Question: Mr. Howard is a 62 y/o male who comes into the primary care clinic for his 6 month follow up for his hypothyroidism. He has been on thyroid replacement therapy for the past 5 years due to a chronic autoimmune disorder. He states about a month ago he was started on omeprazole orally twice a day for GERD and he has another 2 weeks to complete therapy. Labs today reveal a TSH level of 23. The NP verifies that Mr. Howard has been refilling his levothyroxine 100 mcg by mouth daily and taking it as scheduled. What is the most likely explanation for these lab findings? a. Patient is not taking their levothyroxine at all b. This patient has been taking too much levothyroxine c. Drug interaction is impacting the absorption of levothyroxine d. No explanation needed, this TSH level is expected in someone with an autoimmune disorder