent fatigue. TSH is 0.05 mU/L and free T4 is 25 pmol/L. She increased her dose herself because of weight gain. What is the most appropriate management?

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Correct answer: E — Reduce levothyroxine dose and recheck thyroid function

Suppressed TSH and raised free T4 indicate over-replacement, increasing risks such as atrial fibrillation and bone loss. Increasing levothyroxine would worsen iatrogenic thyrotoxicosis. Symptoms such as fatigue are non-specific and should not override biochemical evidence of excess dose.

Reference: NICE NG145; BNF