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April 1979

Thyroid Replacement Therapy

Arch Intern Med. 1979;139(4):489. doi:10.1001/archinte.1979.03630410093031

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To the Editor.—  In an article entitled "Organic Medicine" that appeared in the Archives (138:978-979, 1978), Dr Bunner correctly made the point that the era of prescribing desiccated thyroid is past. Now we have a chemically pure substance, levothyroxine sodium (Synthroid), available that should be prescribed to treat hypothyroidism.I take issue with his recommendation that patients who are taking levothyroxine need to be tested repeatedly with various laboratory tests to see if they are taking the correct amount.I have talked to many colleagues and they believe that it is only rarely necessary to check levels of thyroid hormone, thyroid-stimulating hormone, etc, after the patients start treatment with levothyroxine. The amount of levothyroxine that the patient needs is determined by his clinical response to treatment, and laboratory tests are rarely necessary.It seems a shame that Dr Bunner would recommend this approach to the treatment of hypothyroidism when the

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