We are in general agreement with the comments of Goichot and Vinzio that there is a selection bias in the population. Our 5-year study of the natural history of patients who had initial TSH determinations in 2002 excluded pregnant women and patients who received treatment with levothyroxine or antithyroid drugs (n = 15 081; 3.56% and not 37% as Goichot and Vinzio wrote).1 We already mentioned in the “Comment” section that lack of clinical information about why patients were treated or not treated with thyroid-specific medication raises the possibility that the group we studied may not be entirely representative of patients with abnormal TSH levels. With regard to screening, we also mentioned in the “Comment” section that our data support the recent evidence-based recommendations against population-based screening.
Meyerovitch J, Rotman-Pikielny P, Sherf M, Battat E, Levy Y, Surks MI. Whether to Repeat Thyroid Disease Screening—Reply. Arch Intern Med. 2008;168(3):330-331. doi:10.1001/archinternmed.2007.89