To the Editor.—
The article by Rosenthal et al1 adds in a small way to our understanding of the natural history of noniatrogenic hypothyroidism. Questions of clinical judgment in the design, execution, and editorial evaluation of their study deserve consideration.
Although their patient evaluation included physical examination, only laboratory test data are analyzed. In this perspective the absence of thyrotropinreleasing hormone (TRH) testing is remarkable. One cannot conclude that the presence of a slight elevation in a baseline serum thyrotropin (thyroid-stimulating hormone [TSH]) value necessarily means there will be an increased response to TRH. It is possible that TRH testing might have provided a more sensitive prognostic indicator than microsomal antibody testing.
Current infatuation with laboratory testing aside, simple clinical indexes should not be ignored. In mild noniatrogenic hypothyroidism where sustained TSH level elevations attempt to compensate for falling thyroidal output, usually there is goiter.2 Hence, the presence
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