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In womenlong-term levothyroxine sodium therapy has been associated with increased bone resorptionthereby decreasing bone mineral densityespecially in post-menopausal women on greater than replacement doses or in women who are receiving suppressive doses of levothyroxine sodiumThe increased bone resorption may be associated with increased serum levels and urinary excretion of calcium and phosphorouselevations in bone alkaline phosphatase and suppressed serum parathyroid hormone levelsThereforeit is recommended that patients receiving levothyroxine sodium be given the minimum dose necessary to achieve the desired clinical and biochemical response.

Caution should be exercised when administering SYNTHROID to patients with underlying cardiovascular diseaseto the elderlyand to those with concomitant adrenal insufficiencysee PRECAUTIONS

Cardiac function was evaluated in twenty patients requiring TSH suppression for either thyroid goiter or following thyroidectomy and radioactive iodine therapy for thyroid cancer and in twenty ageand sex-matched controlsTSH suppression was associated with an increased incidence of premature ventricular beatsan increased left ventricular mass indexand enhanced left ventricular systolic functionThe clinical significance of these changes remains to be determinedRef]

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