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Editorial
December 1, 2004

Thyroid Disease in the Oldest OldThe Exception to the Rule

Author Affiliations
 

Author Affiliation: Division of Endocrinology, Sinai Hospital of Baltimore, Johns Hopkins University School of Medicine, Baltimore, Md. Dr Cooper is also a Contributing Editor, JAMA.

JAMA. 2004;292(21):2651-2654. doi:10.1001/jama.292.21.2651

The young man knows the rules, but the old man knows the exceptions. 1

      Oliver Wendell Holmes

Almost 4 decades ago, Bastenie and colleagues2 used the term subclinical hypothyroidism to describe, for the first time, a group of clinically euthyroid individuals with circulating antithyroid antibodies, low normal plasma protein–bound iodine levels, and, using a mouse bioassay, elevated serum thyrotropin levels. Evered and colleagues3 subsequently described a similar group of asymptomatic individuals in whom “conventional tests of thyroid function showed nothing abnormal . . . but they were all found to have a raised serum thyrotropin concentration.” They also used subclinical hypothyroidism to describe this constellation of clinical and laboratory data. Since then, hundreds of articles have been published on this topic, but physicians are no closer to understanding whether this mild, usually asymptomatic form of hypothyroidism presents a clinical risk, requiring screening for detection and thyroid hormone treatment, or whether screening and therapy are unnecessary and possibly even counterproductive.4

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