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THE EFFECTIVENESS OF TRIIODOTHYRONINE OR THYROXINE ADMINISTERED ORALLY IN THE TREATMENT OF MYXEDEMA^*,

HERBERT A. SELENKOW, M.D. and SAMUEL P. ASPER, JR., M.D.

The Department of Medicine, The Johns Hopkins University School of Medicine Baltimore 5, Maryland

THE introduction of the use of whole thyroid gland in the treatment of myxedema in 1891 (1, 2) pioneered the development of specific hormonal replacement therapy. Thyroxine, believed to be the effective principle of the thyroid gland, was isolated in 1915 by Kendall (3). Its chemical structure was determined and its synthesis was accomplished in 1927 by Harington and Barger (4). It has been clearly demonstrated that identical metabolic effects result from the administration of desiccated thyroid and synthetically prepared thyroxine. However, the latter was thought to be ineffective when administered orally to patients with myxedema due to poor absorption from the gastrointestinal tract (5). The numerous difficulties inherent in the chemical synthesis of thyroxine permitted only limited quantities for experimental studies and impeded more extensive investigations on the use of thyroxine by mouth. Desiccated thyroid has thus remained for more than sixty years the agent of choice in the treatment of myxedema.

^* Supported in part by a contract between The Johns Hopkins University and the Atomic Energy Commission; in part by a research grant #A-551(R) from The National Institute of Arthritis and Metabolic Diseases of The National Institutes of Health, Public Health Service; and in part by the Maryland Division of the American Cancer Society.

An abstract of this paper has previously appeared in J. Clin. Invest. 33: 966, 1954.

United States Public Health Service Fellow in Medicine, 1953–1954.

Received July 13, 1954.

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