A 56-Year-Old Woman Is Evaluated for Persistent Fatigue

A 56-year-old woman is evaluated for persistent fatigue.  A year ago, she developed panhypopituitarism following resection of a large nonfunctional pituitary tumor.  Current treatment includes hydrocortisone and levothyroxine, with her most recent dose adjustment a few months ago.  The patient has had no associated headaches, excessive urination, visual disturbances, or weight change.  Vital signs are normal.  BMI is 26 kg/m² with no change in weight over the last 6 months.  Physical examination is unremarkable.
Laboratory results are as follows:
An MRI of the pituitary 6 months ago showed no residual pituitary tumor.  Which of the following is the most appropriate next step in management of this patient's disorder?

A) Add liothyronine therapy
B) Measure free T4 level
C) Measure insulin-like growth factor-1 level
D) Measure total T3 level
E) Reduce levothyroxine dose

Correct Answer:

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