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Sinus bradycardia, low-voltage complexes on an electrocardiogram (ECG), complete heart block, nonspecific ST-T changes, prolongation of the QT interval, and increased QT dispersion, represent frequent findings at the ECG evaluation in patients with severe hypothyroidism.

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Comparison with other studiesPrevious studies examining the association between levothyroxine replacement and fracture risk have yielded inconsistent conclusions and have not tackled the role of levothyroxine dose in this relation.

The Antenatal Thyroid Screening and Childhood Cognitive Function study (CATS) was a prospective, randomized, multicenter trial that involved almost 22 000 women who were screened for thyroid disease within the first 16 weeks of gestation by means of TSH and FT 4 measurements ().

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The option of administering iv l-T 4 solution is not universally available; it should be considered when oral administration cannot be used in patients with severe hypothyroidism ().

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Although this experimental observation cannot be extrapolated to humans without the usual caveats, some studies have reported that low serum FT 3 and significantly higher serum FT 4 levels can be observed in thyroidectomized patients receiving l-T 4 replacement therapy ().

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Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association.

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To counteract these inhibitory effects on absorption, calcium and iron supplements should not be taken until 3 to 4 hours after l-T 4 is taken.

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Periodic follow-up evaluations with repeated TSH testing at 6- and 12-month intervals are appropriate in patients with stable euthyroidism during l-T 4 therapy.

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Adherence to treatment may be improved with simple questions to the patient about their difficulties in taking l-T 4 medication, by better understanding of psychosocial factors that may impact compliance, or by a discussion of the patient's concerns about potential side effects.

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Chemical or laboratory markers may be more sensitive indicators of thyroid hormone effect than the patients' complaints.

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Autoimmune thyroiditis is present in about 10% to 15% of cases with type 1 APS, and it is caused by mutations in the autoimmune regulator gene ( AIRE), resulting in production of defective autoimmune regulator protein (); it may be associated with hypoparathyroidism, Addison's disease, and mucocutaneous candidiasis ().

Other research on dyes and blood and bone marrow cancers, like nonHodgkin lymphoma and leukemia, has also shown conflicting results.

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No negative influence of SHypo was found after using functional mobility as a marker of health status in this elderly population ().

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