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Relative ineffectiveness of exogenous triiodothyronine as a thyroid suppressive agent

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Abstract

In 16 patients with nontoxic goiter T3 was given orally, 20 μg daily for the first month, 40 μg for the second and 60 μg for the third. Before and at the end of each month the basal serum TSH levels and the 30 min response to 200 μg TRH iv were measured. The difference was calculated as δ TSH. Serum T4, T3 resin uptake, and T3 were measured at the beginning and at the end of treatment. The results were compared to those obtained in 2 groups of 18 and 54 patients, respectively, treated with increasing doses of oral T4. In the patients treated with exogenous T3 there was a rise of serum T3 from 2.02 ± 0.06 to 3.48 ± 0.08 nmol/l, and whileon 60 μg/day all had serum T3 levels well within the hyperthyroid range. However, the TRH test became negative in only 62.5% of them. On the contrary, in the groups treated with T4 the TRH test was promptly suppressed completely, and ATSH became 0 with 100 μg of T4 daily in virtually all cases. It is concluded that although 60 μg of T3 are more than the daily maintainance dose and result in hyperthyroid serum T3 levels, the pituitary-thyroid axis is not completely suppressed, probably because pituitary TSH secretion is regulated by the intrapituitary conversion of T4 to T3 and not by serum T3 levels. Hence, if one wants to suppress the pituitary TSH release, as in the treatment of nontoxic goiter, T4 and not T3 is the drug of choice: it is selectively converted to T3 in the pituitary, where it produces higher T3 levels and so more complete suppression of the TSH release, without unduly high serum T3 levels and thyrotoxic manifestations from the peripheral tissues.

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Authors and Affiliations

  1. Department of Clinical Therapeutics, Alexandra Hospital, Athens University, Athens, 611, Greece

    Demetrios A. Koutras, J. Malamitsi, A. Souvatzoglou, G. D. Piperingos, D. P. Livadas, M. Boukis, D. N. Papachristou, J. Sfontouris & S. D. Moulopoulos

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  1. Demetrios A. Koutras
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  2. J. Malamitsi
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  3. A. Souvatzoglou
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  4. G. D. Piperingos
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  5. D. P. Livadas
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  6. M. Boukis
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  7. D. N. Papachristou
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  8. J. Sfontouris
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  9. S. D. Moulopoulos
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Supported by a Research Contract from the Hellenic Ministry for Social Services.

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Koutras, D.A., Malamitsi, J., Souvatzoglou, A. et al. Relative ineffectiveness of exogenous triiodothyronine as a thyroid suppressive agent. J Endocrinol Invest 4, 343–347 (1981). https://doi.org/10.1007/BF03349455

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  • DOI: https://doi.org/10.1007/BF03349455

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