clinical use. a recent meta-analysis published by dutta et al. involving data from 4 studies (294 patients) showed that owt is associated with less efficient control of hypothyroidism, risks of supraphysiologic elevation of thyroid hormone levels along with transient echocardiographic changes in some patients following 2-4 h of thyroxine intake. hence it is not surprising that owt therapy has not become popular and is very sparingly used across the globe.