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High-quality randomized placebo controlled trials of various TH regimens in NTIS addressing whether thyroid axis derangements are adaptive or pathophysiologic are needed but would be challenging to design.

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Genome-wide association studies have suggested that a single-nucleotide polymorphism located near the FOXE1 gene is associated with risk of developing thyroid disease and that the strongest association is with hypothyroidism.

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Using methods similar to those used in previous studies, this study will measure thyroid function tests in approximately 10-20 subjects (18-60 years of age) over a 6 hour period of time after taking their thyroid medication with the specified study beverage for a 6 week period.

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If a combination of a high TSH and a normal or high T 4 concentration is documented by laboratory testing, this pattern could be consistent with the syndrome of thyroid hormone resistance, a TSH-secreting pituitary adenoma, a macro-TSH phenomenon in which TSH complexes with an immunoglobulin and cannot be filtered by the kidney (), or recent resumption of LT 4 therapy ().

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People with hypothyroidism who do not feel well despite optimal levothyroxine dosing may request adjunctive treatment with liothyronine.

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