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—The results reported in the letter by Drs Gross et al are interesting, especially since they seem to contradict those we reported earlier. Perhaps one reason for the discrepancy between their findings and ours is the difference in mean age between the two populations studied. As noted in our articles, the mean age of our patients was approximately ten years younger than those described by Gross et al. As they pointed out, T4RIA is not a sufficient test for ruling out a diagnosis of hyperthyroidism, especially in the elderly, due to a variety of changes in binding proteins, etc, that occur in the elderly. These problems with T4 as a diagnostic test become greater as individuals age, and the ten-year mean age difference in their population compared with ours could possibly account for the divergent results. It is interesting to note that another letter-to-theeditor from Tajiri et
Greenland P, Cobler JL, Williams ME. Thyrotoxicosis in Elderly Patients-Reply. Arch Intern Med. 1985;145(5):952. doi:10.1001/archinte.1985.00360050222046