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==Overview==
==Overview==
Pharmacologic medical therapy for Goiter involves normalizing hormone levels and treating the inflammation. Treatment regimen involves [[Lugol’s iodine]], [[antithyroid drugs]] and [[β-adrenergic blockers]]. In some cases, radioactive iodine may be used to treat an overactive thyroid gland.
Pharmacologic medical therapy for goiter involves normalizing hormone levels and treating the inflammation. Treatment regimen involves Lugol's iodine, [[antithyroid drugs]] and [[β-adrenergic blockers]]. In some cases, radioactive iodine may be used to treat an overactive thyroid gland.


==Medical Therapy==
==Medical Therapy==
*Pharmacologic medical therapy is recommended among patients with Goiter. <ref name="Astwood1960">{{cite journal|last1=Astwood|first1=E. B.|title=Treatment of Goiter and Thyroid Nodules with Thyroid|journal=JAMA|volume=174|issue=5|year=1960|pages=459|issn=0098-7484|doi=10.1001/jama.1960.03030050001001}}</ref> <ref name="pmid2709545">{{cite journal |vauthors=Sawin CT, Geller A, Hershman JM, Castelli W, Bacharach P |title=The aging thyroid. The use of thyroid hormone in older persons |journal=JAMA |volume=261 |issue=18 |pages=2653–5 |year=1989 |pmid=2709545 |doi= |url=}}</ref> <ref name="Sawin1989">{{cite journal|last1=Sawin|first1=Clark T.|title=The Aging Thyroid|journal=JAMA|volume=261|issue=18|year=1989|pages=2653|issn=0098-7484|doi=10.1001/jama.1989.03420180077034}}</ref> <ref name="pmid23008749">{{cite journal |vauthors=Führer D, Bockisch A, Schmid KW |title=Euthyroid goiter with and without nodules--diagnosis and treatment |journal=Dtsch Arztebl Int |volume=109 |issue=29-30 |pages=506–15; quiz 516 |year=2012 |pmid=23008749 |pmc=3441105 |doi=10.3238/arztebl.2012.0506 |url=}}</ref> <ref name="BaskinCobin2002">{{cite journal|last1=Baskin|first1=H. Jack|last2=Cobin|first2=Rhoda H.|last3=Duick|first3=Daniel S.|last4=Gharib|first4=Hossein|last5=Guttler|first5=Richard B.|last6=Kaplan|first6=Michael M.|last7=Segal|first7=Robert L.|last8=Garber|first8=Jeffrey R.|last9=Hamilton|first9=Carlos R.|last10=Handelsman|first10=Yehuda|last11=Hellman|first11=Richard|last12=Kukora|first12=John S.|last13=Levy|first13=Philip|last14=Palumbo|first14=Pasquale J.|last15=Petak|first15=Steven M.|last16=Rettinger|first16=Herbert I.|last17=Rodbard|first17=Helena W.|last18=Service|first18=F. John|last19=Shankar|first19=Talla P.|last20=Stoffer|first20=Sheldon S.|last21=Tourtelot|first21=John B.|title=AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE EVALUATION AND TREATMENT OF HYPERTHYROIDISM AND HYPOTHYROIDISM|journal=Endocrine Practice|volume=8|issue=6|year=2002|pages=457–469|issn=1530-891X|doi=10.4158/1934-2403-8.6.457}}</ref> <ref name="WescheTiel-v Buul2001">{{cite journal|last1=Wesche|first1=Maria F. T.|last2=Tiel-v Buul|first2=Monique M. C.|last3=Lips|first3=Paul|last4=Smits|first4=Nico J.|last5=Wiersinga|first5=Wilmar M.|title=A Randomized Trial Comparing Levothyroxine with Radioactive Iodine in the Treatment of Sporadic Nontoxic Goiter|journal=The Journal of Clinical Endocrinology & Metabolism|volume=86|issue=3|year=2001|pages=998–1005|issn=0021-972X|doi=10.1210/jcem.86.3.7244}}</ref> <ref name="BonnemaBertelsen1999">{{cite journal|last1=Bonnema|first1=Steen J.