<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 25-year-old female with a history of childhood asthma presents to clinic complaining of a three month history of frequent, loose stools. She currently has three to four bowel movements per day, and she believes that these episodes have been getting worse and are associated with mild abdominal pain. She also endorses seeing red blood on the toilet tissue. On further questioning, she also endorses occasional palpitations over the past few months. She denies fevers, chills, headache, blurry vision, cough, shortness of breath, wheezing, nausea, or vomiting. She describes her mood as slightly irritable and she has been sleeping poorly. A review of her medical chart reveals a six pound weight loss since her visit six months ago, but she says her appetite has been normal. The patient denies any recent illness or travel. She is a non-smoker. Her only current medication is an oral contraceptive pill.Her temperature is 37C 98.6F, pulse is 104min, blood pressure is 9565 mmHg, respirations are 16min, and oxygen saturation is 99 on room air. On physical exam, the physician notes that her thyroid gland appears symmetrically enlarged but is non-tender to palpation. Upon auscultation there is an audible thyroid bruit. Her cranial nerve is normal and ocular exam reveals exophthalmos. Her abdomen is soft and non-tender to palpation. Deep tendon reflexes are 3 throughout. Lab results are as follows:Serum:Na: 140 mEqLK: 4.1 mEqLCl-: 104 mEqLHCO3-: 26 mEqlLBUN: 18 mgdLCreatinine 0.9 mgdLHemoglobin: 14.0 gdLLeukocyte count: 7,400mm3Platelet count 450,000mm3TSH Free T4: pendingA pregnancy test is negative. The patient is started on propranolol for symptomatic relief. What is the most likely best next step in management for this patient?? A: IV hydrocortisone, B: Propylthiouracil, C: Adalimumab, D: Thyroid scintigraphy with I-123, E: Surgical thyroidectomy,  <response>: This is a clinical case about a 25-year-old female presenting with diarrhea, abdominal pain, blood in stool, palpitations, irritability, insomnia, weight loss, and enlarged thyroid gland with bruit. The key findings are diarrhea, palpitations, enlarged thyroid with bruit, and exophthalmos. This clinical picture is most consistent with hyperthyroidism, likely Graves disease given the presence of exophthalmos. The lab results show normal electrolytes, kidney function, blood counts. TSH and free T4 are pending which will confirm hyperthyroidism. Pregnancy test is negative. Propranolol was started for symptomatic relief of palpitations. The next best step in management would be to confirm the diagnosis with thyroid function tests and imaging, then initiate antithyroid medication.Choice A IV hydrocortisone would be incorrect, as this patient does not have adrenal insufficiency. Choice B Propylthiouracil would be a reasonable choice as this is an antithyroid medication used to treat Graves disease.Choice C Adalimumab is an anti-TNF alpha drug used for autoimmune conditions and would not be indicated in this case. Choice D Thyroid scintigraphy with I-123 could confirm the diagnosis but antithyroid medication would be more urgent.Choice E Surgical thyroidectomy may eventually be needed if medical therapy fails but is premature before a trial of antithyroid medications.B: Propylthiouracil 