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Dosing must be individualized to account for these factors and dosage adjustments made based on periodic assessment of the patient's clinical response and laboratory parameters 1 Exercise caution with administering to patients with underlying cardiovascular disease, the elderly, and those with concomitant adrenal insufficiency 1 For pregnant patients with pre-existing hypothyroidism, measure serum TSH and free-T4 as soon as pregnancy is confirmed and, at minimum, during each trimester of pregnancy