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To the Editor:—
I have read with great interest Dr. C. R. Tittle's paper entitled "Effects of 3,5,3′L-triiodothyronine in Patients with Metabolic Insufficiency" (J. A. M. A.162:271-274 [Sept. 22] 1956), in which he reports on patients with metabolic insufficiency who were not benefited by treatment with desiccated thyroid but did respond to treatment with triiodothyronine. I have no doubt that for some reason or other some people may be refractory to treatment with whole thyroid, while responding to equivalent doses of triiodothyronine. However, it is evident from Dr. Tittle's report that he did not attempt to compare biologically equivalent doses of desiccated thyroid and of triiodothyronine, inasmuch as identical amounts of the former were substituted by differing amounts of the latter, e. g., a daily maximum dosage of 3 grains ( 0.2 gm. ) of desiccated thyroid was replaced in different patients by a maximum dosage of 50, 62.5,
Zondek H. THYROID REFRACTORINESS. JAMA. 1957;163(6):488–489. doi:10.1001/jama.1957.02970410078024
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