Thyroid replacement not perfect.

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Offical document folks.

http://www.eje.org/eje/149/eje1490091.htm

MINI REVIEW: Intrinsic imperfections of endocrine replacement therapy

J A Romijn, J W A Smit and S W J Lamberts

Departments of Endocrinology, Leiden University Medical Center, Leiden and

of Internal Medicine, Erasmus Medical Center, Rotterdam University,

Rotterdam, The Netherlands

(Correspondence should be addressed to J A Romijn)

Abstract

Hormonal substitution therapy has been extremely successful in the treatment

of the major syndromes of endocrine insufficiency with respect to morbidity

and mortality.

However,

many patients treated for endocrine insufficiencies still suffer from more

or less vague complaints and a decreased quality of life. It is likely that

these complaints are, at least in part, caused by intrinsic imperfections of

hormone replacement strategies to mimic normal hormone secretion.

Unfortunately, these complaints are often difficult to assess by

clinicometric or biochemical tests, because the effects of hormones in

general and, thus of hormone replacement strategies in particular, at the

tissue level are difficult to quantify.

Therefore, in clinical practice we rely mostly on plasma parameters 'plasma

endocrinology', which are a poor reflection of hormone action at the tissue

level. Appreciation of these intrinsic shortcomings of endocrine therapy is of

utmost importance to prevent incorrect labeling of the complaints of many

endocrine patients and to further improve endocrine replacement strategies.