<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 33-year-old man presents with a darkening of the skin on his neck over the past month. Past medical history is significant for primary hypothyroidism treated with levothyroxine. His vital signs include: blood pressure 13080 mm Hg, pulse 84min, respiratory rate 18min, temperature 36.8C 98.2F. His body mass index is 35.3 kgm2. Laboratory tests reveal a fasting blood glucose of 121 mgdL and a thyroid-stimulating hormone level of 2.8 mcUmL. The patients neck is shown in the exhibit. Which of the following is the best initial treatment for this patient?? A: Adjust the dose of levothyroxine, B: Cyproheptadine, C: Exercise and diet, D: Isotretinoin, E: Surgical excision,  <response>: This is a patient with darkening of the skin on the neck, known as acanthosis nigricans. The key findings are a history of hypothyroidism on levothyroxine therapy and obesity. The thyroid stimulating hormone level is within the normal range, suggesting adequate treatment of his hypothyroidism. Acanthosis nigricans is associated with obesity and insulin resistance. The best initial approach is weight loss through exercise and diet modifications rather than medications or surgery.C: Exercise and diet 