RT Journal
A1 Bunner DL
T1 THyroid replacement therapy-reply
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 1979
FD April 1
VO 139
IS 4
SP 489
OP 489
DO 10.1001/archinte.1979.03630410093032
UL http://dx.doi.org/10.1001/archinte.1979.03630410093032
AB In Reply.— 
    In Dr Klinefelter's letter two questions are raised; first, that clinical response is adequate as a guide in assessing dosage, and second, that cost control is needed and laboratory testing as suggested would raise the costs.I clearly agree that testing does raise the cost initially but I ask the cost of chronic underreplacement or overreplacement in terms of patient survival and in actual dollars. The study on absorption of thyroxine by Hays1 helps to explain why one dosage schedule based on body weight or surface area is not satisfactory. I also note that the findings used in following up patients I tested who were receiving thyroid replacement were, in order, historical and physical findings, then laboratory data. Given the frequency of complaints compatible with mild underreplacement, such as fatigue, coldness, and depression, objective guidelines such as thyroxine and thyroid-stimulating hormone levels are of great help in