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Patients should seek medical evaluation if they experience: Persistent symptoms despite adequate levothyroxine replacement (confirmed by normal TSH) Rapid thyroid enlargement or development of thyroid nodules Difficulty swallowing or breathing related to thyroid enlargement Symptoms suggesting thyroid hormone over-replacement (palpitations, tremor, anxiety, heat intolerance) Regular monitoring of thyroid function is essential for patients with Hashimoto's disease

Annually, depression and anxiety cost an estimated US$ 1 trillion due to the loss of 12 billion productive workdays [16]

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