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Treatment USE OF THYROID HORMONE ANALOGS Î Although preclinical data suggest that the concept of thyromimetic use for treatment of non-hypothyroid-related medical conditions may be promising, the ATA recommends against the use of such drugs outside of the research setting due to concerns about the lack of clear benefit or excessive side effects of currently available preparations. (S-L) Î The therapeutic goals of the treatment of patients with genetic syndromes of resistance to thyroid hormone are to improve the symptoms caused by excessive TRα signaling while minimizing the symptoms caused by deficient TRβ signaling. (W-L) Î Although preliminary data from small case series suggest that the use of TRIAC in patients with genetic syndromes of resistance to thyroid hormone may be promising, more clinical research is needed before the use of thyroid hormone analogs can be recommended for this indication. (W-L) ETHICS FRAMEWORK Î Clinical ethical principles in levothyroxine treatment for hypothyroidism revolve around two core ethical principles in medicine: the Principles of Beneficence and Non- Maleficence, which guide the risk/benefit analysis in clinical practice and protect clinicians from deviating from practice to satisfy inappropriate patient demands. Additional ethical obligations revolve around the professional virtues of competence and intellectual honesty. Î There should be recognition that there are not enough data to resolve clinical disagreement among thyroid experts (called ''clinical equipoise'') regarding treatment for hypothyroidism. Clinical equipoise is disturbed only by the results of well-designed randomized controlled trials that have the statistical power to settle the question of efficacy between monotherapy and combination therapy, or other forms of therapy. 10

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