The serum triiodothyronine to thyroxine (T3/T4) ratio in various thyroid disorders and after Levothyroxine replacement therapy

Hormones (Athens). Apr-Jun 2004;3(2):120-6. doi: 10.14310/horm.2002.11120.


In order to examine the significance of differences in the triiodothyronine/thyroxine (T3/T4) ratio in the achievement of euthyroidism and in different thyroidal diseases, we studied 1050 subjects: 233 were euthyroid (Eu), 239 hypothyroid (Hypo) with initial TSH levels >15 mU/L, 273 hypothyroid on substitution therapy with L-thyroxine alone and TSH values of 0.35-3.5 mU/L, (hypoRx), 236 hyperthyroid (hyper) and 69 in the acute phase of subacute thyroiditis De Quervain's (DQ). The ratio of T3/T4 was calculated using the conventional values.

Results: The values of T3/T4 ratio in the various categories were: Eu= 15.89, Hypo= 24.12, hyper= 19.57, hypoRx= 13.42, DQ= 15.16. The T3/T4 ratio was lower in the hypoRx group than in the EU group (P <0.001), although neither TSH values nor T3 values showed any differences between these two groups, whereas T4 levels were significantly higher in the hypoRx group (Eu= 7.99+/-1.46, hypoRx = 9.11+/-1.58, P< 0.001). The T3/T4 ratio in the DQ group was comparable to that of the Eu group, but significantly lower than the hyper group (P=0.95 between Eu and DQ, P<0.001 between DQ and hyper).

Conclusions: These findings indicate that in hypothyroid patients, L-T4-replacement that is sufficient to maintain a normal serum TSH is accompanied by a serum T4 that is higher than in normal individuals and may not result in an appropriately normal serum T3 concentration. In Thyrotoxicosis, a ratio of total T3/T4 >18.9 suggests Graves' disease or toxic multinodular goiter whereas T3/T4 <16 suggests thyroiditis (subacute or silent).