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Figure 1 2 Providing increasing doses of LT4 therapy The optimal treatment for hypothyroidism remains a subject of debate, with the etiology and severity of hypothyroidism and the amount of residual functional thyroid tissue affecting the LT4 dosage ( DIO2 geneparticularly the common Thr92Ala varianthave been associated with altered enzymatic function and reduced intracellular T3 availability in key tissues, despite normal serum TSH and FT4 levels ( PDE8B ) gene, which encodes a high-affinity cAMP-specific phosphodiesterase, as genetic modulators of TSH levels ( 3 LT4+LT3 combination therapy When monitoring the efficacy of LT4 therapy, adequacy is traditionally assessed by TSH and FT4 levels

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