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Thus, if a patient with a normal TSH presents with signs or symptoms consistent with hypothyroidism, which may include low basal body temperature, fatigue, weight gain, depression, cold extremities, muscle aches, headaches, decreased libido, weakness, cold intolerance, water retention, slow reflex relaxation phase or PMS, a combination of both clinical and laboratory assessment, which may include a T3/reverse T3 ratio and the level of sex hormone binding globulin (SHBG), should be used to determine the likely overall thyroid status and if a therapeutic trail of straight T3 or a T4/T3 combination is indicated and not based solely on standard thyroid function tests

The safety of chronic usewhich would be required for preventionis uncharacterized

Coverage for weight loss medications, including those used to treat associated comorbidities, will be excluded from the following commercial product segments: Tufts Health Direct Products (MA) Harvard Pilgrim Individual & Small Group Products (NH, RI) Harvard Pilgrim Merged Market Products (MA, ME) Harvard Pilgrim Large Group Products (MA, NH, ME, RI) on the Select formulary (starting on group anniversary dates) This decision reflects in response to evolving FDA approvals and the broader use of these medications for alternative indications such as cardiovascular conditions

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