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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.<\/p>\n

Caution should be exercised when administering SYNTHROID to patients with underlying cardiovascular diseaseto the elderlyand to those with concomitant adrenal insufficiencysee PRECAUTIONS<\/p>\n

In generallevothyroxine therapy should be instituted at full replacement doses as soon as possibleDelays in diagnosis and institution of therapy may have deleterious effects on the child’s intellectual and physical growth and development.<\/p>\n

The initial dose of levothyroxine varies with age and body weightsee DOSAGE AND ADMINISTRATIONTable 3Dosing adjustments are based on an assessment of the individual patient’s clinical and laboratory parameterssee PRECAUTIONSLaboratory Tests<\/p>\n

Frequency not reportedPalpitationstachycardiahypertensionarrhythmiasincreased pulse and blood pressureheart failureanginamyocardial infarctioncardiac arrestRef]<\/p>\n

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