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Cited by 95Thyroid Disorders and TreatmentsThyroid and Parathyroid SurgeryThyroid Cancer Diagnosis and Treatment

Suppression of Thyrotropin (H-TSH) in Serums of Patients with Myxedema of Varying Etiology Treated with Thyroid Hormones

Cotton, Gerald E., Gorman, Colum A., Mayberry, William E.·1971·New England Journal of Medicine
DOI 10.1056/nejm197109022851001
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Abstract

Abstract Patients with myxedema and high thyrotropin (h-TSH) levels were given levothyroxine (l-T4) orally in doses increasing stepwise from 0.025 to 0.2 mg per day at 3-week intervals. The serum h-TSH response was similar regardless of etiology of the myxedema. In all but one patient, h-TSH levels were suppressed to normal at 0.2 mg per day, but at lower doses, many patients still had increased h-TSH levels when total and free T4 levels were normal. h-TSH was correlated with dose of T4 (r equals -0.99), total T4 (r equals -0.99), and free T4 (r equals -1.0). Five patients were given levo-tri-iodothyronine (l-T3) orally in doses increasing each week by 25 μg daily to 100 μg per day; serum h-TSH levels became normal in all patients with 100 μg per day but not with 75 μg per day. For T3 suppression tests, 75 μg per day is not sufficient for routine use. Serum h-TSH levels appear to offer the best means of diagnosing hypothyroidism and assessing adequacy of thyroid-hormone therapy.

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Crossref · 10.1056/nejm197109022851001

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  • Withdrawal of LT4 or LT3 leads to recurrence of hypothyroidism in patients who had thyroid surgery for thyroid cancer or were diagnosed with profound hypothyroidism.

    “Although there are no randomized clinical trials comparing LT4 to placebo to treat hypothyroidism, it has clearly been demonstrated that LT4 or LT3 withdrawal leads to a recurrence of hypothyroidism in patients who have undergone thyroid surgery for thyroid cancer or who were diagnosed with profound hypothyroidism (44-46).”

    From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [46]

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Authors
Cotton, G. E., Gorman, C. A., & Mayberry, W. E.
Affiliations
University of Minnesota (US)
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
1971-09-02
Volume
285
Issue
10
Pages
529-533
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejm197109022851001
OpenAlex
W2317475302
Cited by
95
References
7
Citations by year
2025: 1 · 2020: 1 · 2019: 3 · 2016: 1 · 2015: 1 · 2014: 1
FWCI
15.25
Type
journal article
Language
en
Open access
closed
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
Keywords
myxedema, hypothyroidism, levothyroxine, thyroid hormone replacement, free thyroxine, TSH response, dose-response relationship
MeSH terms
Administration, Oral, Adult, Aged, Female, Humans, Hyperthyroidism, Hypothyroidism, Iodine Isotopes, Male, Middle Aged, Myxedema, Postoperative Complications, Radioimmunoassay, Thyroidectomy, Thyroiditis, Autoimmune, Thyrotropin, Thyroxine, Triiodothyronine

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