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Contraindications, hypersensitivity to thyroid hormone or other ingredients. Acute MI, thyrotoxicosis, uncorrected adrenal insufficiency. Treatment of obesity or infertility, no contraindications reported by manufacturer for myxedema coma when treated with injection. Cautions, avoid undertreatment or overtreatment, which may result in adverse effects. Proper dose titration and careful monitoring is critical to prevent persistence of hypothyroidism or development of hyperthyroidism. Use caution in cardiovascular disease, HTN, endocrine disorders, osteoporosis, or myxedema. Over-treatment with levothyroxine may cause increase in heart rate, cardiac wall thickness, and cardiac contractility; may precipitate angina or arrhythmias, particularly in patients with cardiovascular disease and in elderly patients; monitor patients receiving concomitant levothyroxine and sympathomimetic synthroid tablet strengths agents for signs and symptoms of coronary insufficiency;. Over- or under-treatment with levothyroxine may have negative effects on growth and development, cardiovascular function, bone metabolism, reproductive function, cognitive function, emotional state, gastrointestinal function, and on glucose and lipid metabolism; titrate dose carefully and monitor response to titration to avoid these effects. Monitor for presence of drug or food interactions when using levothyroxine and adjust dose as necessary; symptoms may be exacerbated or aggravated in patients with diabetes mellitus and insipidus; addition of levothyroxine therapy in patients with diabetes mellitus may worsen glycemic control and result. Use of oral thyroid hormone drug products is not recommended to treat myxedema coma; administer thyroid hormone products formulated for intravenous administration to treat myxedema coma; myxedema coma is a life-threatening emergency characterized by poor circulation and hypometabolism, and may result in unpredictable absorption. Do NOT generally use levothyroxine sodium preparations interchangeably, due to narrow therapeutic index. Check for bioequivalence if switching brands/generics. Synthroid and unithroid tabs contain lactose. Not recommended for TSH suppression in patients with thyroid nodules. Levoxyl tabs swell in mouth: take with full glass of water to avoid choking. Avoid use in postmenopausal women 60 years with osteoporosis, cardiovascular disease, or systemic illness. Avoid use in patients with large thyroid nodules or long-standing goiters, or low-normal TSH levels. Long-term therapy decreases bone mineral density; use lowest dose in postmenopausal women and women using suppressive doses. Use caution in patients with adrenal insufficiency; may exacerbate symptoms or agravate them; treatment with glucocorticoids should precede levothyroxine therapy adrenal insufficiency present; initiation of thyroid hormone therapy prior to initiating glucocorticoid therapy may precipitate acute adrenal crisis in patients with adrenal insufficiency. Monitor for presence of drug or food interactions when using levothyroxine and adjust dose as necessary. See also Precautions synthroid tablet strengths section. Hair loss may occur during the first few months of treatment. This effect is usually temporary as your body adjusts to this medication. If this effect persists or worsens, tell your doctor or pharmacist promptly. Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people synthroid tablet strengths using this medication do not have serious side effects. Tell your doctor right away if any of these unlikely but serious effects of high thyroid hormone levels occur: increased sweating, sensitivity to heat, mental/mood changes (such as nervousness, mood swings tiredness, diarrhea, shaking (tremor headache, shortness of breath, bone pain, easily broken bones. Get medical help right away if any of these rare but serious effects of high thyroid hormone levels occur: chest pain, fast/pounding/irregular heartbeat, swelling hands/ ankles /feet, seizures. A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching /swelling (especially of the face/ tongue /throat severe dizziness, trouble breathing. This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist. In the US, call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www. In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at).