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Comment & Response
June 2017

Promoting Compliance to Practice Guidelines May Improve Primary Care for Thyroid Diseases—Reply

Author Affiliations
  • 1Endocrinology Division, Department of Internal Medicine, University Hospital “Dr. Jose E. Gonzalez”, Monterrey, Mexico
  • 2Knowledge and Evaluation Research Unit in Endocrinology, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota
  • 3Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota
JAMA Intern Med. 2017;177(6):895. doi:10.1001/jamainternmed.2017.1432

In Reply We thank Li et al for their letter concerning our Teachable Moment.1 We agree that for treating hypothyroidism in elderly patients, and when levothyroxine therapy is desired, the “start low and go slow” strategy is ideal. The main issue we highlighted in our case,1 however, is that the quality of evidence that supports levothyroxine initiation (any dose) in patients with subclinical hypothyroidism is very low, and that clinicians should be aware that 1 abnormal elevated thyroid-stimulating hormone value should not be immediately cataloged as hypothyroidism or in need for treatment.2,3

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