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patient.  However, in 2 patients, more than one such optimal dose was evident, so these were not unique optimal doses.  In 4 patients, no dose tested resulted in a normal TRH response, and the optimal dose was taken to be that dose at which the TRH response was closest to normal.  So that's at least 30 percent of the patients in whom a normal dose was not successfully achieved.

I think importantly, though, no significant differences were observed in any clinical symptomatology, weight, pulse rate or any clinical index over the range of thyroxine doses that were studied, 25 micrograms below or 75 micrograms above the optimal.  No patients receiving doses from 25 micrograms below to 75 micrograms above optimal were considered to be hypothyroid or hyperthyroid.

As you get to the discussion part, the authors comment that these data highlight the relative insensitivity of clinical observations which fail to detect clinical differences between patients receiving thyroxine at various doses within the range studied.  In other words, there's no connection between the TSH and the clinical observation.

Patients actually felt better when the

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