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Levothyroxine sodium is both odorless and tasteless83 and therefore easily concealed in small volumes of highly palatable foods or treats. Thyroxine levothyroxine sodium T 4 is the hormone of choice for thyroid hormone replacement owing to its consistent potency and its duration of action. Absorption is increased by fasting and decreased by administration of a number of drugs including sucralfate, cholestyramine, and mineral supplements. Levothyroxine supplementation is monitored by assay of serum TSH levels, with a goal of achieving a normal TSH concentration. Dose adjustments take approximately 5 weeks to induce a new serum steady state. In older patients and patients with cardiac disease, low-dose thyroxine supplementation should be started initially, with subsequent slow titration upward to avoid myocardial ischemia or arrhythmias.

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