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When initiating treatment for primary hypothyroidism, some clinicians prescribe full replacement doses of levothyroxine, whereas others start patients on low doses and titrate upward gradually. In this randomized double-blind trial, researchers compared these approaches in 50 patients with newly diagnosed hypothyroidism (median thyroid-stimulating hormone [TSH] level, ≈55 mIU/L; mean free thyroxine [T4] level, 0.6 ng/dL). Mean age was 47 (range, 22–86), and all enrollees had normal dobutamine echocardiography results and no history of cardiac disease.
Starting doses of levothyroxine were either full (1.6 μg/kg daily) or low (25 μg daily initially, and increased by 25 μg every 4 weeks until euthyroidism was achieved). Median TSH levels had no…