<s>[INST] A 30-year-old female patient presents to your office with a complaint of fatigue, weight loss, and difficulty concentrating. She reports that she has been experiencing these symptoms for the past 6 months. She has a past medical history of hypothyroidism, for which she takes levothyroxine 50 mcg daily. She also reports a family history of type 2 diabetes. 

On physical examination, the patient is noted to be overweight (BMI 28) and has acne on her face and chest. Her thyroid gland is not palpable. 

Laboratory results show:

* Glucose: 105 mg/dL
* Hemoglobin A1c: 6.1%
* TSH: 4.5 mU/L
* Fasting insulin: 25 mU/L
* Free T4: 0.8 ng/dL
* Free T3: 2.5 pg/mL

What is the most likely diagnosis for this patient?[/INST]