Edward N. Ehrlich, MD
Arch Intern Med. 1981;141(6):819. doi:10.1001/archinte.1981.00340060127040.
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To the Editor.  —In an article in the April Archives (1980;140:469) entitled "Management of Thyrotoxicosis With a Low Radioactive Iodine Uptake," Dr Duick noted that thyroid ablation by surgery or radioactive iodine had been used to treat several patients who had repeated episodes of thyrotoxicosis caused by so-called silent or painless thyroiditis. It has been assumed that episodes of thyrotoxicosis in this syndrome, which typically are self-limited, result from the unregulated release of preformed thyroid hormone from the inflamed gland rather than from enhanced biosynthesis.1-3 Therefore, it would seem reasonable to treat patients who have had several recurrences of thyrotoxicosis caused by silent thyroiditis with suppressive doses of thyroid hormone during a quiescent period immediately after thyrotoxicosis subsides, when intrathyroidal stores of hormone are exhausted.Suppressive therapy then should limit the reaccumulation of thyroid hormone to such an extent that little could be discharged from the gland during any


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