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thyroxine dose was increased to 50 micrograms above the dose required to normalize TRH response.  The authors attribute that to a placebo effect, but there's no evidence that that's the case.

Finally, at the end, the authors conclude that our study does not address the all-important question of whether the TRH test fulfills the criteria of a gold standard, whether its application would yield optimal clinical results with minimum morbidity.  The value of routinely adjusting thyroxine doses according to any test of thyroid function remains controversial.

Well, it still is controversial because I did a more recent search of the literature, and I think we need to consider the current status of thyroid function tests, and there was a series of articles in the British Medical Journal that looked at this.  They talked about the confusion surrounding thyroid function tests, and they cited two studies of recent vintage, studies in 1,580 in-patients, 630 out-patients, found that thyroid function tests performed as a screening test yielded abnormal results in 33 and 20 percent of patients, respectively.  In both studies, these biochemical tests suggested thyroid

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