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No potentially deleterious cardiac or bone effects were found using this drug, and only a minor transient increase in liver enzymes was observed, but unfortunately, cartilage damage in long-term dog models led to the withdrawal of eprotirome from clinical trials ().

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The AAP suggests that the measurement of serum T 4 or FT 4 and TSH should be performed 2 or 4 weeks after initial treatment with l-T 4 and then every 1 to 2 months during the first 6 months of life, every 3 to 4 months between 6 months and 3 years of age and subsequently every 6 to 12 months until growth is completed ().

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Deficiency of MCT8 causes Allan-Herndon-Dudley syndrome of childhood psychomotor retardation marked by high serum T 3, low T 4, and normal or high TSH due to impaired access of T 4 to the brain.

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Therefore, the beneficial role or necessity for TSH-suppressive therapy in all patients with DTC is questioned today, given the above-mentioned recent randomized study that failed to show any benefit for TSH-suppressive therapy in patients at low risk levels and the overall increased risk of adverse cardiac and bone effects and the less likely but possible development of other cancers.

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Recommendations for the degree of TSH-suppression therapy required have been modified in recent years because of appreciation of the risk of adverse effects of exogenous TSH suppression and the evidence that suppression may be necessary only in high-risk patients, whereas those patients who appear to be disease-free will enjoy excellent survival without suppression.

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