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Use of gel capsules, instead of standard LT 4, allowed suppression of serum TSH during chronic therapy in patients with thyroid disease that could not be achieved by ingestion of standard LT 4 with Italian style coffee ().

Also seen, if the patient is hyperthyroid, are more general manifestations, which are due to hyperthyroidism itself and which may be seen in any conditions that cause hyperthyroidism (such as toxic multinodular goitre or even thyroid poisoning).

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Levothyroxine is also used to treat subclinical hypothyroidism which is defined by an elevated TSH level and a normal-range free T4 level without symptoms.

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If practitioners would simply switch their focus from “optimizing” TSH to truly optimizing the dialysis-tested free T3 and free T4 serum levels, they would achieve, as I have, this laudable goal in virtually all their patients!

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Many cats treated with radioiodine with maintain low-normal values for both total and free T4 but develop high serum TSH concentrations, a situation commonly referred to as subclinical hypothyroidism in human patients.

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NDT is far, far superior to synthetic T4 mono therapy.

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