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T4 is a pro hormone meaning that it has to be converted to T3 in order for it to be the active hormone.
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Failure of the serum T4 to increase into the upper half of the normal range within 2 weeks of initiation of SYNTHROID therapy and/or of the serum TSH to decrease below 20 IU per liter within 4 weeks may indicate the child is not receiving adequate therapy.