|last2=Bertelsen|first2=Henrik|last3=Mortensen|first3=Jesper|last4=Andersen|first4=Peter B.|last5=Knudsen|first5=Dorthe U.|last6=Bastholt|first6=Lars|last7=Hegedüs|first7=Laszlo|title=The Feasibility of High Dose Iodine 131 Treatment as an Alternative to Surgery in Patients with a Very Large Goiter: Effect on Thyroid Function and Size and Pulmonary Function1|journal=The Journal of Clinical Endocrinology & Metabolism|volume=84|issue=10|year=1999|pages=3636–3641|issn=0021-972X|doi=10.1210/jcem.84.10.6052}}</ref> <ref name="NygaardKnudsen1997">{{cite journal|last1=Nygaard|first1=Birte|last2=Knudsen|first2=Jens Helmer|last3=Hegedüs|first3=Laszlo|last4=Scient|first4=Annegrete Veje Cand|last5=Mølholm Hansen|first5=Jens Erik|title=Thyrotropin Receptor Antibodies and Graves’ Disease, a Side-Effect of131I Treatment in Patients with Nontoxic Goiter1|journal=The Journal of Clinical Endocrinology & Metabolism|volume=82|issue=9|year=1997|pages=2926–2930|issn=0021-972X|doi=10.1210/jcem.82.9.4227}}</ref> <ref name="GreerAstwood1953">{{cite journal|last1=Greer|first1=Monte A.|last2=Astwood|first2=E. B.|title=TREATMENT OF SIMPLE GOITER WITH THYROID*|journal=The Journal of Clinical Endocrinology & Metabolism|volume=13|issue=11|year=1953|pages=1312–1331|issn=0021-972X|doi=10.1210/jcem-13-11-1312}}</ref> <ref name="SquatritoVigneri1986">{{cite journal|last1=Squatrito|first1=S.|last2=Vigneri|first2=R.|last3=Rybello|first3=F.|last4=Ermans|first4=A. M.|last5=Polley|first5=R. D.|last6=Ingbar|first6=S. H.|title=Prevention and Treatment of Endemic Iodine-Deficiency Goiter by Iodination of a Municipal Water Supply*|journal=The Journal of Clinical Endocrinology & Metabolism|volume=63|issue=2|year=1986|pages=368–375|issn=0021-972X|doi=10.1210/jcem-63-2-368}}</ref> <ref name="HegedüsBonnema2010">{{cite journal|last1=Hegedüs|first1=Laszlo|last2=Bonnema|first2=Steen J.|title=Approach to Management of the Patient with Primary or Secondary Intrathoracic Goiter|journal=The Journal of Clinical Endocrinology & Metabolism|volume=95|issue=12|year=2010|pages=5155–5162|issn=0021-972X|doi=10.1210/jc.2010-1638}}</ref> <ref name="HainesKeating1948">{{cite journal|last1=Haines|first1=Samuel F.|last2=Keating|first2=F. Raymond|last3=Power|first3=Marschelle H.|last4=Williams|first4=Marvin M. D.|last5=Kelsey|first5=Mavis P.|title=THE USE OF RADIOIODINE IN THE TREATMENT OF EXOPHTHALMIC GOITER*|journal=The Journal of Clinical Endocrinology & Metabolism|volume=8|issue=10|year=1948|pages=813–825|issn=0021-972X|doi=10.1210/jcem-8-10-813}}</ref> <ref name="Reveno1948">{{cite journal|last1=Reveno|first1=William S.|title=PROPYLTHIOURACIL IN THE TREATMENT OF TOXIC GOITER|journal=The Journal of Clinical Endocrinology & Metabolism|volume=8|issue=10|year=1948|pages=866–874|issn=0021-972X|doi=10.1210/jcem-8-10-866}}</ref> <ref name="BrentaSchnitman2003">{{cite journal|last1=Brenta|first1=G.|last2=Schnitman|first2=M.|last3=Fretes|first3=O.|last4=Facco|first4=E.|last5=Gurfinkel|first5=M.|last6=Damilano|first6=S.|last7=Pacenza|first7=N.|last8=Blanco|first8=A.|last9=Gonzalez|first9=E.|last10=Pisarev|first10=M. A.|title=Comparative Efficacy and Side Effects of the Treatment of Euthyroid Goiter with Levo-Thyroxine or Triiodothyroacetic Acid|journal=The Journal of Clinical Endocrinology & Metabolism|volume=88|issue=11|year=2003|pages=5287–5292|issn=0021-972X|doi=10.1210/jc.2003-030095}}</ref>  
