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Samer El-Kaissi Department of Endocrinology, Medical Subspecialties Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

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Laila AbdelWareth Department of Laboratory Medicine, National Reference Laboratory and Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

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Ruba Dajani Department of Pharmacy, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

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Terrence J. Lee-St. John Research Department, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

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Sherry Ann Santarina Research Department, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

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Fiona Makia Research Department, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

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Malak AlTakruri Department of Pharmacy, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

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AbedElRahman Kaskas Department of Patient Education, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

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Yahya Ahmed Department of Pharmacy, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

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, most people consume 2 meals, the main meal or “Iftar” at dusk and a smaller meal at dawn “Suhur.” The altered eating habits during Ramadan, in addition to time constraints during the nonfasting period, present a challenge for levothyroxine

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Roberto Negro Division of Endocrinology, ‘V. Fazzi' Hospital, Lecce

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Giacomo Greco Faculty of Medicine, San Raffaele Hospital, Milan, Italy

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subclinical hypothyroidism. The EPC levels reverted to normal after replacement treatment with levothyroxine (LT4) [ 7 , 8 , 9 ]. Patients with Hashimoto thyroiditis present low-grade chronic inflammation with endothelial dysfunction and altered nitric

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Wolfgang J. Schnedl Practice for General Internal Medicine, Bruck/Mur

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Siroos Mirzaei Department of Nuclear Medicine, Wilhelminenspital, Vienna

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Sandra J. Wallner-Liebmann Institute of Pathophysiology, Centre for Molecular Medicine, Medical University of Graz

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Erwin Tafeit Institute of Physiological Chemistry, Centre of Physiological Medicine, Medical University of Graz

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Harald Mangge Clinical Institute of Medical and Chemical Laboratory Diagnosis, Medical University of Graz

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Robert Krause Departments of Internal Medicine, Medical University of Graz, Graz, Austria

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Rainer W. Lipp Radiology, Medical University of Graz, Graz, Austria

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% increase in cerebral blood flow on 99m Tc-hexamethylpropyleneamine oxime (HMPAO)single-photon emission computed tomography (SPECT) under levothyroxine therapy. This was accompanied by a more than 10-fold decrease in autoantibodies to thyroid peroxidase

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Sampath Satish Kumar Departments of Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds, UK

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Sheila Fraser Departments of Endocrine Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK

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Andrew Scarsbrook Departments of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK

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Ken MacLennan Leeds Institute of Molecular Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK

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Mark Lansdown Departments of Endocrine Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK

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Robert D. Murray Departments of Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds, UK

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lungs and liver highly suggestive of metastatic disease, and not previously described in Riedel’s thyroiditis. These lesions turned out to be hyalinised fibrous tissue. Following institution of levothyroxine replacement therapy, significant improvement

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Shirley Langham Departments of Endocrinology, Great Ormond Street Hospital, Hospital for Children

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Peter Hindmarsh Developmental Endocrinology Research Group, Institute of Child Health, University College London, London, UK

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Steven Krywawych Departments of Chemical Pathology, Great Ormond Street Hospital, Hospital for Children

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Catherine Peters Departments of Endocrinology, Great Ormond Street Hospital, Hospital for Children
Developmental Endocrinology Research Group, Institute of Child Health, University College London, London, UK

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which the thyroid gland has either failed to develop (agenesis or dysgenesis) or there is a defect in thyroid hormonogenesis (dyshormonogenesis). In the neonatal stage and early childhood years, levothyroxine is essential for normal brain development [ 5

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Rajesh Rajput Department of Endocrinology and Medicine Unit V, Pt. B.D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, India

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Vaibhav Pathak Department of Endocrinology and Medicine Unit V, Pt. B.D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, India

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Introduction Hypothyroidism is one of the most common hormone deficiencies with a straightforward diagnosis and treatment as well as an excellent outcome if the patient continues to take treatment regularly. Levothyroxine (LT4) at a dose of 1

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Bjarke Borregaard Medici Department of Endocrinology, Herlev University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

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Jeppe Lerche la Cour Department of Endocrinology, Herlev University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

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Luba Freja Michaelsson Department of Endocrinology, Herlev University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

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Jens Oscar Faber Department of Endocrinology, Herlev University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

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Birte Nygaard Department of Endocrinology, Herlev University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

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Background Hypothyroidism is a common disease that affects primarily women with a range of symptoms. Levothyroxine (L-T 4 ) is the mainstay replacement therapy of choice according to guidelines, but some patients report persistent hypothyroid

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Georgios K. Markantes Division of Endocrinology, Department of Internal Medicine, University of Patras Medical School, Patras, Greece

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Konstantinos Dimitropoulos Division of Endocrinology, Department of Internal Medicine, University of Patras Medical School, Patras, Greece

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Irene Mamali Division of Endocrinology, Department of Internal Medicine, University of Patras Medical School, Patras, Greece

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Ioulia Tseti Uni-Pharma S.A., Athens, Greece

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George Sakellaropoulos Department of Medical Physics, School of Medicine, University of Patras, Patras, Greece

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Kostas B. Markou Division of Endocrinology, Department of Internal Medicine, University of Patras Medical School, Patras, Greece

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Marina A. Michalaki Division of Endocrinology, Department of Internal Medicine, University of Patras Medical School, Patras, Greece

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[ 1 ]. Levothyroxine (LT4) monotherapy is the standard of care in hypothyroidism, and the goal of treatment is the normalization of serum TSH levels [ 2 ]. Nowadays, several different LT4 formulations are available on the market; tablets, soft gel

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Luba Freja Michaelsson Department of Endocrinology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark

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Jeppe Lerche  la Cour Department of Endocrinology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark

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Bjarke Borregaard Medici Department of Endocrinology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark

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Torquil Watt Department of Endocrinology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark

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Jens Faber Department of Endocrinology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

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Birte Nygaard Department of Endocrinology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

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Introduction Hypothyroidism is a common disease usually treated with levothyroxine (L-T 4 ) substitution [ 1 ]. Still, 5–10% of individuals with hypothyroidism are not satisfied with L-T 4 monotherapy, and do not consider their previous well

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Jacqueline Jonklaas Division of Endocrinology, Georgetown University, Washington, District of Columbia, USA

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Antonio C. Bianco Section of Adult and Pediatric Endocrinology and Metabolism, University of Chicago, Chicago, Illinois, USA

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Anne R. Cappola Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA

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Francesco S. Celi Division of Endocrinology, Diabetes and Metabolism, Virginia Commonwealth University, Richmond, Virginia, USA

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Eric Fliers Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Center, Amsterdam, The Netherlands

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Heike Heuer Department of Endocrinology, Diabetes and Metabolism, University Duisburg-Essen, Essen, Germany

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Elizabeth A. McAninch Division of Endocrinology, Rush University, Chicago, Illinois, USA

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Lars C. Moeller Department of Endocrinology, Diabetes and Metabolism, University Duisburg-Essen, Essen, Germany

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Birte Nygaard Center for Endocrinology and Metabolism, Department of Internal Medicine, Herlev and Gentofte Hospitals, Herlev, Denmark

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Anna M. Sawka Division of Endocrinology, University Health Network and University of Toronto, Toronto, Ontario, Canada

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Torquil Watt Department of Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

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Colin M. Dayan Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, United Kingdom

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Introduction Endocrinologists are frequently asked to consult on adult patients with hypothyroidism taking levothyroxine (LT4) who are dissatisfied with their therapy. Once other nonthyroid-related causes of these symptoms have been fully

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