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Thyroidal production of triiodothyronine (T3) is absent in patients with athyreosis. Whether this has adverse clinical consequences is not clear, and results of studies of combined levothyroxine (LT4) and T3 therapy vs LT4 alone to improve symptoms of hypothyroidism have been inconclusive. In this issue, Jonklaas and colleagues report results of a prospective study of 50 euthyroid patients who had assessments of thyroid hormone levels before and 16 weeks after undergoing total thyroidectomy, with the objective of determining whether LT4 therapy alone could
restore T3 levels to normal. The authors found that LT4 monotherapy was associated with normal T3 levels in athyreotic patients. In an editorial, Cooper discusses thyroid physiology and thyroid hormone replacement and the clinical challenge posed by biochemically euthyroid but symptomatic patients.
This Week in JAMA . JAMA. 2008;299(7):727. doi:10.1001/jama.299.7.727
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