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L-Thyroxine Dosage: A Reevaluation of Therapy with Contemporary Preparations

MAJ. JAMES V. HENNESSEY, M.D.; JUDY E. EVAUL, M.S.P.H.; YUEH-CHU TSENG, Ph.D.; COL. KENNETH D. BURMAN, M.D.; and COL. LEONARD WARTOFSKY, M.D.
[+] Article and Author Information

Grant support: by the Department of Clinical Investigation, Walter Reed Army Medical Center (Project no. 1350-84).

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of the Army or the Department of Defense.

▸Requests for reprints should be addressed to COL Leonard Wartofsky, M.D.; Endocrine-Metabolic Service 7D, Walter Reed Army Medical Center; Washington, DC 20307-5001.


Washington, D.C.; and Bethesda, Maryland


Ann Intern Med. 1986;105(1):11-15. doi:10.7326/0003-4819-105-1-11
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Traditional L-thyroxine dosing formulas may overestimate the thyroid hormone requirement in patients treated with contemporary L-thyroxine preparations. We did clinical and laboratory assessments of 41 patients treated in successive periods with Levothroid (Armour Pharmaceuticals, Kankakee, Illinois) and Synthroid (Flint Division, Travenol Laboratories, Morton Grove, Illinois), obtaining 87 sets of data. Clinical subgroups were defined on the basis of the thyrotrophin response to thyrotrophin-releasing hormone. Normal responses were seen in 9 of 14 (64%) patients taking 100 µg/d and were associated with an average replacement dosage of 127 µg/d (1.7 µg/kg body weight). Nine of twenty-eight (32%) serum thyroxine values in the "physiologically replaced" group were elevated. Forty-three of fifty-four (80%) patients ingesting 125 µg or more had blunted responses (thyroxine "overreplaced"), averaging a daily dosage of 154 µg (2.14 µg/kg · d). No significant difference was found between Levothroid and Synthroid in predicting clinical group assignment. Guidelines for currently available L-thyroxine preparations should be revised and the recommended dosage reduced.

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thyroxine

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