Thyroxine should be tried in clinically hypothyroid but biochemically euthyroid patients

BMJ 1997;314:1764 (14 June)

Letters

Thyroxine should be tried in clinically hypothyroid but biochemically euthyroid patients

Editor–We wish to question present medical practice, whichconsiders abnormal serum concentrations of free thyroxine andthyroid stimulating hormone–those outside the 95% referenceinterval–to indicate hypothyroidism but incorrectly considers "normal"free thyroxine and thyroid stimulating hormone concentrationsto negate this diagnosis.¹ It is unusual for doctors to startthyroxine replacement in clinically hypothyroid but biochemicallyeuthyroid patients.

The free thyroxine and thyroid stimulating hormone concentrationsin 80 patients considered to be hypothyroid on established criteriaindicated that only five patients had free thyroxine concentrations(just) below the reference interval of 10-19 pmol/l (values of9.4, 9.8, 9.8, 9.9, and 9.9 pmol/l) and only four patients hadthyroid stimulating hormone values above the reference intervalof 0.5-5.5 mU/l (values of 5.6, 8.4, 11.8, and 30.1 mU/l); moreoverin these 80 patients the mean (SE) concentration of free thyroxinewas 12.9 (0.2) pmol/l and the mean concentration of thyroidstimulating hormone was . . . [Full text of this article]

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