What are some differential diagnosis for this patient? What initial testing would you order and why?

What are some differential diagnosis for this patient? What initial testing would you order and why? All her labs come back normal except the following: TSH 6.78 mU/L, T4 0.4 ng/dL. Based on her test results, what would be your next steps? What education would you provide her for when she gets pregnant again and frequency of monitoring?

 

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