Further studies are presented on a previously described sibship 1 with a familial syndrome combining deaf mutism, delayed bone maturition, stippled epiphyses, goiter, and high levels of circulating thyroid hormone in the presence of euthyroid clinical state. Seventy-five to 90% of the circulating iodinated compounds were L-thyroxine and L-triiodothyronine by chromatography, ability to bind to thyroxine-binding globulin, L-amino acid oxidase digestion, and precipitation to constant specific activity. The usual basic laboratory tests were normal, and there was no direct evidence of endocrine disease other than that of the thyroid. Although all standard tests of thyroid function, with the exception of the basal metabolic rate (BMR), were typically those of hyperthyroidism, the patients appeared clinically euthyroid. This diagnosis is supported by the normal BMR, serum lipids, cholesterol, tyrosine, enzymes and albumin metabolism, and by normal caloric intake, dentition, and steady growth. Certain tissues appeared to be resistant to thyroid hormone action. We observed delayed bone age, epiphyseal stippling, and low hydroxyproline excretion. Sensorineural deafness, congenital nystagmus, elevated serum carotene, and possibly metachromasia in the cultured skin fibroblasts were also suggestive of hypothyroidism. Endogenous pituitary thyrotropin secretion was not completely suppresed by the high, blood hormone level. Administration of 1 mg/day L-T 4 or 375 μg/day L-T 3 produced some effect on connective tissues. Thyroid gland activity was only partially suppressed with such treatment. Administration of the acetic acid analogue of triiodothyronine had no effect other than thyroid gland suppression, attributed to the liberation of large amounts of iodine. β-Adrenergic blockage and 45 days of propylthiouracil therapy also failed to produce detectable effects. Labeled thyroxine and triiodothyronine studies indicate that these hormones penetrate the liver and other tissues normally or even at an excess rate and are degrated three- to five fold more rapidly than normal. Progressive amelioration of the syndrome has been noted over the past 6–7 yr. The etiology of this syndrome remains unclear. It appears to date to be a congenital. inherited metabolic and possibly transient defect associated with variable degrees of intracellular resistance to the action of thyroid hormone, which has been partially compensated by excess hormone production.