*Pharmacologic medical therapy is recommended among patients with goiter.<ref name="Astwood1960">{{cite journal|last1=Astwood|first1=E. B.|title=Treatment of Goiter and Thyroid Nodules with Thyroid|journal=JAMA|volume=174|issue=5|year=1960|pages=459|issn=0098-7484|doi=10.1001/jama.1960.03030050001001}}</ref><ref name="pmid2709545">{{cite journal |vauthors=Sawin CT, Geller A, Hershman JM, Castelli W, Bacharach P |title=The aging thyroid. The use of thyroid hormone in older persons |journal=JAMA |volume=261 |issue=18 |pages=2653–5 |year=1989 |pmid=2709545 |doi= |url=}}</ref><ref name="Sawin1989">{{cite journal|last1=Sawin|first1=Clark T.|title=The Aging Thyroid|journal=JAMA|volume=261|issue=18|year=1989|pages=2653|issn=0098-7484|doi=10.1001/jama.1989.03420180077034}}</ref><ref name="pmid23008749">{{cite journal |vauthors=Führer D, Bockisch A, Schmid KW |title=Euthyroid goiter with and without nodules--diagnosis and treatment |journal=Dtsch Arztebl Int |volume=109 |issue=29-30 |pages=506–15; quiz 516 |year=2012 |pmid=23008749 |pmc=3441105 |doi=10.3238/arztebl.2012.0506 |url=}}</ref><ref name="BaskinCobin2002">{{cite journal|last1=Baskin|first1=H. Jack|last2=Cobin|first2=Rhoda H.|last3=Duick|first3=Daniel S.|last4=Gharib|first4=Hossein|last5=Guttler|first5=Richard B.|last6=Kaplan|first6=Michael M.|last7=Segal|first7=Robert L.|last8=Garber|first8=Jeffrey R.|last9=Hamilton|first9=Carlos R.|last10=Handelsman|first10=Yehuda|last11=Hellman|first11=Richard|last12=Kukora|first12=John S.|last13=Levy|first13=Philip|last14=Palumbo|first14=Pasquale J.|last15=Petak|first15=Steven M.|last16=Rettinger|first16=Herbert I.|last17=Rodbard|first17=Helena W.|last18=Service|first18=F. John|last19=Shankar|first19=Talla P.|last20=Stoffer|first20=Sheldon S.|last21=Tourtelot|first21=John B.|title=AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE EVALUATION AND TREATMENT OF HYPERTHYROIDISM AND HYPOTHYROIDISM|journal=Endocrine Practice|volume=8|issue=6|year=2002|pages=457–469|issn=1530-891X|doi=10.4158/1934-2403-8.6.457}}</ref><ref name="WescheTiel-v Buul2001">{{cite journal|last1=Wesche|first1=Maria F. T.|last2=Tiel-v Buul|first2=Monique M. C.|last3=Lips|first3=Paul|last4=Smits|first4=Nico J.|last5=Wiersinga|first5=Wilmar M.|title=A Randomized Trial Comparing Levothyroxine with Radioactive Iodine in the Treatment of Sporadic Nontoxic Goiter|journal=The Journal of Clinical Endocrinology & Metabolism|volume=86|issue=3|year=2001|pages=998–1005|issn=0021-972X|doi=10.1210/jcem.86.3.7244}}</ref><ref name="BonnemaBertelsen1999">{{cite journal|last1=Bonnema|first1=Steen J.|last2=Bertelsen|first2=Henrik|last3=Mortensen|first3=Jesper|last4=Andersen|first4=Peter B.|last5=Knudsen|first5=Dorthe U.