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
Rodriguez-Gutierrez R, Portillo-Sanchez P, Brito JP. Promoting Compliance to Practice Guidelines May Improve Primary Care for Thyroid Diseases—Reply. JAMA Intern Med. 2017;177(6):895. doi:10.1001/jamainternmed.2017.1432
Coronavirus Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: