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Older adults: Evaluate medication-associated malabsorption, autoimmune gastritis, prior gastrointestinal surgery, dietary factors, neurologic status, renal function, and the anticipated need for maintenance therapy [1,2]

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In clinical practice, this suggests that TSH does not reliably indicate tissue-level euthyroidism in the context of LT4 therapy, and it can translate into persistent symptoms of hypothyroidism despite apparently adequate replacement (10)