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Dr. Theo Friedman
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The Diagnosis and Treatment of Hypothyroidism

Most endocrinologists use L-thyroxine preparations for the initial treatment of all forms of hypothyroidism. Although the use of L-thyroxine (T4) compared to L-triiodothyronine (T3) may be surprising, as T3 is the more bioactive thyroid hormone, T4 is most frequently used. This is because tissues convert T4 to T3 to maintain physiologic levels of the T3. Thus, administration of T4 results in bioavailable T3 and T4. As T4 is more stable than T3, T4 therapy gives even blood levels, while T3 therapy leads to high levels after taking the medicine and low levels before the next dose. Armour thyroid is the least expensive preparation. Because Armour thyroid comes from pig thyroids, some endocrinologists feel that there is high pill to pill variability, but this is unlikely to be true.

A recent study published in New England Journal of Medicine in 1999 suggested that brain T4 to T3 conversion may be impaired in some patients and that a select group of patients should be treated with both T4 and T3. Other studies published in Journal of Clinical Endocrinology and Metabolism in 2003 suggested that addition of T3 to T4 treatment is not needed for most patients with primary hypothyroidism.

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