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answer without explanation A 32-year-old woman presents with 5 months of fatigue. She is getting exhausted at work, has trouble concentrating, and is afraid she may lose her job. She has no suicidal ideation. Her history is significant for bipolar disorder, hypertension, and autoimmune pancreatitis. She is taking lithium and hydrochlorothiazide. She has a history of multiple hospitalizations due to depressive and manic episodes. Her last hospitalization was 1 year ago. She tried quetiapine and lamotrigine in the past but said that lithium is the only medication that helps her. Mental status examination and physical examination are unremarkable. Laboratory tests show a lithium level of 0.8 mmol/L (range: 0.6-1.2), hemoglobin of 12 g/dL, mean corpuscular volume 93 fL, white blood cells 8,000/mm3, sodium 140 mEq/L, potassium 4.4 mEq/L, bicarbonate 25 mEq/L, creatinine 0.9 mg/dL, calcium 8.2 mg/dL, thyroid-stimulating hormone (TSH) 13 μU/mL, and free T4 0.5 ng/dL. What is the next best step in management?A. Continue lithium and give levothyroxine. B. Decrease the dose of lithium and add another mood stabilizer and levothyroxine. C. Discontinue lithium and give another mood stabilizer and levothyroxine. D. Decrease the dose of lithium and add levothyroxine.

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