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Comment & Response
March 2015

Treatment of Borderline Elevated Thyrotropin Levels

Author Affiliations
  • 1Division of Endocrinology, Department of Internal Medicine, University of Illinois at Chicago
  • 2Department of Internal Medicine, University of Kansas School of Medicine–Wichita
JAMA Intern Med. 2015;175(3):465-466. doi:10.1001/jamainternmed.2014.7841

To the Editor In their retrospective report on the falling threshold for treatment of borderline elevated thyrotropin (TSH) levels in the United Kingdom, Taylor and colleagues1 show an increased annual rate of new levothyroxine prescriptions and a decline in the median TSH threshold at the time of an index levothyroxine prescription. During follow-up for 6 months to 5 years of patients treated with levothyroxine, the percentage of those with a TSH level less than 0.1 mIU/L increased from 2.7% to 5.8%. As noted by the authors, and paralleling their results, the Colorado thyroid disease prevalence study showed a greater frequency of subclinical hyperthyroidism among patients in the United States taking thyroid medication for thyroid hormone replacement or for suppression therapy.2 The authors of the UK study consider the possibility that greater use of confirmatory testing might reduce unnecessary prescriptions for levothyroxine.1

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