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Suppression of thyrotropin (h-TSH) in serums of patients with myxedema of varying etiology treated with thyroid hormones.

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.