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FOOD AND DRUG ADMINISTRATION - page 195 / 263

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the perfect thyroxine dose judged by their serum TSH levels and TRH tests, as well as thyroid hormone levels and a symptom questionnaire.  They then increased the dose or decreased the dose by 25-microgram increments or decrements and you can see the major effect on TSH with a slight reduction or suppression with a slight increase, and these are over the range of again the various dosage strengths of levothyroxine that are available to us.

This has an impact on particular populations in our practices.  Most patients taking thyroid hormone tend to be older because of the increased frequency of hypothyroidism with each advancing decade, and our older patients have cardiovascular disease, particularly sensitive to excess thyroid hormone.  You heard from Dr. Brown this morning about the risk of hypothyroidism on the neonate, on the newborn, and pregnant women who are under-dosed with thyroid hormone will give birth to children with lower IQ, and you've heard about the importance in our patients with thyroid cancer.  With insufficient dose of even a mild degree, cholesterol levels go up, atherosclerosis is accelerated, leading to an increased risk of heart attacks, myocardial infarction, as well as

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