|last6=Bastholt|first6=Lars|last7=Hegedüs|first7=Laszlo|title=The Feasibility of High Dose Iodine 131 Treatment as an Alternative to Surgery in Patients with a Very Large Goiter: Effect on Thyroid Function and Size and Pulmonary Function1|journal=The Journal of Clinical Endocrinology & Metabolism|volume=84|issue=10|year=1999|pages=3636–3641|issn=0021-972X|doi=10.1210/jcem.84.10.6052}}</ref><ref name="NygaardKnudsen1997">{{cite journal|last1=Nygaard|first1=Birte|last2=Knudsen|first2=Jens Helmer|last3=Hegedüs|first3=Laszlo|last4=Scient|first4=Annegrete Veje Cand|last5=Mølholm Hansen|first5=Jens Erik|title=Thyrotropin Receptor Antibodies and Graves’ Disease, a Side-Effect of131I Treatment in Patients with Nontoxic Goiter1|journal=The Journal of Clinical Endocrinology & Metabolism|volume=82|issue=9|year=1997|pages=2926–2930|issn=0021-972X|doi=10.1210/jcem.82.9.4227}}</ref><ref name="GreerAstwood1953">{{cite journal|last1=Greer|first1=Monte A.|last2=Astwood|first2=E. B.|title=TREATMENT OF SIMPLE GOITER WITH THYROID*|journal=The Journal of Clinical Endocrinology & Metabolism|volume=13|issue=11|year=1953|pages=1312–1331|issn=0021-972X|doi=10.1210/jcem-13-11-1312}}</ref><ref name="SquatritoVigneri1986">{{cite journal|last1=Squatrito|first1=S.|last2=Vigneri|first2=R.|last3=Rybello|first3=F.|last4=Ermans|first4=A. M.|last5=Polley|first5=R. D.|last6=Ingbar|first6=S. H.|title=Prevention and Treatment of Endemic Iodine-Deficiency Goiter by Iodination of a Municipal Water Supply*|journal=The Journal of Clinical Endocrinology & Metabolism|volume=63|issue=2|year=1986|pages=368–375|issn=0021-972X|doi=10.1210/jcem-63-2-368}}</ref><ref name="HegedüsBonnema2010">{{cite journal|last1=Hegedüs|first1=Laszlo|last2=Bonnema|first2=Steen J.|title=Approach to Management of the Patient with Primary or Secondary Intrathoracic Goiter|journal=The Journal of Clinical Endocrinology & Metabolism|volume=95|issue=12|year=2010|pages=5155–5162|issn=0021-972X|doi=10.1210/jc.2010-1638}}</ref><ref name="HainesKeating1948">{{cite journal|last1=Haines|first1=Samuel F.|last2=Keating|first2=F. Raymond|last3=Power|first3=Marschelle H.|last4=Williams|first4=Marvin M. D.|last5=Kelsey|first5=Mavis P.|title=THE USE OF RADIOIODINE IN THE TREATMENT OF EXOPHTHALMIC GOITER*|journal=The Journal of Clinical Endocrinology & Metabolism|volume=8|issue=10|year=1948|pages=813–825|issn=0021-972X|doi=10.1210/jcem-8-10-813}}</ref><ref name="Reveno1948">{{cite journal|last1=Reveno|first1=William S.|title=PROPYLTHIOURACIL IN THE TREATMENT OF TOXIC GOITER|journal=The Journal of Clinical Endocrinology & Metabolism|volume=8|issue=10|year=1948|pages=866–874|issn=0021-972X|doi=10.1210/jcem-8-10-866}}</ref><ref name="BrentaSchnitman2003">{{cite journal|last1=Brenta|first1=G.|last2=Schnitman|first2=M.|last3=Fretes|first3=O.|last4=Facco|first4=E.|last5=Gurfinkel|first5=M.|last6=Damilano|first6=S.|last7=Pacenza|first7=N.|last8=Blanco|first8=A.|last9=Gonzalez|first9=E.|last10=Pisarev|first10=M. A.|title=Comparative Efficacy and Side Effects of the Treatment of Euthyroid Goiter with Levo-Thyroxine or Triiodothyroacetic Acid|journal=The Journal of Clinical Endocrinology & Metabolism|volume=88|issue=11|year=2003|pages=5287–5292|issn=0021-972X|doi=10.1210/jc.2003-030095}}</ref>  


*In cases of hypothyroidism, thyroid hormone replacement with [[levothyroxine]] may help resolve hypothyroidism symptoms and also help with the slow release of [[TSH]] ([[Thyroid Stimulating Hormone]]) from [[pituitary]] which would result in the decrease in the size of the goiter.
