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The Use and Misuse of Thyroid Hormone^*

ELIO ROTI, ROBERTA MINELLI, ELIANA GARDINI and LEWIS E. BRAVERMAN

Centro per lo Studio, Prevenzione, Diagnosi e Cura della Tireopatie, Cattedra di Endocrinologia, Universita di Parma Parma, Italy
The Division of Endocrinology and Metabolism, University of Massachusetts Medical School Worcester, Massachusetts 01655

Correspondence: Address requests for reprints to: Lewis E. Braverman, M.D., Division of Endocrinology and Metabolism, University of Massachusetts, 55 Lake Avenue North, Worcester, Massachusetts 01655.

Abstract

I. Introduction: THYROID hormones are frequently prescribed for appropriate and, at times, inappropriate conditions. It has been estimated that 1.2% of the total population in Sweden receives synthetic levothyroxine (L-T₄) (1), and 18 million prescriptions for thyroid hormone preparations are filled annually in the United States, corresponding to more than 1% of all medical prescriptions (2). Therefore, it is important to review the various thyroid hormone preparations (Table 1), the therapeutic indications (Table 2), the misuse of thyroid hormone (Table 3), controversial uses of thyroid hormone (Table 4), the thyroid function tests to evaluate the correct treatment dose, and the possible side effects of treatment.

Thyroid Hormone Preparations: A. Thyroid extract

Since 1891, when Murray reported the beneficial effects of sheep thyroid extract given im to a patient with myxedema (3), desiccated thyroid has been used in the treatment of patients with thyroid disease. Thyroid extract is obtained from animal thyroid glands, primarily cattle, and contains T₄ and T₃ in variable ratios, depending upon the preparation process and the iodine content in the diet of the animals from which the thyroids have been obtained, resulting in variable quantities of T₄ and T₃ in the extract.

Footnotes

^* This work was supported in part by Grants 89.04244.04, 90.01540.CT04, and 91.00316.CT04 from Consiglio Nazionale delle Ricerche (Rome, Italy); Grant "Patologia della Tiroide: Indagine dei Fattori Etiopatogenetici" of Ministero Pubblica Istruzione 40% (Rome, Italy); Grant Ricerca Finalizzata Regione Emilia Romagna 1988–1990; and NIH Grant DK-18919.

Recipients of a fellowship from Associazione Volontaria Promozione Ricerca Tumori (A.VO.PRO.RI.T.), Parma, Italy.

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