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These latter results raise again the possibility that l-thyroxine may beneficially affect even euthyroid controls and emphasize the absolute need for using placebo controls and blinding participants in any studies that assess the efficacy of l-thyroxine therapy for SH.

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When these deficiencies are then taken care of, with large prescription doses of these minerals, patients are far less likely to respond negatively to high, or even high-normal, blood levels of thyroid hormones.

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From the conflicting data in the randomized community surveys of Whickham (, ), Maryland (), and Rotterdam (), one may question 1) whether SH is associated with dyslipidemia, 2) whether treatment of SH may reverse dyslipidemia, and 3) whether l-thyroxine therapy may prevent development of atherosclerosis if dyslipidemia is not the predominant mechanism causing presumed atherosclerotic disease in SH.

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