Which sign may indicate excessive levothyroxine replacement?

Which sign may indicate excessive levothyroxine replacement?

• A. Weight gain and fatigue
• B. Cold intolerance and dry skin
• C. High blood pressure and sweating
• D. High heart rate or chest pain/tremors

Answer: (D)

Excess levothyroxine replacement pushes the body into a hyperthyroid-like state, elevating metabolism and activating the sympathetic nervous system. This produces tachycardia, palpitations, tremors, sweating, and heat intolerance. The most telling sign among the options is a high heart rate accompanied by chest pain and tremors, reflecting thyrotoxic cardiovascular stress and neuromuscular excitability. The other choices describe hypothyroid symptoms or less specific hyperthyroid features. If over-replacement is suspected, adjust the dose and obtain thyroid function tests; manage acute tachycardia or chest pain as clinically indicated.

Excess levothyroxine replacement pushes the body into a hyperthyroid-like state, elevating metabolism and activating the sympathetic nervous system. This produces tachycardia, palpitations, tremors, sweating, and heat intolerance. The most telling sign among the options is a high heart rate accompanied by chest pain and tremors, reflecting thyrotoxic cardiovascular stress and neuromuscular excitability. The other choices describe hypothyroid symptoms or less specific hyperthyroid features. If over-replacement is suspected, adjust the dose and obtain thyroid function tests; manage acute tachycardia or chest pain as clinically indicated.