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We appreciate the comments by Dr Wiener but wish to clarify a few points. First, although a diagnosis of secondary hypothyroidism was made in eight patients with low thyroxine and normal thyroid-stimulating hormone levels, only one clearly had a pituitary gland lesion. The others may well have had a hypothalamic disorder—tertiary hypothyroidism. Thyrotropin-releasing hormone (TRH) testing, which was not available at the time of our study, would have helped to confirm that diagnosis. The need for thyroxine therapy in hypothalamic hypothyroidism has not been established, although we have seen several patients who were sufficiently symptomatic to warrant a trial of hormone replacement. Second, in addition to finding a modest number of new cases, the screening tests uncovered another group of patients with previously diagnosed thyroid disease who were taking inappropriate amounts of thyroid hormone, possibly contributing to their acute psychiatric problems. We think that the yield of the
Cohen KL, Swigar ME. Thyroid Function Screening in Psychiatric Patients-Reply. JAMA. 1980;243(20):2028-2029. doi:10.1001/jama.1980.03300460012006