Dr Hamburger suggests that TRH testing may be a more sensitive prognostic indicator. This would at best be useful in carefully selected patients, and not as a general screening measure, by virtue of the time and expense involved. More worrisome, studies of the response to TRH testing among the elderly have resulted in widely divergent data. A blunted response has been reported particularly among older men.1 Such inconsistent age differences might vitiate the diagnostic utility of TRH testing in mildly affected patients such as those in our recent study.Dr Hamburger's second contention regarding the utility of detecting goiter is worthy of evaluation. While goiter is classically described in Hashimoto's thyroiditis, the thyroid gland tends to atrophy and become impalpable with chronic involvement, as presumably pertains in many elderly patients. This may explain the fact that we detected a small enlargement of the thyroid in only one
Rosenthal MJ. Thyroid Failure in the Elderly-Reply. JAMA. 1987;258(19):2698. doi:10.1001/jama.1987.03400190079028
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