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The recommended frequency of monitoring of TSH and total or free T 4 in children is as followsat 2 and 4 weeks after the initiation of treatmentevery 1-2 months during the first year of lifeevery 2-3 months between 1 and 3 years of ageand every 3 to 12 months thereafter until growth is completedMore frequent intervals of monitoring may be necessary if poor compliance is suspected or abnormal values are obtainedIt is recommended that TSH and T 4 levelsand a physical examinationif indicatedbe performed 2 weeks after any change in SYNTHROID dosageRoutine clinical examinationincluding assessment of mental and physical growth and developmentand bone maturationshould be performed at regular intervalssee PRECAUTIONSPediatric Use and DOSAGE AND ADMINISTRATION
WARNING/CAUTIONEven though it may be raresome people may have very bad and sometimes deadly side effects when taking a drugTell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:
Certain medicines can make levothyroxine less effective if taken at the same timeIf you use any of the following drugsavoid taking them within 4 hours before or 4 hours after you take Synthroid:
The adequacy of therapy is determined by periodic assessment of appropriate laboratory tests and clinical evaluationThe choice of laboratory tests depends on various factors including the etiology of the underlying thyroid diseasethe presence of concomitant medical conditionsincluding pregnancyand the use of concomitant medicationssee DRUG INTERACTIONS and DrugLaboratory Test InteractionsPersistent clinical and laboratory evidence of hypothyroidism despite an apparent adequate replacement dose of SYNTHROID may be evidence of inadequate absorptionpoor compliancedrug interactionsor decreased T 4 potency of the drug product.
Thyroid hormone synthesis and secretion is regulated by the hypothalamic-pituitary-thyroid axisThyrotropin-releasing hormoneTRHreleased from the hypothalamus stimulates secretion of thyrotropin-stimulating hormoneTSHfrom the anterior pituitaryTSHin turnis the physiologic stimulus for the synthesis and secretion of thyroid hormonesL-thyroxineT 4and L-triiodothyronineT 3by the thyroid glandCirculating serum T 3 and T 4 levels exert a feedback effect on both TRH and TSH secretionWhen serum T 3 and T 4 levels increaseTRH and TSH secretion decreaseWhen thyroid hormone levels decreaseTRH and TSH secretion increase.
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do not take an antacid or a product that has iron or calcium in it within 4 hours of taking synthroid.