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Research Article

Clinical Response to Thyroxine Sodium in Clinically Hypothyroid but Biochemically Euthyroid Patients

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Pages 115-124 | Published online: 13 Jul 2009
 

Abstract

Purpose: To examine clinical response to thyroid replacement therapy in patients considered to be clinically hypothyroid but with normal thyroid biochemistry . Design: Practice-based open intervention study; control group used for baseline laboratory values only. Materials and Methods: Clinical response to thyroxine (T4 only) was examined in 139 patients who were considered hypothyroid by 16 recognized criteria but whose free thyroxine (FT4) and thyroid stimulating hormone (TSH) fell within 95% laboratory reference intervals (133 patients) or whose FT4 or TSH fell within these intervals (6 patients). Patients were treated with 25 &#119 g day−1 thyroxine sodium for 1 week followed by 50 &#119 g day−1 for 6 weeks and an increase thereafter of 25 &#119 g at 6 week intervals until the patient was clinically euthyroid. Clinical response was adjudged by improvement or disappearance of clinical features of hypothyroidism; thyroid chemistry was estimated in 41 patients at 6-12 months following institution of thyroid replacement. Results: There was improvement or disappearance of all 16 clinical features in 30 patients (22%) and in over 12 features in 106 patients (76%), with a decrease in the mean number of clinical features from 13.3 &#45 0.18 before treatment to 3.0 &#45 0.23 following treatment over a minimum follow-up period of 6 months. Energy loss and poor memory and concentration were most responsive to treatment while reduction in tongue size and weight gain improved in 57% and 24% of patients respectively. Clinical response correlated with the level of thyroid replacement but not significantly with pre-treatment or post-treatment levels of FT4 and TSH nor with duration of illness or treatment. Conclusions: Clinically hypothyroid but biochemically euthyroid patients had favourable clinical response to thyroid replacement which correlated with the level of thyroid replacement. It is suggested that these findings be examined in a prospective placebo controlled clinical trial.

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