To the Editor.
—In their analysis of thyroid screening, Mr Danese and colleagues1 point out that most of the net benefit comes from minimizing the sequelae of mild thyroid failure and clinically overt hypothyroidism. Since these conditions are rarely fatal, the value of thyroid screening is thus largely attributable to quality-of-life improvements. In a Markov model (as used by the authors), the quality-of-life effect of an adverse clinical condition is a function of the quality-adjustment factor (utility) and the time patients spend in the state.Thirty percent of the net benefit of thyroid screening (for women) was the result of reducing the symptoms associated with the health state "mild thyroid failure"—patients with an elevated thyrotropin (TSH), but no sign of overt hypothyroidism. This state was given a utility of 0.90, similar to that assigned to patients with severe back pain, ulcer disease, or angina. The authors either have assigned
Welch HG, Birkmeyer JD. Should Physicians Screen for Mild Thyroid Failure?. JAMA. 1996;276(19):1550. doi:10.1001/jama.1996.03540190022014