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Levothyroxine sodium should be reduced in dose or temporarily discontinued if signs or symptoms of overdosage occur.

Frequency not reportedAutoimmune disorderse.gchronic autoimmune thyroiditisRef]

Occasionallychronic autoimmune thyroiditis may occur in association with other autoimmune disorders such as adrenal insufficiencypernicious anemiaand insulin-dependent diabetes mellitusPatients with concomitant adrenal insufficiency should be treated with replacement glucocorticoids prior to initiation of treatment with levothyroxine sodiumFailure to do so may precipitate an acute adrenal crisis when thyroid hormone therapy is initiateddue to increased metabolic clearance of glucocorticoids by thyroid hormonePatients with diabetes mellitus may require upward adjustments of their antidiabetic therapeutic regimens when treated with levothyroxinesee DRUG INTERACTIONS

If this condition is treateda lower levothyroxine sodium dosee.g1 mcg/kg/daythan that used for full replacement may be adequate to normalize the serum TSH levelPatients who are not treated should be monitored yearly for changes in clinical status and thyroid laboratory parameters.

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