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April 7, 2004

Screening and Treatment for Subclinical Thyroid Disease—Reply

Author Affiliations

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

JAMA. 2004;291(13):1562. doi:10.1001/jama.291.13.1562-c

In Reply: Drs Biondi, Lombardi, and Palmieri raise the point that left ventricular diastolic function, more so than systolic function, may be adversely affected by subclinical hypothyroidism. We agree that these initial observations concerning diastolic function1,2 are interesting and believe that they warrant additional investigation. The fact that different experimental modalities were used in these studies strengthens the findings but also points out that there remains no clinically accepted, noninvasive criterion standard to assess diastolic function. Many new methods of studying diastolic function, such as tissue Doppler, appear promising but have not yet been applied to large, diverse populations on which to base guideline recommendations for screening. Furthermore, a recommendation for routine levothyroxine treatment of patients with subclinical hypothyroidism who have diastolic dysfunction necessitates proof that such treatment reverses the dysfunction, that reversal subsequently translates into improved clinical status or outcomes, and that these putative benefits outweigh risks of treatment. Such data do not yet exist.

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