*In cases of hypothyroidism, thyroid hormone replacement with [[levothyroxine]] may help resolve hypothyroidism symptoms and also help with the slow release of [[TSH]] ([[Thyroid Stimulating Hormone]]) from [[pituitary]] which would result in the decrease in the size of the goiter.
Line 13: Line 13:
*In cases of inflammation of thyroid gland, medication to treat the inflammation are generally prescribed. For goiters associated with [[hyperthyroidism]], you may need medications to normalize hormone levels.
*In cases of inflammation of thyroid gland, medication to treat the inflammation are generally prescribed. For goiters associated with [[hyperthyroidism]], you may need medications to normalize hormone levels.
*'''[[Radioactive Iodine]]:''' In some cases, [[radioactive iodine]] may be used to treat an overactive thyroid gland. [[Radioactive iodine]] is prescribed as an oral medication which helps destroy thyroid cells resulting in the decreasing the size of the goiter. This therapy may also lead to under-activity of the thyroid gland.
*'''[[Radioactive Iodine]]:''' In some cases, [[radioactive iodine]] may be used to treat an overactive thyroid gland. [[Radioactive iodine]] is prescribed as an oral medication which helps destroy thyroid cells resulting in the decreasing the size of the goiter. This therapy may also lead to under-activity of the thyroid gland.
*[[Lugol’s iodine]]:
*[[Lugol's iodine]]:
**↓ Thyroid hormone synthesis  
**↓ Thyroid hormone synthesis  
**↓ Vascularity  
**↓ Vascularity  
*[[Antithyroid drugs]] eg [[Carbimazole]]:
*[[Antithyroid drugs]] e.g. [[Carbimazole]]:
**Used to restore the patient to a euthyroid state  
**Used to restore the patient to a euthyroid state  
*[[β-adrenergic blockers]] E.g. [[propranolol]]:
*[[β-adrenergic blockers]] e.g. [[propranolol]]:
**↓ [[tachycardia]] and palpitations
**↓ [[tachycardia]] and palpitations
**Used to restore the patient to a [[euthyroid]]
**Used to restore the patient to a [[euthyroid]]

Revision as of 21:47, 20 September 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Pharmacologic medical therapy for goiter involves normalizing hormone levels and treating the inflammation. Treatment regimen involves Lugol's iodine, antithyroid drugs and β-adrenergic blockers. In some cases, radioactive iodine may be used to treat an overactive thyroid gland.

Medical Therapy

References

  1. ↑ Astwood, E. B. (1960). "Treatment of Goiter and Thyroid Nodules with Thyroid". JAMA. 174 (5): 459. doi:10.1001/jama.1960.03030050001001. ISSN 0098-7484.
  2. ↑ Sawin CT, Geller A, Hershman JM, Castelli W, Bacharach P (1989). "The aging thyroid. The use of thyroid hormone in older persons". JAMA. 261 (18): 2653–5. PMID 2709545.
  3. ↑ Sawin, Clark T. (1989). "The Aging Thyroid". JAMA. 261 (18): 2653. doi:10.1001/jama.1989.03420180077034. ISSN 0098-7484.
  4. ↑ Führer D, Bockisch A, Schmid KW (2012). "Euthyroid goiter with and without nodules--diagnosis and treatment". Dtsch Arztebl Int. 109 (29–30): 506–15, quiz 516. doi:10.3238/arztebl.2012.0506. PMC 3441105. PMID 23008749.
  5. ↑ Baskin, H. Jack; Cobin, Rhoda H.; Duick, Daniel S.; Gharib, Hossein; Guttler, Richard B.; Kaplan, Michael M.; Segal, Robert L.; Garber, Jeffrey R.; Hamilton, Carlos R.; Handelsman, Yehuda; Hellman, Richard; Kukora, John S.; Levy, Philip; Palumbo, Pasquale J.; Petak, Steven M.; Rettinger, Herbert I.; Rodbard, Helena W.; Service, F. John; Shankar, Talla P.; Stoffer, Sheldon S.; Tourtelot, John B. (2002). "AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE EVALUATION AND TREATMENT OF HYPERTHYROIDISM AND HYPOTHYROIDISM". Endocrine Practice. 8 (6): 457–469. doi:10.4158/1934-2403-8.6.457. ISSN 1530-891X.
