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Primary hypothyroidism is a common medical disorder that usually presents secondary to autoimmune thyroiditis. Symptoms of hypothyroidism include fatigue, weight gain, cold intolerance, and constipation. Treatment of hypothyroidism with levothyroxine is effective, but starting doses vary. There are two strategies for initiating levothyroxine in healthy adults younger than 65 years: lowdose (50 meg) and full-dose (1.6 to 1.7 meg per kg). Traditionally, lower starting doses of 25 to 50 meg per day are recommended for patients 65 years and older or who have ischemic heart disease. Low-dose initiation of thyroid supplementation usually takes four to six months before plasma thyrotropin and free thyroxine (FT^sub 4^) levels become normal. Roos and associates compared the full starting dose of levothyroxine with the low dose in individuals with primary hypothyroidism without known cardiac disease.
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