Thyroxine replacement therapy

There is much debate about what is the correct dose of thyroxine replacement therapy and whether suppression of the serum TSH concentration, when measured by an assay with a lower limit of detection of 0.1 mU/l or less, is a risk factor for osteoporosis. Nor is there agreement about whether patients with subclinical hypothyroidism are at an increased risk of developing ischaemic heart disease. Normalisation of serum TSH in such patients is by no means a universal policy. Increasingly, it is recognised that hypothyroidism may be temporary and may even remit spontaneously after many years of treatment with thyroxine.