  6. ↑ Wesche, Maria F. T.; Tiel-v Buul, Monique M. C.; Lips, Paul; Smits, Nico J.; Wiersinga, Wilmar M. (2001). "A Randomized Trial Comparing Levothyroxine with Radioactive Iodine in the Treatment of Sporadic Nontoxic Goiter". The Journal of Clinical Endocrinology & Metabolism. 86 (3): 998–1005. doi:10.1210/jcem.86.3.7244. ISSN 0021-972X.
  7. ↑ Bonnema, Steen J.; Bertelsen, Henrik; Mortensen, Jesper; Andersen, Peter B.; Knudsen, Dorthe U.; Bastholt, Lars; Hegedüs, Laszlo (1999). "The Feasibility of High Dose Iodine 131 Treatment as an Alternative to Surgery in Patients with a Very Large Goiter: Effect on Thyroid Function and Size and Pulmonary Function1". The Journal of Clinical Endocrinology & Metabolism. 84 (10): 3636–3641. doi:10.1210/jcem.84.10.6052. ISSN 0021-972X.
  8. ↑ Nygaard, Birte; Knudsen, Jens Helmer; Hegedüs, Laszlo; Scient, Annegrete Veje Cand; Mølholm Hansen, Jens Erik (1997). "Thyrotropin Receptor Antibodies and Graves' Disease, a Side-Effect of131I Treatment in Patients with Nontoxic Goiter1". The Journal of Clinical Endocrinology & Metabolism. 82 (9): 2926–2930. doi:10.1210/jcem.82.9.4227. ISSN 0021-972X.
  9. ↑ Greer, Monte A.; Astwood, E. B. (1953). "TREATMENT OF SIMPLE GOITER WITH THYROID*". The Journal of Clinical Endocrinology & Metabolism. 13 (11): 1312–1331. doi:10.1210/jcem-13-11-1312. ISSN 0021-972X.
  10. ↑ Squatrito, S.; Vigneri, R.; Rybello, F.; Ermans, A. M.; Polley, R. D.; Ingbar, S. H. (1986). "Prevention and Treatment of Endemic Iodine-Deficiency Goiter by Iodination of a Municipal Water Supply*". The Journal of Clinical Endocrinology & Metabolism. 63 (2): 368–375. doi:10.1210/jcem-63-2-368. ISSN 0021-972X.
  11. ↑ Hegedüs, Laszlo; Bonnema, Steen J. (2010). "Approach to Management of the Patient with Primary or Secondary Intrathoracic Goiter". The Journal of Clinical Endocrinology & Metabolism. 95 (12): 5155–5162. doi:10.1210/jc.2010-1638. ISSN 0021-972X.
  12. ↑ Haines, Samuel F.; Keating, F. Raymond; Power, Marschelle H.; Williams, Marvin M. D.; Kelsey, Mavis P. (1948). "THE USE OF RADIOIODINE IN THE TREATMENT OF EXOPHTHALMIC GOITER*". The Journal of Clinical Endocrinology & Metabolism. 8 (10): 813–825. doi:10.1210/jcem-8-10-813. ISSN 0021-972X.
  13. ↑ Reveno, William S. (1948). "PROPYLTHIOURACIL IN THE TREATMENT OF TOXIC GOITER". The Journal of Clinical Endocrinology & Metabolism. 8 (10): 866–874. doi:10.1210/jcem-8-10-866. ISSN 0021-972X.
  14. ↑ Brenta, G.; Schnitman, M.; Fretes, O.; Facco, E.; Gurfinkel, M.; Damilano, S.; Pacenza, N.; Blanco, A.; Gonzalez, E.; Pisarev, M. A. (2003). "Comparative Efficacy and Side Effects of the Treatment of Euthyroid Goiter with Levo-Thyroxine or Triiodothyroacetic Acid". The Journal of Clinical Endocrinology & Metabolism. 88 (11): 5287–5292. doi:10.1210/jc.2003-030095. ISSN 0021-972X.

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