A 55-year-old woman with newly diagnosed autoimmune primary hypothyroidism and no coronary artery disease is started on levothyroxine. What is the standard full replacement dose?

• A 50 µg on alternate days
• B 0.3 µg/kg body weight daily
• C 25 µg daily with doubling every two weeks
• D 1.6 µg/kg body weight daily ✓

Explanation

The standard full replacement dose of levothyroxine in a young or middle-aged adult with primary hypothyroidism and no cardiac disease is 1.6 µg/kg daily. Lower starting doses (25 to 50 µg) with gradual titration are reserved for elderly patients or those with known coronary artery disease to avoid precipitating angina or arrhythmia.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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