Serum Thyrotropin Levels and Adrenotoxicosis

To the Editor.—  The devil's advocate role assumed by Sundbeck et al¹ in relationship to my hypothesis on the significance of a low serum thyrotropin level in the elderly,² is both stimulating and welcome. However, I remain optimistic that it will prove of value for the following reasons. It is stated that there was no evidence of panic disorder in any of the 18 probands, but half of them received no psychiatric examination, and, in this country at least, it has been estimated that panic disorder remains undiagnosed in 77% of such patients.Moreover, even in those who were examined, panic disorder was evaluated under the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, which reflected thinking in the late 1970s when the prevalence of panic disorder was considered to be only 1.5%.By the mid-1980s, however, the publication of new data³ was reflected in the