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Exercise caution when administering levothyroxine to patients with cardiovascular disorders and to the elderly in whom there is an increased risk of occult cardiac diseaseIn these patientslevothyroxine therapy should be initiated at lower doses than those recommended in younger individuals or in patients without cardiac diseasesee WARNINGSPRECAUTIONSGeriatric Useand DOSAGE AND ADMINISTRATIONIf cardiac symptoms develop or worsenthe levothyroxine dose should be reduced or withheld for one week and then cautiously restarted at a lower doseOvertreatment with levothyroxine sodium may have adverse cardiovascular effects such as an increase in heart ratecardiac wall thicknessand cardiac contractility and may precipitate angina or arrhythmiasPatients with coronary artery disease who are receiving levothyroxine therapy should be monitored closely during surgical proceduressince the possibility of precipitating cardiac arrhythmias may be greater in those treated with levothyroxineConcomitant administration of levothyroxine and sympathomimetic agents to patients with coronary artery disease may precipitate coronary insufficiency.

Partial hair loss may occur rarely during the first few months of levothyroxine therapybut this is usually temporary.

Tell your doctor about all the medicines you take including prescription and non-prescription medicinesvitaminsand herbal supplements.

The mechanisms by which thyroid hormones exert their physiologic actions are not completely understoodbut it is thought that their principal effects are exerted through control of DNA transcription and protein synthesisT 3 and T 4 diffuse into the cell nucleus and bind to thyroid receptor proteins attached to DNAThis hormone nuclear receptor complex activates gene transcription and synthesis of messenger RNA and cytoplasmic proteins.

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