A clinical score of hypothyroidism25 was completed on each visit (every 4 weeks during the first 24 weeks of treatment and every 12 weeks thereafter) by a blinded physician (A.B.). The 12 symptoms and signs included dry skin, hoarseness, paresthesia, diminished sweating, constipation, impaired hearing, weight gain, delayed ankle reflex, cold skin, slow movements, periorbital puffiness, and coarse skin. The symptoms and signs were quantified as 1 point, meaning present, or 0 points, meaning absent. Two questionnaires were obtained at 0, 12, 24, and 48 weeks. This interval of 12 weeks was chosen to minimize recall bias. The first questionnaire assessed 10 symptoms of hypothyroidism: lack of energy, dry skin, constipation, aches and pains, cold intolerance, poor memory, depression, weight gain, tiredness after waking up, and feeling down.26 Patients scored these symptoms as 1, indicating not present; 2, hardly present; 3, present; or 4, severely present. The second questionnaire was a general quality-of-life questionnaire (the RAND 36-Item Health Survey questionnaire27) that concerned 8 scales: physical functioning, social functioning, role limitations (physical problems), role limitations (emotional problems), mental health, vitality, pain, and general health perception. Scores per scale ranged from 0 to 100, the highest score indicating the best state of health.