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To the Editor: In their Scientific Review and Clinical Applications article about subclinical thyroid disease, Dr Col and colleagues¹ performed thyroid screening for 3 asymptomatic patients (patients 1, 3, and 4) who did not seem to have any indication for these tests. As far as I know, there have been no authoritative calls for screening for asymptomatic thyroid disease.²

The negative consequences (eg, iatrogenic disease, clinical cascade, labelling) of performing laboratory tests in patients with a low prior probability of disease often outweigh the benefits.³

A. Mark Clarfield, MD, FRCPC
Department of Geriatrics
Soroka Hospital
Ben Gurion University of the Negev
Beer-sheva, Israel

1. Col NF, Surks MI, Daniels GH. Subclinical thyroid disease: clinical applications. JAMA. 2004;291:239-243. FREE FULL TEXT 2. US Preventive Services Task Force. Recommendation Statement: Screening for Thyroid Disease. Available at: http://www.ahrq.gov/clinic/3rduspstf/thyroid/thyrrs.htm. Accessibility verified March 12, 2004. 3. Sackett DL, Haynes RB, Guyatt GH, Tugwell P. Clinical Epidemiology: A Basic Science for Clinical Medicine. 2nd ed. Boston, Mass: Little Brown & Co; 1992:153-170.

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291:1562.

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