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For example many patients start with a small dose and work up to a full one in order to keep side-effects in check

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Patients should seek medical evaluation if they experience: Persistent symptoms despite adequate levothyroxine replacement (confirmed by normal TSH) Rapid thyroid enlargement or development of thyroid nodules Difficulty swallowing or breathing related to thyroid enlargement Symptoms suggesting thyroid hormone over-replacement (palpitations, tremor, anxiety, heat intolerance) Regular monitoring of thyroid function is essential for patients with Hashimoto's disease