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—Dr Helfand points out that it is not possible to know in advance which symptomatic patients with mild thyroid failure will respond to thyroxine sodium therapy. He questions the precise benefit achieved from symptom relief in our decision and cost-effectiveness analysis and the impact that uncertainty regarding the reversibility of symptoms has on the final results.We have considered this issue further and find that it has little effect on the results of the model for 3 reasons. First, relatively few patients were treated for potentially reversible symptoms alone. Because there are no data regarding overlap of the 3 treatment indications—reversible symptoms (28% of patients), antithyroid antibodies predicting progression of disease (67% of women, 40% of men), and hypercholesterolemia (25% of patients)—we assumed that these treatment indications were independently associated in patients with mild thyroid failure. Consequently, most patients with symptoms also had another indication for treatment; only 6% of
Danese MD, Powe NR, Ladenson PW. More on Screening for Mild Thyroid Failure-Reply. JAMA. 1997;277(6):459. doi:10.1001/jama.1997.03540300027022