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Circulating thyroid hormones are greater than 99bound to plasma proteinsincluding thyroxine-binding globulinTBGthyroxine-binding prealbuminTBPAand albuminTBAwhose capacities and affinities vary for each hormoneThe higher affinity of both TBG and TBPA for T 4 partially explains the higher serum levelsslower metabolic clearanceand longer half-life of T 4 compared to T 3Protein-bound thyroid hormones exist in reverse equilibrium with small amounts of free hormoneOnly unbound hormone is metabolically activeMany drugs and physiologic conditions affect the binding of thyroid hormones to serum proteinssee PRECAUTIONSDrug Interactions and Drug-Laboratory Test InteractionsThyroid hormones do not readily cross the placental barriersee PRECAUTIONSPregnancy

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.

Iron and calcium supplements and antacids can decrease the absorption of levothyroxineThereforelevothyroxine should not be administered within 4 hrs of these products.

Dosing of levothyroxine must be individualizedYour doctor will determine the best levothyroxine dose for youwhich will likely be carefully and slowly adjustedRegular blood tests will be required to monitor your progressFollow the directions on your prescription label carefullyDo not take more or less than prescribedIt may take several weeks before you begin to notice a change in your symptomsDo not stop taking levothyroxine without talking to your doctor.

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