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checked their TSHs, they were all high, and I said, what is going on here?  So, finally, I marched over to the pharmacy and found out that the pharmacy had substituted another levothyroxine preparation without the knowledge of the endocrine service.  So, I had to start all over again on these patients to get them under control.

So, it is very important for clinicians to be able to depend on the bioequivalence of these various preparations that are being looked at by the FDA.  So, I would urge the FDA to do just that, to use a different methodology so that they all are equivalent.

Thank you.

DR. KIBBE:  Thank you, Dr. Silva.

Dr. Brown?

DR. BROWN:  Good morning.  My name is Rosalind Brown, and for 23 years, I was at the University of Massachusetts Medical School, where I was Professor of Pediatrics and Director of the Pediatric Endocrine Group Division, so that unlike the speakers you have heard today, I look after the children with endocrine disorders, particularly thyroid disease, and I have just relocated to Children's Hospital Boston and Harvard Medical School

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