A randomized, placebo-controlled, masked study was conducted of the responses of thyroid parameters, cortisol, and the cardiovascular system to a single dose of triiodothyronine (T 3 ) 24 h after birth, followed by a daily dose of thyroxine (T 4 ) during 6 wk to infants Ͻ28 wk gestational age. Thirty-one infants were assigned to three groups: 1) group A: T 3 24 h after birth plus daily T 4 during 6 wk; 2) group B: placebo T 3 and T 4 during 6 wk; and 3) group C: placebo T 3 and placebo T 4 . T 4 , free T 4 , T 3 , free T 3 , reverse T 3 , thyroid-stimulating hormone, and cortisol were measured in cord blood and on days 1, 3, 7, 14, 21, 42, and 56. Data on pulse rate, blood pressure, and cumulative dose of inotropic agents were collected. T 3 (0.5 g/kg) resulted in a plasma increase until day 3. Thereafter, plasma T 3 levels were comparable between the groups. T 4 , free T 4 , and reverse T 3 were increased in groups A and B during the period of T 4 administration. Thyroid-stimulating hormone suppression was of shorter duration in group A. T 3 and T 4 administration did not have any effect on cortisol levels. We did not find any effects of T 3 or of T 4 administration on the cardiovascular system. A single injection of T 3 (0.5 g/kg) given 22-26 h after birth only leads to a 2-d increase of T 3 levels and does not have effects on the cardiovascular system. This study does not support the use of T 3 according to our regimen in preterm infants. Thyroid hormones play an important role in normal growth and development of the CNS (1, 2). In term infants, thyroxine (T 4 ) and triiodothyronine (T 3 ) increases shortly after birth. In premature infants, transient hypothyroxinemia after birth is a common finding (3-7). This hypothyroxinemia is characterized by low levels of T 4 and T 3 , which do not cause elevations in thyroid-stimulating hormone (TSH) above 20 mU/L. The degree of hypothyroxinemia is related to gestational age (GA) and the severity of neonatal disease. Low T 3 and T 4 levels in premature infants have been found to be associated with poor neurologic and developmental outcome (8 -11).Transient hypothyroxinemia is a multicausal phenomenon in which immaturity of thyroid hormone metabolism with high activity of deiodinase type 3 together with factors such as immaturity of the hypothalamo-pituitary-thyroid axis and the sudden interruption of the maternal contribution to fetal thyroid hormone pools are involved. Thyroid hormone supplementation in preterm infants has been the subject of several clinical studies with clinical and neurodevelopmental parameters as primary outcome (12)(13)(14). To date, no clear effect of supplemental T 4 treatment on neurodevelopmental outcome has been demonstrated. In an earlier study, however, we observed that a subgroup of T 4 -treated infants of Ͻ29 wk GA tended to have a better developmental outcome than infants of similar GA in the placebo group (13,15).T 4 administration to preterm infants of Ͻ30 wk GA did not result in increased plasma T 3 levels; in fact, it resulted in de...