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Cited by 184Thyroid Disorders and TreatmentsThyroid and Parathyroid SurgeryThyroid Cancer Diagnosis and Treatment

Replacement Dosage of L-Thyroxine in Hypothyroidism: A Re-Evaluation

Stock, Jerrold M., Surks, Martin I., Oppenheimer, Jack H.·1974·New England Journal of Medicine
DOI 10.1056/nejm197403072901001
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Abstract

The replacement dose of L-thyroxine was determined in 44 patients with hypothyroidism, 35 with primary thyroidal insufficiency and nine with pituitary failure. In patients with primary hypothyroidism the adequacy of replacement was confirmed by thyrotropin radioimmunoassay values within the normal range. The average daily replacement dose of thyroxine was 169 jug per day (2.25 μg per kilogram), and 89 per cent of the patients were maintained with doses between 100 and 200 μg per day. This amount is significantly less than recommended in current textbooks. The replacement dose correlated with body weight. The average serum thyroxine concentration in treated patients, 8.1 μg per 100 ml, was only slightly higher than that in 55 controls, 7.1 μg. Over 96 per cent of patients receiving replacement had thyroxine concentrations in the generally accepted normal range. The average serum concentration of tri-iodothyronine in treated patients was 130 ng per 100 ml — slightly less than that in control subjects, 140 ng. These data support previous estimates that the bulk of circulating tri-iodothyronine in euthyroid subjects with unstimulated glands is derived from the peripheral conversion of thyroxine. (N Engl J Med 290:529–533, 1974)

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Registry

Crossref · 10.1056/nejm197403072901001

Cites

4 of 4 references verified0 citation errors · 0 not checkable

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  • Patients with hypothyroidism kept on LT4 with a normal serum TSH exhibit a relative and sometimes absolute deficiency of T3.

    “The second discovery was that patients with hypothyroidism kept on LT4, with a normal serum TSH, exhibit a relative (and sometimes absolute) deficiency of T3.”

    From Emerging Therapies in Hypothyroidism (2024) · cites this paper as [21]

  • In LT4-treated hypothyroid patients with normal serum TSH, serum T3 levels are about 10% lower than normal.

    “in LT4-treated hypothyroid patients with normal serum TSH, serum T3 levels are ∼10% lower”

    From Liothyronine and Desiccated Thyroid Extract in the Treatment of Hypothyroidism (2020) · cites this paper as [16]

  • In LT4-treated hypothyroid patients with normal serum TSH, serum T4 levels are about 12% higher than normal.

    “whereas serum T4 levels are ∼12% higher (12–16).”

    From Liothyronine and Desiccated Thyroid Extract in the Treatment of Hypothyroidism (2020) · cites this paper as [16]

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Authors
Stock, J. M., Surks, M. I., & Oppenheimer, J. H.
Affiliations
Albert Einstein College of Medicine (US)
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
1974-03-07
Volume
290
Issue
10
Pages
529-533
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejm197403072901001
OpenAlex
W2336106614
Cited by
184
References
4
Citations by year
2025: 6 · 2024: 2 · 2023: 2 · 2022: 3 · 2021: 2 · 2020: 5 · 2019: 4 · 2017: 1 · 2016: 3 · 2015: 3 · 2014: 2 · 2013: 2 · 2012: 3
FWCI
14.02
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
levothyroxine, hypothyroidism, primary hypothyroidism, pituitary failure, thyroid-stimulating hormone, triiodothyronine, body weight, dose adequacy
MeSH terms
Adult, Age Factors, Body Weight, Evaluation Studies as Topic, Female, Humans, Hypopituitarism, Hypothyroidism, Male, Middle Aged, Radioimmunoassay, Thyrotropin, Thyroxine, Triiodothyronine

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