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Given its short half-life, 3 daily doses of T 3 are usually required to obtain physiological and stable circulating T 3 levels ().

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Higher doses of l-T 4 were associated with a 2 to 3-fold increased risk of fractures compared with lower doses ().

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The analysis indicated that l-T 4 treatment was associated with decreased nodule volume in 17% of patients and was able to inhibit growth in another 10% ().

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As a consequence, several studies have suggested a rationale and potential indication for combined treatment with l-T 4 and l-T 3 in selected hypothyroid patients ().

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Test came back t4 and t3 were normal but my thyroid antibodies are elevated.

The assessment of serum FT 4 targeting the mid reference range should be considered when monitoring l-T 4 therapy.

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This may constitute another rationale for l-T 4 treatment of patients with nodules in hope of reducing the potential development of thyroid cancer by reducing serum TSH levels ().

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Incident cerebrovascular disease events were unchanged, and incident AF was not related to l-T 4 exposure ().

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This has been explained as due to either undertreatment or an abnormal maturation of T 4 feedback control of TSH secretion.

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However, we should caution that high doses of iodine may induce development of hyperthyroidism especially in elderly subjects.

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Is your PCP currently treating you for your hypothyroidism?

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Would every doctor say the same to me or would some consider my levels high?

Moreover, the recently updated guidelines have recommended being prudent in interpreting serum FT 4 levels during pregnancy.

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The AAP suggests that the measurement of serum T 4 or FT 4 and TSH should be performed 2 or 4 weeks after initial treatment with l-T 4 and then every 1 to 2 months during the first 6 months of life, every 3 to 4 months between 6 months and 3 years of age and subsequently every 6 to 12 months until growth is completed ().

The studies described are very preliminary and far from ready for prime time; we know that preliminary studies are often overturned by larger, betterdesigned studies.

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The average age of the study participants was 67, and about half were women. Just over 36 percent had a history of cardiac disease.

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As a consequence, elderly patients and patients with comorbidities are more safely treated with lower doses of l-T 4, usually in the range of 100 to 150 μg oral l-T 4 daily.

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Optimal management of l-T 4 replacement treatment should take into account conditions increasing the l-T 4 requirement (eg, pregnancy, glomerular disease, malabsorption, drugs interfering with l-T 4 absorption, increased metabolism, or deiodinase activity) or those conditions that may decrease the l-T 4 dose (weight loss, withdrawal of drugs interfering with l-T 4, and atrial arrhythmias).

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The most commonly used form of desiccated thyroid, known as Armour Thyroid, is of porcine origin and may be viewed as a mixture of T 3 and T 4 (1 grain, about 60 mg desiccated pig thyroid extract is approximately equivalent to 88 μg l-T 4) ().

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Stratification into a risk-adapted management scheme for l-T 4 therapy in patients with DTC was summarized in a recent review that considered the aggressiveness of the DTC as well as the potential adverse effects induced by iatrogenic subclinical hyperthyroidism ().

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The presence of the D2 Thr92Ala polymorphism was associated with the need for higher l-T 4 doses to normalize serum TSH in 191 consecutive thyroid cancer patients, previously treated with near-total thyroidectomy and radioiodine ablation ().

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