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In patients with nontoxic diffuse goiter or nodular thyroid diseaseparticularly the elderly or those with underlying cardiovascular diseaselevothyroxine sodium therapy is contraindicated if the serum TSH level is already suppressed due to the risk of precipitating overt thyrotoxicosissee CONTRAINDICATIONSIf the serum TSH level is not suppressedSYNTHROID should be used with caution in conjunction with careful monitoring of thyroid function for evidence of hyperthyroidism and clinical monitoring for potential associated adverse cardiovascular signs and symptoms of hyperthyroidism.
The recommended frequency of monitoring of TSH and total or free T 4 in children is as followsat 2 and 4 weeks after the initiation of treatmentevery 1-2 months during the first year of lifeevery 2-3 months between 1 and 3 years of ageand every 3 to 12 months thereafter until growth is completedMore frequent intervals of monitoring may be necessary if poor compliance is suspected or abnormal values are obtainedIt is recommended that TSH and T 4 levelsand a physical examinationif indicatedbe performed 2 weeks after any change in SYNTHROID dosageRoutine clinical examinationincluding assessment of mental and physical growth and developmentand bone maturationshould be performed at regular intervalssee PRECAUTIONSPediatric Use and DOSAGE AND ADMINISTRATION
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