Little is known about the kinetics and metabolism of thyroid hormones in the hypothyroid state. To investigate these factors, we developed a reliable method for measurement of serum thyroxine (T 4 ), triiodothyronine (T 3 ), reverse-T 3 (rT 3 ) and stable isotope-labeled T 4 ([ 13 C 9 ]T 4 ), using online solid-phase extraction liquid chromatography-mass spectrometry/mass spectrometry (online SPE LC-MS/MS). We measured supply and turnover rates of T 4 in thyroidectomized (Tx) rats using [ 13 C 9 ]T 4 as a tracer. In rats, serum T 4 , T 3 and rT 3 were decreased but not completely ablated after surgical Tx. Endogenous T 4 and T 3 levels in Tx rats were maintained at a constant low level throughout the experimental period. [ 13 C 9 ]T 4 levels declined with a half-life of w1 . 2 days after it was administered to Tx rats intravenously. These findings strongly suggest that serum T 4 levels in Tx rats are maintained by T 4 supplied by extra-thyroidal tissues (e.g. secretion of extra-thyroidal storage, enhancement of enterohepatic recirculation, and production in extra-thyroidal tissues). Moreover, the turnover rate of T 4 in Tx rats was approximately twofold lower than in controls. This finding suggests that degradation of serum T 4 is repressed by Tx. In conclusion, serum T 4 is maintained at a constant low level by T 4 supply from extra-thyroidal tissues and repression of T 4 degradation in Tx rats. The powerful online SPE LC-MS/MS tool can be used to investigate thyroid hormones kinetics and metabolism, and thus has the potential to be used as a diagnostic tool and to investigate the pathogenesis of thyroid disease.