This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Mark Helfand, MD, MPH
Department of Veterans Affairs Medical Center Portland, Ore

John Schmittner
American College of Physicians Philadelphia, Pa

JAMA. 1993;270(19):2297.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—In their letter, "Optimal Use of Blood Tests for Assessment of Thyroid Function," Becker et al¹ reassert the American Thyroid Association (ATA) guidelines^2,3 that the principal diagnostic tests for thyroid dysfunction should be estimation of free thyroxine (FT₄) and a sensitive thyrotropin assay (sTSH). However, published studies do not justify the conclusion that the sTSH is the best initial test in all clinical situations. Most studies were conducted in the referral clinic setting, where patients with clinically obvious thyroid disease and patients with misleading thyroxine test results are concentrated. Others merely report the results of all assays performed by a hospital-based referral laboratory, with very little information about the clinical setting in which the tests were ordered. Still others compare the performance of the sTSH in patients who have conditions that are known to decrease the accuracy of other tests. The design of these . . . [Full Text PDF of this Article]

Footnotes
Edited by Drummond Rennie, MD, Deputy Editor (West), and Margaret A. Winker, MD, Senior Editor.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?