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Family Medicine

Answer 6
  1. Initial dose of 25 µg daily, titrated every 4 to 6 weeks to achieve a normal serum TSH level. In the stable elderly patient, it is recommended to begin therapy at a low synthetic T4 dose of 25 g daily and increase the dose by 25- to 50-g increments every 4 to 6 weeks, based on results of the TSH test. Checking a TSH level before 4 weeks have passed is likely to show a falsely elevated level. A sudden increase in levothyroxine may place excessive strain on the patient’s cardiac reserve. The TSH level, not the T4 level, is used as the metabolic marker. The goal of treatment is to normalize, not suppress, the TSH level. In patients with central hypothyroidism, the T4 level is monitored because the cause of the hypothyroidism is a low TSH level. This condition usually occurs as a result of postpartum pituitary necrosis (Sheehan’s syndrome) or a pituitary tumor.

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